胃镜在健康体检人群胃早癌及癌前疾病筛查中的临床意义

Clinical significance of gastroscope in healthy population screening of early gastric cancer and precancerous diseases

摘要:

了解健康人群胃早癌及癌前疾病的发病趋势及特点，探讨健康人群行胃镜检查的重要性，为将来制定胃早癌及癌前疾病的筛查方案提供临床依据。方法?选取2015年9月－2018年6月1 281例于该院胃镜健康查体人群的镜下及病理结果，并选取同时期内因消化道症状到消化科门诊行胃镜检查的患者1 281例作为对照。结果?体检组慢性萎缩性胃炎、胃溃疡、胃息肉及胃癌检出率分别为5.62%、5.85%、8.20%和0.16%，其中胃早癌2例。门诊组检出相应疾病率分别为9.84%、8.04%、8.82%及0.86%，其中胃早癌1例，两组检出疾病比较，差异除胃息肉外均有统计学意义；两组检出胃溃疡、胃癌均以男性为主，胃息肉以女性居多。慢性萎缩性胃炎在体检组中以男性为主，但在门诊组中以女性居多（P <0.05）；慢性萎缩性胃炎、胃溃疡检出率随着受检者年龄增长检出率增高，胃息肉及胃癌检出与年龄增长无明显相关，但随着年龄升高，疾病检出亦呈增高趋势。两组中慢性萎缩性胃炎在40～50岁和51～60岁中检出率差异明显，胃溃疡在>60岁中检出率差异明显。两组胃息肉检出年龄高峰段为51～60岁及>60岁，各年龄组间差异无统计学意义。胃癌高发于60岁以上人群，随年龄增长检出率增高；两组慢性萎缩性胃炎的萎缩程度差异有统计学意义，体检组萎缩程度明显轻于门诊组，而肠化程度差异无统计学意义；两组胃溃疡中萎缩及肠化程度比较，差异无统计学意义。结论?健康体检人群年龄大于40岁的胃癌及癌前疾病检出率相对较高，有必要针对性开展胃镜体检筛查；健康人群胃镜体检可明显提高胃早癌的检出率，组织活检对于疾病的病情程度及预后评估具有重要意义。

Abstract:

To understand the incidence trend and characteristics of early gastric cancer and precancerous diseases in healthy people, and explore the importance of gastroscopy in healthy people, so as to provide clinical basis for future screening programs for early gastric cancer and precancerous diseases. Methods 1 281 cases of gastroscopic health examination from September 2015 to June 2018 were selected as study subjects (health group), and 1 281 cases of gastroscopic health examination in digestive outpatient department due to gastrointestinal symptoms were selected as controls (outpatient group). Results The detection rate of chronic atrophic gastritis, gastric ulcer, gastric polyps and gastric cancer in health group is 5.62%, 5.85%, 8.20% and 0.16% respectively, including 2 early gastric cancer. Outpatient group check out the corresponding disease rate of 9.84%, 8.04%, 8.82% and 0.86% respectively, including1early gastric cancer. The difference between the two groups was statistically significant except for gastric polyps. The two groups detected gastric ulcer and gastric cancer mainly in men, and the majority of gastric polyps were in women. Chronic atrophic gastritis was mainly male in the physical examination group, but mostly female in the outpatient group (P < 0.05). The detection rate of chronic atrophic gastritis and gastric ulcer increased with the age of the patients. The detection rate of gastric polyps and gastric cancer was not significantly related to the age growth, but with the age, the detection rate of diseases also increased. The detection rates of chronic atrophic gastritis in the two groups were significantly different between 40-50 years old and 51-60 years old, and gastric ulcer was more than 60 years old. The peak detection age of gastric polyps in the two groups was 51-60 years old and over 60 years old. There was no significant difference between the two groups. The incidence of gastric cancer is higher in people over 60 years old, and the detection rate increases with age. The atrophy degree of chronic atrophic gastritis in the two groups has statistical significance. The atrophy degree in the physical examination group is significantly lighter than that in the outpatient group, but the degree of intestinal metaplasia has no statistical significance. There is no statistical difference in the atrophy and intestinal metaplasia degree of gastric ulcer between the two groups. Conclusion The detection rate of gastric cancer and precancerous diseases in healthy people over 40 years old is relatively high, so it is necessary to carry out gastroscopic screening. The detection rate of early gastric cancer can be significantly improved by gastroscopic screening in healthy people. Tissue biopsy is of great significance for disease severity and prognosis evaluation.