早期胃癌内镜特点及高危因素分析

Endoscopic features of early gastric cancer and multivariate Logistic regression analysis

摘要:

目的 探讨早期胃癌内镜下表现的高危因素，提高早期胃癌的内镜检出率。方法 回顾性分析该院2016年12月－2018年6月行胃镜精查患者的临床病理资料，共245例患者247处病变。记录患者内镜诊断、病变大小、形态、颜色、是否附着黏液、病变部位、靛胭脂染色情况、窄带成像技术联合放大内镜（NBI-ME）下表现等，先用 ²检验分析早期胃癌的相关危险因素，再应用多因素Logistic回归模型分析早期胃癌内镜下表现的高危因素，并进行分层分析，同时探讨NBI-ME对早期胃癌的诊断敏感性和特异性。结果 ²检验分析结果表明：萎缩性胃炎、病变位于胃窦部、病变形态为凹陷型、病变 > 1 cm、白光下存在边界、颜色发红、靛胭脂染色后不着色及存在边界、NBI-ME下观察可见边界、表面微结构不规则、微血管不规则均与早期胃癌有关；Logistic回归分析表明：靛胭脂染色后不着色（O = 4.474，95%CI：1.576～12.701，P = 0.005）、NBI-ME观察存在边界（O = 7.608，95%CI：1.427～40.570，P = 0.017）、NBI-ME观察微血管不规则（O = 8.051，95%CI：1.509～42.949，P = 0.015）为早期胃癌的独立危险因素。分层分析显示：NBI-ME观察微血管不规则联合靛胭脂染色不着色诊断早期胃癌的准确性为78.3%。NBI-ME诊断早期胃癌的敏感性为72.1%，特异性为78.9%。结论 内镜下发现病变靛胭脂染色后不着色、NBI-ME观察到微血管不规则或NBI-ME观察到存在边界，提示为早期胃癌可能性较大。其中NBI-ME观察到微血管不规则联合靛胭脂染色不着色诊断早期胃癌的准确度较高。

Abstract:

Objective To explore the high risk factors for endoscopic findings of early gastric cancer and improve the endoscopic detection rate.Methods Clinicopathological data of 247 lesions in 245 patients underwent fine gastroscopy from December 2016 to June 2018 were analyzed retrospectively. We recorded the endoscopic diagnosis, the size, color, shape, location, mucus of gastric lesion, and forms after indigo carmine staining and under NBI-ME. Risk factors for endoscopic manifestations associated of early gastric cancer were analyzed by Chi-square and were also analyzed by multivariate Logistic regression.Results Single factor analysis showed that atrophic gastritis, sinuses lesion, depressed lesion, size > 1 cm, reddish, demarcation line under white light endoscopy and indigo carmine staining, demarcation line, irregular microvascular and microsurface pattern under NBI-ME were risk factors for endoscopic manifestations of early gastric cancer. Multivariate Logistic regression analysis showed that non-staining after indigo carmine staining (O = 4.474, 95%CI: 1.576 ~ 12.701, P = 0.005), demarcation line under NBI-ME (O = 7.608, 95%CI: 1.427~40.570, P = 0.017), irregular microvascular pattern (O = 8.051, 95%CI: 1.509 ~ 42.949, P = 0.015) were independent risk factor for endoscopic manifestations of early gastric cancer. The accuracy of irregular microvascular pattern under NBI-ME together with non-staining after indigo carmine staining for diagnosis of early gastric cancer is 78.3%. The sensitivity of NBI-ME for diagnosis early gastric cancer is 72.1%, specificity is 78.9%.Conclusion Non-staining after indigo carmine staining, demarcation line under NBI-ME, or irregular microvascular pattern could predict early gastric cancer, irregular microvascular pattern under NBI-ME combined with non-staining after indigo carmine staining has high diagnostic value for early gastric cancer.