汪得胜; 龚伟; 肖冰; 夏瑰丽; 黄思霖; 王芳; 曾志宇; 郭培

doi:10.3760/cma.j.cn321463-20191228-00869

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胃炎评价系统及基于肠化的胃炎评价系统对慢性萎缩性胃炎癌变风险的预测价值

中华消化内镜杂志, 2020,37(11) : 781-786. DOI: 10.3760/cma.j.cn321463-20191228-00869

摘要

目的

探讨胃炎评价(operative link on gastritis assessment，OLGA)系统及基于肠化的胃炎评价(operative link on gastritis assessment based on intestinal metaplasia，OLGIM)系统对慢性萎缩性胃炎患者发生癌变的风险预测价值，以及可能的其他胃癌相关危险因素。

方法

回顾性分析2016年7月—2018年11月在南方医科大学深圳医院经内镜结合病理确诊慢性萎缩性胃炎或肠化的643例患者资料。标准胃镜检查评估有无萎缩及其范围，病理证实并评估萎缩、肠化严重程度，以及有无上皮内瘤变。采用OLGA及OLGIM系统进行萎缩和肠化分期，比较OLGA和OLGIM低分级与高分级患者高级别上皮内瘤变(high-grade intraepithelial neoplasia，HGIN)检出率。

结果

OLGA高分级患者HGIN检出率(13.89%，10/72)显著高于低分级患者(3.85%，22/571, χ²＝13.618，P<0.001)；OLGIM高分级患者HGIN检出率(13.41%，11/82)显著高于低分级患者(3.74%，21/561,χ²＝14.150，P<0.001)；OLGA与OLGIM均为高分级患者，HGIN检出率进一步升高[21.21%(7/33)比4.10%(25/610),χ²＝19.389，P<0.001]。Logistic回归分析显示，OLGA、OLGIM高分级患者发生HGIN的危险度是低分级患者的2.640倍(95%CI：1.083～6.439，P＝0.033)及2.747倍(95%CI：1.156～6.528，P＝0.022)，OLGA与OLGIM均为高分级患者，比值比为6.300(95%CI：2.497～15.897，P<0.001)。

结论

OLGA与OLGIM系统对慢性萎缩性胃炎有较好的癌变风险预测价值，是患者进行胃镜精查和制定随访策略的重要参考依据。

引用本文: 汪得胜, 龚伟, 肖冰, 等. 胃炎评价系统及基于肠化的胃炎评价系统对慢性萎缩性胃炎癌变风险的预测价值 [J] . 中华消化内镜杂志, 2020, 37(11) : 781-786. DOI: 10.3760/cma.j.cn321463-20191228-00869.

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消化内镜技术的进步推动了早期消化道癌筛查意识的增强和推广，近年来慢性萎缩性胃炎的检出率显著升高。南方医科大学深圳医院消化内镜中心的数据显示慢性萎缩性胃炎在年轻人中并不少见。关于慢性胃炎和消化不良症状的关系至今并没有清晰的界定，但是慢性萎缩性胃炎作为一种癌前病变一直备受关注。中国的慢性胃炎相关指南虽然有推荐的筛查随访流程，但只是做了一个概要分级，缺乏精确性，其中有关于应用胃炎评价(operative link on gastritis assessment, OLGA)系统及基于肠化的胃炎评价(operative link on gastritis assessment based on intestinal metaplasia，OLGIM)系统对患者进行癌变风险预测的推荐^[1]。OLGA及OLGIM系统结合萎缩或肠上皮化生(简称肠化)分布部位(胃窦、胃体)和程度(轻、中、重度)进行分期，有较好的胃癌风险预测价值^{[2,3,4,5,6,7,8,9]}。但因其实施相对繁琐，国内临床应用并不广泛，也缺乏相应的客观参考数据。本研究通过回顾性横断面调查，分析广东深圳局部地区确诊慢性萎缩性胃炎患者的临床特征、萎缩范围和程度评分，以及高级别上皮内瘤变(high-grade intraepithelial neoplasia，HGIN)检出率，探讨OLGA及OLGIM系统对慢性萎缩性胃炎癌变风险的预测价值。

贡献者信息

汪得胜

南方医科大学深圳医院消化内科　518110

龚伟

南方医科大学深圳医院消化内科　518110

肖冰

南方医科大学南方医院消化内科，广州　510515

夏瑰丽

南方医科大学深圳医院消化内科　518110

黄思霖

南方医科大学深圳医院消化内科　518110

王芳

南方医科大学深圳医院消化内科　518110

曾志宇

南方医科大学深圳医院消化内科　518110

郭培

南方医科大学深圳医院病理科　518110

通信作者

龚伟

南方医科大学深圳医院消化内科　518110

Email：drgwei@foxmail.com

关键词

胃炎，萎缩性; 化生; 癌变风险评估; 胃炎评价; 基于肠化的胃炎评价;

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出版日期：2020-11-20

收稿日期：2019-12-28

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Original Article

Predictive value of operative link on gastritis assessment and operative link on gastritis assessment based on intestinal metaplasia on cancerization risk of patients with chronic atrophic gastritis

Wang Desheng, Gong Wei, Xiao Bing, Xia Guili, Huang Silin, Wang Fang, Zeng Zhiyu, Guo Pei

Published 2020-11-20

Cite as Chin J Dig Endosc, 2020, 37(11): 781-786. DOI: 10.3760/cma.j.cn321463-20191228-00869

Abstract

Objective

To investigate the predictive value of operative link on gastritis assessment (OLGA) and operative link on gastritis assessment based on intestinal metaplasia (OLGIM) on the risks of gastric cancer of patients with chronic atrophic gastritis.

Methods

Data of 643 patients were collected in the retrospective study, who were diagnosed with chronic atrophic gastritis or intestinal metaplasia by endoscopy and pathology in Shenzhen Hospital of Southern Medical University from July 2016 to November 2018. Standard gastroscopy was performed to assess the presence and extent of atrophy, and the severity of atrophy, intestinal metaplasia, and the presence of intraepithelial neoplasia were confirmed by pathologic diagnosis. Atrophy and intestinal metaplasia were graded according to OLGA and OLGIM systems, and the detection rate of high-grade intraepithelial neoplasia (HGIN) was compared in patients with different grades.

Results

The detection rate of HGIN in patients with high OLGA grade (13.89%, 10/72) was significantly higher than that in patients with low OLGA grade (3.85%, 22/571, χ²=13.618, P<0.001). The detection rate of HGIN in patients with high OLGIM grade (13.41%, 11/82) was significantly higher than that in patients with low OLGIM grade (3.74%, 21/561,χ²=14.150, P<0.001). The detection rate of HGIN was further increased in patients with high grade in both OLGA and OLGIM systems [21.21% (7/33) VS 4.10% (25/610),χ²=19.389, P<0.001]. Compared with patients with low grade, the odds ratio of occurrence of HGIN in patients with high grade of OLGA and that with high grade of OLGIM were 2.640 (95%CI: 1.083-6.439, P=0.033) and 2.747 (95%CI: 1.156-6.528, P=0.022), respectively, and the odds ratio of patients with high grade in both OLGA and OLGIM was 6.300 (95%CI: 2.497-15.897, P<0.001).

Conclusion

OLGA and OLGIM systems have a remarkable predictive value for assessment of cancerization risk of chronic atrophic gastritis, and can be used as an important reference for patients to perform magnifying gastroscopy and to make follow-up strategies.

Key words:

Gastritis, atrophic; Metaplasia; Cancerization risk assessment; Operative link on gastritis assessment; Operative link on gastritis assessment based on intestinal metaplasia

Contributor Information

Wang Desheng