胃黏膜低级别上皮内瘤变的临床病理特征与转归及影响因素

Clinical pathologic features and prognosis of gastric low-grade intraepithelial neoplasia and influencing factors

【摘要】目的 探讨胃黏膜低级别上皮内瘤变(LGIN)的临床病理特征及转归。方法 回顾性分析2016年1月至2022年10月于延安大学附属医院行内镜检查及病理活检并首次诊断为LGIN的1060例患者的临床资料,探讨LGIN的临床病理特征。其中221例LGIN患者获得内镜和活检病理随访,根据首次及末次病理学对比结果将患者分为消退组(166例)和未消退组(55例),对可能影响LGIN转归的变量进行单因素和多因素分析,筛选出影响其转归的相关因素。采用SPSS 26.0统计软件进行数据分析,根据数据类型,采用χ²检验进行组间比较。采用二分类logistic回归模型分析LGIN持续存在及进展的影响因素。结果 LGIN多发于60岁及以上人群,其中男女比例为2.1∶1,胃窦部最为多见,占57.5%(609/1060)；病变以平坦型多见,占47.6%(505/1060)；伴有肠化、萎缩、Hp感染者分别占63.2%(670/1060)、42.0％(445/1060)及38.5%(408/1060)。萎缩与非萎缩患者年龄、萎缩部位及镜下形态比较,差异有统计学意义(P＜0.05)；肠化与非肠化患者性别、年龄及肠化部位比较,差异有统计学意义(P＜0.05)。随访患者病变消退者占75.1%(166/221),稳定者占17.6%(39/221),进展者占7.2%(16/221)。病变位于贲门胃底(OR=9.022,95%CI 2.489~32.701；P＜0.05)、病变大小＞10mm(OR=3.283,95%CI 1.028~10.481；P＜0.05)、病变多发(OR=3.378,95%CI 1.232~9.264；P＜0.05)及合并萎缩(OR=2.647,95%CI 1.096~6.392；P＜0.05)是影响LGIN持续存在及进展的危险因素。结论 LGIN病变位于贲门胃底、病变大小＞10mm、多病灶及合并萎缩会增加LGIN病变持续存在及进展的发生风险,对于合并上述危险因素的LGIN患者,应积极进行内镜下切除,以辅助诊断及治疗。

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【Abstract】Objective To investigate the clinical pathologic features of gastric low-grade intraepithelial neoplasia (LGIN) and prognosis. Methods A retrospective analysis was conducted on 1060 patients diagnosed with LGIN through endoscopic examination and pathological biopsy in our hospital from January 2016 to October 2022 for the clinical and pathological characteristics of LGIN. Among them, 221 patients were followed up by endoscopy and biopsy pathology.Based on the first and last pathological comparison results, the patients were divided into regression group (166 cases) and non-regression group (55 cases). Univariate and multivariate analyses were conducted on variables that may affect the outcome of LGIN, and relevant factors affecting its outcome were screened. SPSS statistics 26.0 was used to perform the statistical analysis. Chi-square test was employed for intergroup comparison depending on data type. Binary logistic regression model was adopted to identify the relevant factors for the persistence and progression of LGIN. Results In the cohort, LGIN was more common in those aged 60 years and over, with a male to female ratio of 2.1∶1, the lesions were mainly found in the antrum, accounting for 57.5% (609/1060). The most common lesions were flat type, accounting for 47.6%(505/1060). The patients with intestinal metaplasia, atrophy, and Hp infection accounted for 63.2% (670/1060), 42.0% (445/1060), and 38.5% (408/1060), respectively. There were statistical differences in age, atrophic location, and microscopic morphology between the atrophy group and the non-atrophy group (P<0.05), and there were also significant differences in gender, age, and metaplastic location between the intestinal metaplasia group and the non-intestinal metaplasia group (P<0.05). During follow-up, 75.1% (166/221) of the patients had regression, 17.6% (39/221) were stable, and 7.2% (16/221) were progressive. The lesions in the cardia and fundus (OR=9.022, 95%CI 2.489-32.701; P＜0.05), lesion size >10 mm (OR=3.283,95%CI 1.028-10.481; P＜0.05), multiple lesions (OR=3.378, 95%CI 1.232-9.264; P＜0.05) and atrophy (OR=2.647, 95%CI 1.096-6.392; P＜0.05) were risk factors for the persistence and progression of LGIN. Conclusion Lesions in the cardia and fundus, lesions size >10 mm, multiple lesions and combined atrophy increase the risk for persistence and progression of LGIN. For LGIN patients with above risk factors, endoscopic resection should be actively performed to assist the diagnosis and treatment.