CAJ | 학술논문

目的:食管和贲门上皮不典型增生是癌前病变,分为轻度,中度和重度三个级别.2000年WHO建议用上皮内瘤变取代不典型增生,将轻度和中度归为低级别内瘤变,并将贲门腺癌称为食管-胃交界腺癌.本文探讨食管癌高发区食管和食管-胃交界部低级别上皮内瘤变癌变危险性和时间演变规律,为食管癌二级预防提供科学数据.方法:选择磁县2个乡于2001年10月～2002年10月,开展内镜碘染色队列筛查,干预乡0～85岁总人口数为22 016例,其中40～69岁共计6 596例,男性3 257例,女性3 339例,除去禁忌症、外出打工、拒绝参加者外,实际内镜筛查3 506例,筛查率53.2%.病理以WHO诊断为标准,将食管鳞状上皮轻度和中度不典型增生及食管-胃交界部轻度不典型增生划为低级别内瘤变人群,共诊断616例;内镜筛查无癌前病变和非癌诊断的作为正常人群共2478例.2008年6～9月对该队列人群进行随访核实.其中有174例失访,随访率95.0%.结果:低级别内瘤变人群和内镜病理正常人群随访分别为3 970.7人·年和16 120.0人·年,低级别内瘤变人群癌变率251.7/10万人·年,正常人群68.2/10万人·年;中位癌变时间分别是38个月和47个月.与正常人群比较,LIN癌变相对危险度RR=3.69(1.57～8.69),P=0.001.结论:低级别内瘤变人群是一组高危险人群,每年内镜复查是必要的.
목적:식관화분문상피불전형증생시암전병변,분위경도,중도화중도삼개급별.2000년WHO건의용상피내류변취대불전형증생,장경도화중도귀위저급별내류변,병장분문선암칭위식관-위교계선암.본문탐토식관암고발구식관화식관-위교계부저급별상피내류변암변위험성화시간연변규률,위식관암이급예방제공과학수거.방법:선택자현2개향우2001년10월～2002년10월,개전내경전염색대렬사사,간예향0～85세총인구수위22 016례,기중40～69세공계6 596례,남성3 257례,녀성3 339례,제거금기증、외출타공、거절삼가자외,실제내경사사3 506례,사사솔53.2%.병리이WHO진단위표준,장식관린상상피경도화중도불전형증생급식관-위교계부경도불전형증생화위저급별내류변인군,공진단616례;내경사사무암전병변화비암진단적작위정상인군공2478례.2008년6～9월대해대렬인군진행수방핵실.기중유174례실방,수방솔95.0%.결과:저급별내류변인군화내경병리정상인군수방분별위3 970.7인·년화16 120.0인·년,저급별내류변인군암변솔251.7/10만인·년,정상인군68.2/10만인·년;중위암변시간분별시38개월화47개월.여정상인군비교,LIN암변상대위험도RR=3.69(1.57～8.69),P=0.001.결론:저급별내류변인군시일조고위험인군,매년내경복사시필요적.
Objective: Epithelial dysplasia of the esophagus and gastric cardia is precancerous lesion, including mild, moderate and severe levels. In 2000 year, WHO recommended to replace dysplasia with intraepithelial neoplasia. Mild and moderate dysplasia were classified as low-grade intraepithelial neoplasia (LIN). Cardia adenocarcinoma was suggested to be called esophageal-gastric junction adenocarcinoma. The risk of cancer development and the rule of time evolution were detected in esophagus and esophageal-gastdc junction LIN in high incidence area of esophageal cancer in Northern China, in an effort to provide scientific data for the prevention of esophageal cancer. Methods: Between October 2001 and October 2002, two townships of Cixian were chosen to carry out endoscopic iodine staining screening cohort study. The total population aged 0-85 was 22,016, of which 6,596 aged 40-69 (3257 males and 3339 females). Except for thoese with contraindications and those who refused to join the study, 3,506 cases were finally recruited in the study, and the screening rate was 53.2%. According to WHO criteria of the pathological diagnosis, the esophageal squamous epithelium with mild and moderate dysplasia and esophageal-gastric junction with mild dysplasia were classified into LIN groups (including 616 cases). The control group contained a total of 2,478 cases without precancerous lesions and free of cancer in endoscopic screening. Results: From June to September in 2008, the cohort was followed up and 174 cases were lost, with a follow-up rate of 95.0%. Follow-up was 3,970.7 person- years in the LIN group and 16,120.0 person-years in the control group.Carcinomous conversion rates were 251.7 and 68.2/per 100,000 person- years respectively in the LIN group and the control group. The median time in the two groups was 38 and 47 months, respectively. Compared with that of the normal population, the relative risk (RR) of LIN was 3.69 (95% CI=1.57-8.69, P=0.001). Conclusion: Population with LIN are at high-risk for esophageal cancer and endoscopic examination every year is absolutely necessary.