Application value of different imaging modes of blue laser endoscopy in histological grading of intestinal metaplasia and atrophy of gastric mucosa
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摘要:
目的评价蓝激光内镜不同成像模式用于胃粘膜组织学变化及其分级诊断的临床价值。 方法收集2019年7月~2020年9月，体检或因消化不良等症状在南方医科大学深圳医院门诊或住院行蓝光成像放大内镜检查，经内镜检查取活检病理确诊为胃粘膜肠化生和萎缩的160例患者作为研究对象。蓝光成像内镜检查过程中，依次应用普通白光模式、亮蓝光成像模式、蓝光成像模式观察全胃黏膜外观形态，白光模式下依据慢性胃炎活检病理诊断共识取材，亮蓝光成像模式、蓝光成像模式均于黏膜色泽异常部位取材。使用配对卡方检验分析不同观察模式下活检病理对胃粘膜肠化生和萎缩的诊断率，使用Wilcoxon符号秩检验分析不同观察模式下CG各组织学变化分级（0、+、++、+++）的辅助识别能力。 结果白光模式、亮蓝光成像模式、蓝光成像模式下活检病理胃黏膜萎缩诊断率分别为6.9%（11/160）、49.4%（79/160）、20.6%（33/160），活检病理胃黏膜肠化诊断率分别为3.75%（6/160）、22.5%（36/160）、55.0%（88/160）; 与白光模式比较，亮蓝光成像模式下的活检病理胃黏膜萎缩诊断率最高（P < 0.01），蓝光成像模式下的活检病理胃黏膜肠化诊断率最高（P < 0.01）。CG组织学分级中辅助识别能力方面，与白光模式比较，亮蓝光成像模式用于胃黏膜萎缩分级的辅助识别能力最好（Z=-7.685，P < 0.01），蓝光成像用于胃黏膜肠化分级的辅助识别能力最好（Z=-8.272，P < 0.01）。 结论蓝激光成像内镜用于CG胃粘膜肠化生和萎缩组织学分级诊断方面具有较好的临床应用价值，其中亮蓝光成像模式更适用于胃黏膜萎缩的活检病理取材和辅助组织学分级，蓝光成像模式更适用于胃黏膜肠化的活检病理取材和辅助组织学分级。 Abstract:ObjectiveTo evaluate the clinical value of blue light endoscopy in the diagnosis of histological changes and grading of gastric mucosa. MethodsA total of 160 patients with intestinal metaplasia and atrophy of gastric mucosa confirmed by pathological examination from July 2019 to September 2020 were selected. They were all performed the blue light imaging magnifying endoscopy in Shenzhen Hospital of Southern Medical University for physical examination or for dyspepsia and other symptoms. In the process of blue light imaging endoscopy, the appearance of the whole gastric mucosa was observed in the normal white light mode, the bright blue light imaging mode and the blue light imaging mode in turn. Under the white light mode, the samples were taken according to the pathological diagnosis consensus of chronic gastritis biopsy. Under the bright blue light imaging mode and blue light imaging mode, the samples were taken at the abnormal part of mucosal color. Paired chi- square test was used to analyze the diagnostic rate of biopsy pathology for intestinal metaplasia and atrophy of gastric mucosa under different observation model. Wilcoxon signed rank test was used to analyze the auxiliary recognition ability of CG histological change grades (0, +, + +, + + +) under different observation modes. ResultsThe diagnostic accuracy of gastric mucosal atrophy were 6.9% (11/160), 49.4% (79/160) and 20.6% (33/160) in white light mode, bright blue light mode and blue light mode, respectively. The diagnostic rates of intestinal metaplasia were 3.75% (6/160), 22.5% (36/160), 55.0% (88/160), respectively. Compared with the white light mode, the diagnosis rate of gastric mucosal atrophy was the highest under bright blue light imaging mode (P < 0.01). The diagnosis rate of intestinal metaplasia of gastric mucosa was the highest in blue light imaging mode (P < 0.01). The diagnosis rate of intestinal metaplasia of gastric mucosa was the highest in the blue light imaging mode (P < 0.01). In that aspect of the auxiliary identification ability in the CG histological grade, compared with the white light mode, bright blue light imaging mode was the best auxiliary recognition ability for grading gastric mucosal atrophy (Z=-7.685, P < 0.01), blue light imaging was the best auxiliary recognition ability for grading intestinal metaplasia (Z=-8.272, P < 0.01). ConclusionBlue light imaging endoscopy has a good clinical value in the diagnosis of intestinal metaplasia and atrophy of gastric mucosa in CG. Bright blue light imaging mode is more suitable for biopsy pathology and auxiliary histological grading of gastric mucosa atrophy. Blue light imaging mode is more suitable for biopsy pathology and auxiliary histological grading of intestinal metaplasia of gastric mucosa. -
Key words:
- intestinal metaplasia /
- atrophy /
- histological grading /
- blue laser imaging
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图 1 不同成像模式下的胃黏膜萎缩表现
A: 内镜白光模式下的黏膜外观; B: 内镜亮蓝光成像模式下见黏膜呈茶褐色改变; C: 内镜亮蓝光成像模式下放大观察见黏膜腺体短缩; D: 病理提示胃黏膜萎缩（HE, ×200）.
Figure 1. Different imaging modes of atrophy of gastric mucosa.
图 2 不同成像模式下的胃黏膜肠化表现
A: 内镜白光模式下的黏膜外观; B: 内镜蓝光成像模式下见黏膜呈棕色; C: 内镜蓝光成像模式下放大观察见亮蓝冠; D: 病理提示胃黏膜肠化（HE, ×200）
Figure 2. Different imaging modes of gastric intestinal metaplasia.
表 1 不同内镜模式下胃粘膜的活检病理结果
Table 1. Pathological results of gastric mucosa biopsy under different endoscopic mode (n=160)
内镜取活检模式 萎缩 肠化 阴性 阳性[n(%)] 阴性 阳性[n(%)] 亮蓝光成像 93 79（49.4）a 124 36（22.5） 蓝光成像 127 33（20.6） 72 88（55.0）a 白光 149 11（6.9） 154 6（3.75） aP<0.01 vs 白光. 
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表 2 不同内镜模式下胃粘膜的活检结果比较
Table 2. Comparison of gastric mucosa biopsy results in different endoscopic mode
不同观察模式比较 萎缩 肠化 χ2 P χ2 P 亮蓝光成像V〃白光 63.99 < 0.01 24.67 < 0.01 蓝光成像V〃白光 12.75 < 0.01 101.29 < 0.01 亮蓝光成像VV蓝光成像 23.75 < 0.01 35.6 < 0.01
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表 3 不同内镜观察模式下的组织学变化及其组织学分级诊断
Table 3. Histological changes and histological grading diagnosis under different endoscopic observation modes (n=160)
内镜观察模式 萎缩 萎缩 0 + ++ +++ 0 + ++ +++ 亮蓝光成像 81 55 16 8 124 17 12 7 蓝光成像 127 18 9 6 62 61 18 9 白光 149 0 6 5 154 0 2 4
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