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浙江大学学报（医学版）
浙江大学学报（医学版）  2019, Vol. 48 Issue (5): 504-510    DOI: 10.3785/j.issn.1008-9292.2019.10.07
原著     
探头式激光共聚焦显微内镜在胃癌及癌前病变临床诊断中的作用
马盼盼1(),蔡利军1,吕宾1,*(),乐敏2,*()
1. 浙江中医药大学附属第一医院消化内科 浙江省消化道疾病病理生理研究重点实验室, 浙江 杭州 310006
2. 浙江大学医学院附属第一医院消化内科, 浙江 杭州 310003
Application of probe-based confocal laser endomicroscopy in diagnosis of gastric carcinoma and precancerous lesions
MA Panpan1(),CAI Lijun1,LYU Bin1,*(),YUE Min2,*()
1. Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Key Laboratory for Pathophysiological Research on Digestive System Diseases, Hangzhou 310006, China
2. Department of Gastroenterology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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摘要：

目的: 探讨探头式共聚焦激光显微内镜（pCLE）在胃癌及其癌前病变临床诊断中的作用。方法: 选取2013年12月至2014年11月于浙江大学医学院附属第一医院及2014年1月至2017年12月于浙江中医药大学附属第一医院行pCLE上消化道检查患者的资料，根据已知胃黏膜病变的pCLE诊断标准，以病理诊断作为金标准，统计分析pCLE诊断萎缩性胃炎（AG）、胃黏膜肠上皮化生（GIM）、低级别上皮内瘤变（LGIN）、高级别上皮内瘤变（HGIN，包含胃癌）的诊断效能。结果: 共纳入119例患者，共计154个胃黏膜病变。pCLE诊断AG的敏感度、特异度分别为94.34%、91.09%，符合率为92.21%，κ值为0.83。pCLE诊断GIM的敏感度、特异度分别为84.47%、92.16%，符合率为87.01%，κ值为0.72。pCLE与病理诊断完全型GIM的符合率为0.75，κ值为0.49；诊断不完全型GIM的符合率为0.79，κ值为0.48。pCLE诊断LGIN的敏感度、特异度分别为85.29%、87.50%，符合率为87.01%，κ值为0.66；pCLE诊断HGIN的敏感度、特异度分别为95.83%、97.17%，符合率为96.75%，κ值为0.92。结论: pCLE可用于诊断胃癌及癌前病变且诊断效能高，并可对GIM进行初步分型诊断。
关键词： 癌前状态/病理学;  胃肿瘤/病理学;  内窥镜检查;  激光    
Abstract:

Objective: To assess the application of probe-based confocal laser endomicroscopy (pCLE) in diagnosis of gastric carcinoma and precancerous lesions. Methods: Patients underwent pCLE in the First Affiliated Hospital of Zhejiang University School of Medicine during December 2013 and November 2014 and in the First Affiliated Hospital of Zhejiang Chinese Medical University during January 2014 and December 2017 were enrolled. The consistency between pCLE diagnosis and pathological diagnosis of gastric lesions, including atrophic gastritis, gastric intestinal metaplasia, low-grade intraepithelial neoplasia and high-grade intraepithelial neoplasia (including gastric carcinoma) was analyzed. Results: Totally 154 gastric lesions from 119 patients were detected by pCLE. Using pathological diagnosis as gold standard, the sensitivity, specificity, coincidence rate and κ value of pCLE diagnosis for atrophic gastritis were 94.34%, 91.09%, 92.21%and 0.83; those indicators for gastric intestinal metaplasia were 84.47%, 92.16%, 87.01% and 0.72. The coincidence rate and κ value of pCLE diagnosis of complete gastric intestinal metaplasia were 0.75 and 0.49; for incomplete gastric intestinal metaplasia were 0.79 and 0.48, respectively. The sensitivity, specificity, coincidence rate and κ value of pCLE diagnosis for low-grade intraepithelial neoplasia were 85.29%, 87.50%, 87.01%and 0.66; those for high-grade intraepithelial neoplasia (including gastric carcinoma) were 95.83%, 97.17%, 96.75%and 0.92. Conclusion: pCLE can be used for diagnosis of gastric carcinoma and pericancerous lesions and also for typing of gastric intestinal metaplasia.
Key words: Precancerous conditions/pathology    Stomach neoplasms/pathology    Endoscopy    Lasers
收稿日期: 2019-04-09 出版日期: 2020-01-04
:  R730.49  
基金资助: 国家自然科学基金(81770535);浙江省自然科学基金(LY16H290001);国家中医药管理局重大疑难疾病中西医临床协作试点项目;浙江省医药卫生科技计划(2016KYB094)
通讯作者: 吕宾,乐敏     E-mail: mapanpan0616@163.com;lvbin@medmail.com.cn;1376186619@qq.com
作者简介: 马盼盼(1990—), 女, 博士, 住院医师, 主要从事消化道早期癌症和炎性肠疾病相关研究; E-mail: mapanpan0616@163.com; https://orcid.org/0000-0003-1193-9454
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引用本文:

马盼盼,蔡利军,吕宾,乐敏. 探头式激光共聚焦显微内镜在胃癌及癌前病变临床诊断中的作用[J]. 浙江大学学报（医学版）, 2019, 48(5): 504-510.

MA Panpan,CAI Lijun,LYU Bin,YUE Min. Application of probe-based confocal laser endomicroscopy in diagnosis of gastric carcinoma and precancerous lesions. J Zhejiang Univ (Med Sci), 2019, 48(5): 504-510.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2019.10.07    或    http://www.zjujournals.com/med/CN/Y2019/V48/I5/504

图 1  胃癌及癌前病变的pCLE及组织病理学表现
pCLE诊断AG病理诊断GIM病理诊断LGIN病理诊断HGIN病理诊断
阳性阴性总计阳性阴性总计阳性阴性总计阳性阴性总计
pCLE：探头式共聚焦激光显微内镜；AG：萎缩性胃炎；GIM：胃黏膜肠上皮化生；LGIN：低级别上皮内瘤变；HGIN：高级别上皮内瘤变.
阳性509598749129154446349
阴性3929516476351051102103105
总计53101154103511543412015448106154
表 1  胃癌及癌前病变的pCLE诊断与病理诊断结果比较
癌前病变敏感度(%)特异度(%)阳性预测值(%)阴性预测值(%)约登指数
AG：萎缩性胃炎；GIM：胃黏膜肠上皮化生；LGIN：低级别上皮内瘤变；HGIN：高级别上皮内瘤变.
AG94.34(83.37~98.53)91.09(83.32~95.59)84.75(72.51~92.37)96.84(90.39~99.18)0.8543(0.6669~0.9412)
GIM84.47(75.70~90.59)92.16(80.25~97.46)95.60(88.50~98.58)74.60(61.81~84.37)0.7663(0.5595~0.8805)
LGIN85.29(68.17~94.46)87.50(79.92~92.60)65.91(50.00~79.07)95.45(89.20~98.31)0.7279(0.4809~0.8706)
HGIN95.83(84.57~99.28)97.17(91.35~99.27)93.88(82.13~98.41)98.10(92.62~99.67)0.9300(0.7592~0.9855)
表 2  探头式共聚焦激光显微内镜诊断胃癌及癌前病变的效能
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