以内镜下黏膜表面形态为分型依据的慢性萎缩性胃炎的诊断研究

目的 研究以内镜下黏膜表面形态为分型依据的慢性萎缩性胃炎（CAG）的诊断.方法 以内镜下黏膜表面形态为分型依据,将慢性胃炎胃窦黏膜表现分5型,每型根据其亚特征再细分亚型,对每型病变不同特征表现处分别取材与病理组织学对照,比较各型及亚型对CAG的诊断价值.结果 光滑红斑型、粗糙不平型、结节不平型、凹陷不平型、凹凸不平型病理CAG检出率分别是3.8％、12.5％、63.3％、84％和96.8％;结节不平型分均匀结节、非均匀结节、散发灰色结节和散发红色结节4亚型,其中均匀结节型仅7.1％ （2/28）有轻度萎缩,而非均匀结节型病理CAG检出率高达95.7％ （45/47）,散发的灰色结节和红色结节亦有较高的CAG检出率,分别为80.0％和53.8％;凹陷不平型分明显凹陷和轻微凹陷2亚型,其中8例非萎缩性胃炎全部在轻微凹陷型;凹凸不平型凹陷处病理CAG检出率（96.8％）稍高于凸起处（87.1％）,而凸起处黏膜病理肠上皮化生检出率（41.9％）较凹陷处（12.9％）高,差异有统计学意义（P＜0.01）.粗糙不平型病理示CAG者其粗糙程度明显加重,侧面仔细观察均可见不均匀结节样改变.结论 以内镜下黏膜表面形态为分型依据诊断CAG,客观性强,简单实用,可提高胃镜诊断准确率.

Study on classification and diagnostic of chronic atrophic gastritis according to different gastroscopic manifestations of uneven gastric antrum mucosa

Objective To investigate the classification and diagnostic of chronic atrophic gastritis（CAG） according to different gastroseopic manifestations of uneven gastric antrum mucosa. Methods Different gastroscopie manifestations of an- trum mucosal lesions were divided into five types, and subdivided into subtypes based on the characteristics of each type. The characteristic manifestations of every types pathological changes were sampled separately to be examined by the pathologist, as to compare with histopathology. Finally,to compare the diagnostic value of various types and subtypes to CAG. Results The detection rate of CAG in smooth type, rough type, nodular type, concave type and concave convex type were 3.8%, 12.5%, 63.3% ,84% and 96.8%. Nodular type was divided into four subtypes such as even-nodular subtype, uneven-nodular subtype, gray-nodular subtype and red-nodular subtype. 7.1% （2/28） of even-Nodular type existed mild atrophy, but there were higher detection rate of CAG in non-even, gray and red nodular subtype,which were 95.7% （45/47） ,80% and 53.8 %o respectively. Concave type was divided into two subtypes such as obvious-concave subtype and mild-concave subtype, the latter including all 8 cases of non-atrophic gastritis. The detection rate of CAG at concave in concave convex type was higher slightly than that at the convex （96.8% vs. 87.1% ） ,but The detection rate of intestinal metaplasia at the convex was higher slightly than that at the concave （41.9% vs. 12.9% ） , the differences were statistically significant （P 〈 0.01 ）. Through pathological examination, the Mueosa of the rough type was rougher obviously than others, and side careful observation showed uneven nodular changes. Conclusion This kind of the classification and diagnostic method of CAG according to different gastroseopic manifestations of uneven gastric antrum mucosa is objective,simple and practical,which can improve the gastroscope diagnosis accuracy.