蓝激光成像技术微放大分型对慢性胃炎萎缩性病灶的诊断价值

Diagnostic value of microamplification typing with blue laser imaging in atrophic lesions of chronic gastritis

摘要:

目的 评估蓝激光成像技术（BLI）微放大分型对慢性胃炎萎缩性病灶的诊断价值。方法 2017年12月－2019年6月随机对解放军总医院第四医学中心420例慢性胃炎患者使用BLI微放大检查（放大40～60倍），计算其诊断慢性胃炎萎缩性病灶的敏感度、特异度、阳性预测值和阴性预测值，评估其诊断价值。结果 共发现慢性萎缩性胃炎231例，非萎缩性胃炎189例。共活检822处病灶。其中，萎缩性病灶376处，非萎缩性病灶446处；根据团队以往经验，将慢性胃炎BLI微放大分为四型：菊花绒毛型（共106处）、结节绒毛型（共203处）、鱼鳞型（共20处）和规则型（共493处）。106处菊花绒毛型病灶中，萎缩性病灶88处，非萎缩性病灶18处，诊断萎缩性病灶的阳性预测值为83.0%（88/106）；203处结节绒毛型病灶中，萎缩性病灶170处，非萎缩性病灶33处，诊断萎缩性病灶的阳性预测值为83.7%（170/203）；20处鱼鳞型病灶中，萎缩性病灶18处，非萎缩性病灶2处，诊断萎缩性病灶的阳性预测值为90.0%（18/20）；493处规则型病灶中，萎缩性病灶100处，非萎缩性病灶393处，诊断非萎缩性病灶的阳性预测值为79.7%（393/493）。菊花绒毛型、结节绒毛型和鱼鳞型三型联合诊断萎缩性病灶的敏感度为73.4%，特异度为88.1%，阳性预测值为83.9%，阴性预测值为79.7%，准确度为81.4%，诊断中重度萎缩性病灶的敏感度可提升至85.7%。结论 BLI微放大分型有助于提高慢性胃炎萎缩性病灶的内镜识别度及诊断率，尤其是中重度萎缩性病灶。

Abstract:

Objective To evaluate the diagnostic value of Blue Laser Imaging (BLI) in atrophic lesions of chronic gastritis.Methods 420 patients were randomly examined by BLI with microamplification typing (about 40 ~ 60 times) from December 2017 to June 2019. The sensitivity, specificity, false positive and false negative were calculated to evaluate the diagnostic value of BLI in chronic atrophic gastritis.Results 231 patients with chronic atrophic gastritis and 189 patients with non atrophic gastritis were found. 376 biopsied lesions were identified to be the atrophic lesions while 446 lesions were identified to be the non atrophic lesions in the total 822 biopsied lesions. There were four types of chronic gastritis examined by BLI with microamplification including chrysanthemum villous type (106), nodular villous type (203), fish scale type (20) and regular type (493) according to the previous experience of the team. Among the 106 chrysanthemum villous lesions, 88 lesions were the atrophic lesions and 18 lesions were the non atrophic lesions. The positive predictive value of atrophic lesions was 83.0% (88/106). Among the 203 villous nodular lesions, 170 lesions were the atrophic lesions and 33 lesions were the non atrophic lesions. The positive predictive value of atrophic lesions was 83.7% (170/203). Among the 20 fish scale lesions, 18 lesions were the atrophic lesions and 2 lesions were the non atrophic lesions. The positive predictive value of atrophic lesions was 90.0% (18/20). Among the 493 regular lesions, there were 100 atrophic lesions and 393 non atrophic lesions. The positive predictive value of non atrophic lesions was 79.7% (393/493). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the combination of chrysanthemum villous type, nodular villous type and fish scale type in the diagnosis of atrophic lesions was 73.4%, 88.1%, 83.9%, 79.7% and 81.4%, respectively. The sensitivity of moderate and severe atrophic lesions can be increased to 85.7%.Conclusion The classification of chronic gastritis in BLI with microamplification is helpful to improve the endoscopic identification and diagnosis of atrophic lesions in chronic gastritis, especially for the moderate and severe atrophic lesions.