CAJ | 학술논문

目的评估慢性胃炎OLGA分期、分级评估系统在国人胃黏膜活检组织病理学评价中的应用价值.方法回顾性总结2007年至2012年在北京大学第三医院消化科行上消化道内镜检查的108例患者的内镜及病理资料,依据慢性胃炎OLGA评估系统标准,对入组病例胃黏膜腺体萎缩程度进行分期,对炎症程度进行分级,分析慢性胃炎OLGA分期、分级与胃黏膜异型增生和/或癌的发生以及与幽门螺杆菌(H.pylori )感染的关系.结果检出的2例早期腺癌分别位于OLGAⅢ期和Ⅳ期;高OLGA分期(OLGAⅢ～Ⅳ期)患者的胃黏膜癌前病变(肠化生、异型增生)的检出率显著高于低OLGA分期(OLGA 0～Ⅱ期)患者(肠化生:100.0％比65.3％,P＜0.001;异型增生:77.8％比13.9％,P ＜0.001),且OLGA分期与检出异型增生的程度呈显著正相关(r=0.671,P＜0.001);低OLGA分期患者仅检出10例(13.9％)异型增生病例,且均为轻度异型增生.不同OLGA分级病例之间H.pylori现症感染率差异具有统计学意义(P ＜0.001),且OLGA分级与H.pylori现症感染程度呈显著正相关(r =0.586,P＜0.001).结论高OLGA分期患者更易检出异型增生及腺癌,慢性胃炎OLGA分期能有效地根据胃癌风险性将胃炎病例进行分层,而慢性胃炎OLGA分级与H.pylori现症感染密切相关.
목적 평고만성위염OLGA분기、분급평고계통재국인위점막활검조직병이학평개중적응용개치.방법 회고성총결2007년지2012년재북경대학제삼의원소화과행상소화도내경검사적108례환자적내경급병리자료,의거만성위염OLGA평고계통표준,대입조병례위점막선체위축정도진행분기,대염증정도진행분급,분석만성위염OLGA분기、분급여위점막이형증생화/혹암적발생이급여유문라간균(H.pylori )감염적관계.결과 검출적2례조기선암분별위우OLGAⅢ기화Ⅳ기;고OLGA분기(OLGAⅢ～Ⅳ기)환자적위점막암전병변(장화생、이형증생)적검출솔현저고우저OLGA분기(OLGA 0～Ⅱ기)환자(장화생:100.0％비65.3％,P＜0.001;이형증생:77.8％비13.9％,P ＜0.001),차OLGA분기여검출이형증생적정도정현저정상관(r=0.671,P＜0.001);저OLGA분기환자부검출10례(13.9％)이형증생병례,차균위경도이형증생.불동OLGA분급병례지간H.pylori현증감염솔차이구유통계학의의(P ＜0.001),차OLGA분급여H.pylori현증감염정도정현저정상관(r =0.586,P＜0.001).결론 고OLGA분기환자경역검출이형증생급선암,만성위염OLGA분기능유효지근거위암풍험성장위염병례진행분층,이만성위염OLGA분급여H.pylori현증감염밀절상관.
Objective To evaluate the clinical value of OLGA (Operative Link on Gastritis Assessment) system in pathological assessment of gastric mucosa from Chinese patients.Methods Endoscopic and pathological data of patients,who underwent the endoscopic examination of upper gastrointestinal tract from 2007 to 2012,were analyzed.Using the Sydney protocol,we graded atrophy and staged the Helicobacter pylori infection status in gastric biopsies from 108 patients with dyspepsia.We applied the OLGA system to assess the relationship between OLGA staging and grading and dysplasia/cancer,and the relationship between OLGA grading and Helicobacter pylori infection.Results Two cases of early gastric adenocarcinoma were detected at stage Ⅱ and Ⅳ,respectively.The detection rates of precancerous lesions (including intestinal metaplasia and dysplasia) in cases clustered in stages Ⅲ-Ⅳ were significantly higher than those in stages 0-Ⅱ (intestinal metaplasia:100.0％ VS 65.3％,P ＜0.001 ;dysplasia:77.8％ VS 13.9％,P ＜0.001,respectively),and there were significant differences between OLGA staging and the degree of dysplasia (r =0.671,P ＜0.001).In the subjects at stage 0-Ⅱ,we observed only 10 cases (13.9％) of mild dysplasia.The difference in rate of Helicobacter pylori infection was significant at different OLGA grade (P ＜ 0.001),and the correlation between OLGA grading and infection degree of Helicobacter pylori was significant (r =0.586,P ＜ 0.001).Conclusion Precancerous lesions and gastric adenocarcinoma tend to be discovered in patients clustered at high-risk (Ⅲ-Ⅳ) OLGA stages.OLGA staging of dysplasia can effectively differentiate the risks of gastric cancer.The OLGA grading system is consistently associated with the Helicobacter pylori infection.