胃粘膜低级别上皮内瘤变随访研究

目的探讨胃粘膜低级别上皮内瘤变自然转归及其影响因素。方法收集2005—2010年合肥市第二人民医院内镜中心经病理诊断为低级别上皮内瘤变410例患者的临床病理资料进行回顾性分析，并随访其中63例患者的内镜形态学、病理学及血清学幽门螺旋杆菌细胞毒素相关基因蛋白A（Hp—CagA）结果。结果胃粘膜低级别上皮内瘤变的内镜表现形态各异，缺乏特异性。随着年龄的增加，胃低级别上皮内瘤变的比例也逐渐增加。位于贲门胃底的低级别上皮内瘤变中960岁患者占64．3％（36／56），高于其他部位（均有P〈0．05）。63例患者中6例发生进展，其中4例癌变，癌变率6．3％（4／63）。病灶〉15mm、凹陷性病变、伴有不典型增生性肠化、Hp-CagA阳性是影响胃粘膜低级别上皮内瘤变转归的因素（均有P〈0．05）。结论胃粘膜低级别上皮内瘤变患者具有一定癌变潜力，不同患者应区别对待。胃镜随访有利于发现早期胃癌。

Follow-up study of gastric mucosai low-grade intraepithelial neoplasia

Objective To investigate the natural history of the gastric mucosal low grade intraepithelial neoplasia and factors affecting its outcome. Methods Clinical and pathological data of 410 patients diagnosed as gastric low-grade intraepithelial neoplasia from Endoscopy Center, the Second People＇s Hospital of Hefei during 2005 -2010 were retrospec- tively analyzed, and 63 patients were followed up with endoscopic morphology, pathology and serological CagA results. Re- suits The endoscopic findings of gastric lesions with low-grade intraepithelial neoplasia were lack of specificity. The pro- portion of developing gastric low grade intraepithelial neoplasia gradually increased with age. Patients aged more than 60 years old and low grade intraepithelial neoplasia in gastric cardia occupied 64.3% , which was significantly higher than that in other parts of stomach （ all P 〈 0. 05）, the risk factors for the deterioration of low-grade intraepithelial neoplasia was as- sociated with lesions 〉 15 mm in length,depressed lesions, atypical hyperplastic intestinal metaplasia and serum Hp-CagA- positive （ all P 〈 0. 05）. Conclusions Gastric low-grade intraepithelial neoplasia has the potential risk for developing gastric cancer. Various patients should be treated differently, for the existence of risk factors, patients should take a more aggressive endoscopic treatment. Follow-up of gastroscopy contributes to the early detection of gastric cancer.