应用精查胃镜随访中重度萎缩性胃炎的效果评价
| 作 者：刘金殿, 边玉龙, 吴正奇, 卢林芝, 赵光源, 李晓春 |
| 单 位：武威肿瘤医院 |
| 基金项目：甘肃省科技重点研发计划-社会发展类；武威市市级科技计划项目 |
| 摘 要： |
| 背景：中重度萎缩性胃炎作为明确的胃癌前状态，癌变风险较高，胃镜随访是其防控的关键手段。普通胃镜对细微病变的识别存在局限，精查胃镜的随访价值尚需明确。目的：比较精查胃镜和普通胃镜对中重度萎缩性胃炎的随访结果，探讨精查胃镜在中重度萎缩性胃炎患者随访中的应用价值。方法：纳入2015年10月—2022年10月于甘肃省武威肿瘤医院接受胃镜检查并经病理检查证实为中重度萎缩性胃炎的患者662例，按随访时间长短（<1年、1~3年、>3年）进行分层，再采用随机数字表法将各层内受检者随机分配至普通胃镜组或精查胃镜组，比较两组胃镜随访结果。结果：共纳入中重度萎缩性胃炎患者662例，其中普通胃镜组331例，精查胃镜组331例。按随访时间分层，<1年组204例，1~3年组224例，>3年组234例。总体比较，精查胃镜组操作时间显著延长[13 (11, 15) min对8 (6, 9) min，P<0.001]，活检块数显著增加[3 (3, 4)块对2 (2, 3)块，P<0.001]，内镜下诊断符合率[80.0% (70.0%, 80.0%)对70.0% (60.0%, 70.0%)，P<0.001]、中重度萎缩检出率（57.4%对49.2%，P=0.035）、中重度炎症检出率（48.9%对39.6%，P=0.015）、高级别上皮内瘤变和癌的检出率（7.9%对3.9%，P=0.032）均显著高于普通胃镜组；两组中重度肠化生检出率差异无统计学意义（27.8%对21.8%，P=0.072）。按随访时间分层分析，<1年组中，精查胃镜组操作时间显著延长，活检块数显著增加，内镜下诊断符合率显著高于普通胃镜组（P均<0.001））；1~3年组中，精查胃镜组中重度萎缩检出率显著高于普通胃镜组（50.9%对37.5%，P=0.044）；>3年组中，精查胃镜组中重度萎缩检出率（52.1%对35.0%，P=0.008）、中重度炎症检出率（53.8%对37.6%，P=0.013）、高级别上皮内瘤变和癌的检出率（9.4%对2.6%，P=0.027）均显著高于普通胃镜组。全组确定漏诊5例（精查胃镜组4例，普通胃镜组1例），可疑漏诊20例（精查胃镜组11例，普通胃镜组9例），新生癌14例（精查胃镜组11例，普通胃镜组3例）。结论：应用精查胃镜随访中重度萎缩性胃炎患者，可提高新生癌和高级别上皮内瘤变、中重度萎缩和中重度炎症的检出率。 |
| 关键词：胃炎, 萎缩性； 精查胃镜； 胃肿瘤； 随访研究 |
Evaluation of Detailed Gastroscopy for Follow-up of Moderate-to-severe Atrophic Gastritis
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| Abstract: |
| Background: Moderate‑to‑severe atrophic gastritis is a well‑established premalignant condition of gastric cancer with elevated cancer‑transformation risk. Gastroscopic follow‑up serves as a core strategy for its prevention and control. Conventional gastroscopy has limitations in identifying subtle lesions, and the follow‑up value of detailed gastroscopy remains to be clarified. Aims: To compare follow‑up outcomes between detailed gastroscopy and conventional gastroscopy in patients with moderate‑to‑severe atrophic gastritis, and to explore the application value of detailed gastroscopy in the follow‑up of such patients. Methods: A total of 662 patients pathologically confirmed as moderate‑to‑severe atrophic gastritis who underwent gastroscopy at Gansu Wuwei Tumour Hospital from October 2015 to October 2022 were enrolled. Patients were stratified by follow‑up duration (<1 year, 1‑3 years, >3 years). Subjects within each stratum were randomly assigned to either the conventional gastroscopy group or the detailed gastroscopy group using a random‑number table method. Follow‑up gastroscopic findings were compared between the two groups. Results: Among the 662 enrolled patients, 331 were in the conventional gastroscopy group and 331 in the detailed gastroscopy group. Stratified by follow‑up time, 204 patients had follow‑up <1 year, 224 had 1‑3 years, and 234 had >3 years. Overall, the detailed gastroscopy group had significantly longer procedural time [13 (11, 15) min vs. 8 (6, 9) min, P<0.001] and significantly higher number of biopsy specimens [3 (3, 4) vs. 2 (2, 3), P<0.001]. The detailed gastroscopy group showed significantly higher endoscopic‑pathological diagnostic concordance [80.0% (70.0%, 80.0%) vs. 70.0% (60.0%, 70.0%), P<0.001], detection rate of moderate‑to‑severe atrophy (57.4% vs. 49.2%, P=0.035), detection rate of moderate‑to‑severe inflammation (48.9% vs. 39.6%, P=0.015), and detection rate of high‑grade intraepithelial neoplasia plus carcinoma (7.9% vs. 3.9%, P=0.032). No significant inter‑group difference was observed for the detection rate of moderate‑to‑severe intestinal metaplasia (27.8% vs. 21.8%, P=0.072). In the <1 year stratum, the detailed gastroscopy group presented longer procedure time, more biopsy specimens, and superior endoscopic‑pathological diagnostic concordance (all P<0.001). In the 1‑3 years stratum, the detection rate of moderate‑to‑severe atrophy was significantly higher in the detailed gastroscopy group (50.9% vs. 37.5%, P=0.044). In the >3 years stratum, the detailed gastroscopy group yielded significantly higher detection rates of moderate‑to‑severe atrophy (52.1% vs. 35.0%, P=0.008), moderate‑to‑severe inflammation (53.8% vs. 37.6%, P=0.013), as well as high‑grade intraepithelial neoplasia plus carcinoma (9.4% vs. 2.6%, P=0.027). Across the whole cohort, definite missed diagnosis occurred in 5 cases (4 in the detailed gastroscopy group, 1 in the conventional gastroscopy group), suspected missed diagnosis in 20 cases (11 in the detailed gastroscopy group, 9 in the conventional gastroscopy group), and new‑onset gastric carcinoma in 14 cases (11 in the detailed gastroscopy group, 3 in the conventional gastroscopy group). Conclusions: Detailed gastroscopy for follow‑up of patients with moderate‑to‑severe atrophic gastritis improves the detection rates of new‑onset gastric carcinoma, high‑grade intraepithelial neoplasia, moderate‑to‑severe atrophy and moderate‑to‑severe inflammation. |
| Keywords: Gastritis, Atrophic; Detailed Gastroscopy; Stomach Neoplasms; Follow-Up Studies |
| 投稿时间：2026-01-05 |
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