CAJ | 학술논문

目的应用共聚焦激光显微内镜对胃黏膜肠上皮化生(GIM)的严重程度进行即时诊断,探讨该内镜对GIM分级诊断的价值.方法采用Pentax EC3870K共聚焦激光显微内镜对已知GIM患者进行检查,即时判断有无GIM,根据肠化面积及杯状细胞数量,借鉴新悉尼标准,判断严重程度(分为轻、中、重度),以病理诊断为金标准.对轻、中、重度GIM进行分型诊断,判断是否合并异型增生,检测Ki67表达情况.结果共扫描58例患者的GIM阳性部位151个,有92、34和25个部位分别被诊断为轻、中、重度GIM.经病理证实有146个部位存在GIM,总诊断阳性率96.7%.其中轻、中、重度GIM部位分别有82、36、28个.共聚焦激光显微内镜对轻、中、重度GIM诊断的敏感性和特异性分别是90.2%和73.9%、69.4%和92.2%、71.4 0A和95.9%,与病理诊断一致性的κ值分别是0.65、0.63、0.70.GIM越严重,不完全型GIM的比例、伴异型增生的比例、Ki67的表达强度越高.结论共聚焦激光显微内镜可在胃镜检查时对GIM的严重程度作出即时、准确的诊断.分级诊断有临床指导意义.
목적 응용공취초격광현미내경대위점막장상피화생(GIM)적엄중정도진행즉시진단,탐토해내경대GIM분급진단적개치.방법 채용Pentax EC3870K공취초격광현미내경대이지GIM환자진행검사,즉시판단유무GIM,근거장화면적급배상세포수량,차감신실니표준,판단엄중정도(분위경、중、중도),이병리진단위금표준.대경、중、중도GIM진행분형진단,판단시부합병이형증생,검측Ki67표체정황.결과 공소묘58례환자적GIM양성부위151개,유92、34화25개부위분별피진단위경、중、중도GIM.경병리증실유146개부위존재GIM,총진단양성솔96.7%.기중경、중、중도GIM부위분별유82、36、28개.공취초격광현미내경대경、중、중도GIM진단적민감성화특이성분별시90.2%화73.9%、69.4%화92.2%、71.4 0A화95.9%,여병리진단일치성적κ치분별시0.65、0.63、0.70.GIM월엄중,불완전형GIM적비례、반이형증생적비례、Ki67적표체강도월고.결론 공취초격광현미내경가재위경검사시대GIM적엄중정도작출즉시、준학적진단.분급진단유림상지도의의.
Objective To evaluate the efficacy of confocal laser endomicroscopy(CLE)for the assessment of the grading of gastric intestinal metaplasia(GIM)in vivo.Methods Patients with known GIM underwent CLE(Pentax EC-3870K).The presence of GIM was indentified immediately by the endoscopist during the procedure.The updated Sydney Classifycation System as reference,GIM was subdivided as mild,moderate and severe according to the area of intestinal metaplasia glands and the number of goblet cells.The histological evaluation remained the gold standard for the final diagnosis of GIM.The presence of the dysplasia and the expression of the Ki67 were examined.Results A total of 151 GIM positive areas were found in 58 patients with mild in 92,moderate in 34.and severe in 25 by CLE. One hundred and forty-six GIM areas were examined histopathologically with positive rate of 96.7%(mild in 82,moderate in 36 and severe in 28).The sensitivity and specificity of CLE were 90.2%and 73.9%in diagnosis of mild GIM,69.4 oA and 92.2%in moderate GIM,71.4% and 95.9%in severe GIM.The kappa coefficient of CLE criteria and the histopathological grading for mild,moderate and severe GIM were 0.65,0.63 and 0.70,respectively.The more severe the GIM,the higher the ratio of incomplete GIM,the ratio of dysplasia and the stronger expression of Ki67.Conclusions CLE may offer an instant and reliable diagnosis for GIM with high accuracy.It is helpful in grading of GIM.