CAJ | 학술논문

背景：Barrett 食管（BE）中的肠上皮化生和异型增生可经内镜活检病理检查得到诊断。目的：评估普通内镜下乙酸染色靶向活检对 BE 中肠上皮化生和异型增生的诊断价值。方法：纳入2012年1月-2014年11月上海市静安区中心医院内镜下发现食管下段有柱状上皮化生的患者100例，普通内镜下行乙酸染色，于黏膜形态异常处取多点活检，其余 BE 黏膜常规间隔1~2 cm 取四象限活检，比较乙酸染色靶向活检和四象限活检对柱状上皮、肠上皮化生和异型增生的检出率。结果：共96例患者诊断为 BE。乙酸染色靶向活检对柱状上皮的检出率为96.9％（93/96），四象限活检的检出率为90.6％（87/96）。McNemar 检验显示，两种方法对柱状上皮的检出率差异无统计学意义（P =0.146）；一致性检验显示，两种方法的一致性较差（κ =0.340）。共32例患者诊断为 BE 伴肠上皮化生。乙酸染色靶向活检对肠上皮化生的检出率为84.4％（27/32），四象限活检的检出率为40.6％（13/ 32）。McNemar 检验显示，两种方法对肠上皮化生的检出率差异显著（ P =0.007）；一致性检验显示，两种方法的一致性较差（κ=0.266）。此外，共检出5例轻度异型增生，均由乙酸染色靶向活检检出。结论：乙酸染色靶向活检较四象限活检更易检出 BE 伴肠上皮化生和异型增生。
배경：Barrett 식관（BE）중적장상피화생화이형증생가경내경활검병리검사득도진단。목적：평고보통내경하을산염색파향활검대 BE 중장상피화생화이형증생적진단개치。방법：납입2012년1월-2014년11월상해시정안구중심의원내경하발현식관하단유주상상피화생적환자100례，보통내경하행을산염색，우점막형태이상처취다점활검，기여 BE 점막상규간격1~2 cm 취사상한활검，비교을산염색파향활검화사상한활검대주상상피、장상피화생화이형증생적검출솔。결과：공96례환자진단위 BE。을산염색파향활검대주상상피적검출솔위96.9％（93/96），사상한활검적검출솔위90.6％（87/96）。McNemar 검험현시，량충방법대주상상피적검출솔차이무통계학의의（P =0.146）；일치성검험현시，량충방법적일치성교차（κ =0.340）。공32례환자진단위 BE 반장상피화생。을산염색파향활검대장상피화생적검출솔위84.4％（27/32），사상한활검적검출솔위40.6％（13/ 32）。McNemar 검험현시，량충방법대장상피화생적검출솔차이현저（ P =0.007）；일치성검험현시，량충방법적일치성교차（κ=0.266）。차외，공검출5례경도이형증생，균유을산염색파향활검검출。결론：을산염색파향활검교사상한활검경역검출 BE 반장상피화생화이형증생。
Background:Intestinal metaplasia(IM)and dysplasia in Barrett’s esophagus(BE)can be detected by endoscopic biopsy combined with pathological examination. Aims:To evaluate the efficacy of acetic acid stain-guided biopsies in detection of IM and dysplasia in BE under standard endoscopy. Methods:One hundred patients found to have columnar-lined esophagus by endoscopy from January 2012 to November 2014 at Shanghai Jing’an District Central Hospital were enrolled. Under standard endoscopy,acetic acid was sprayed and multi-point biopsies were performed in visible abnormal regions. This was followed by four-quadrant biopsies at every 1 to 2 cm of the remaining BE segments. Detection rates of columnar epithelium,IM and dysplasia were compared between acetic acid stain-guided biopsies and four-quadrant biopsies. Results:A total of 96 patients were diagnosed as BE. Detection rates of columnar epithelium by acetic acid stain-guided biopsies and four-quadrant biopsies were 96. 9%(93 / 96)and 90. 6% (87 / 96),respectively,no significant difference was found between the two methods(McNemar test,P = 0. 146),however,consistency of the two methods was poor(κ = 0. 340). A total of 32 patients were diagnosed as BE with IM. Detection rates of IM by acetic acid stain-guided biopsies and four-quadrant biopsies were 84. 4%(27 / 32)and 40. 6%(13 / 32),respectively,difference in detection rate between the two methods was significant(McNemar test,P = 0. 007),and consistency of the two methods was poor(κ =0. 266). Five cases of low-grade dysplasia were detected by acetic acid stain-guided biopsies only. Conclusions:Acetic acid stain-guided biopsies can detect BE with IM and dysplasia better than four-quadrant biopsies.