Barrett食管症状、内镜下分型与病理特征探讨

尹霞,徐艳丽,周隽等.Barrett食管症状、内镜下分型与病理特征探讨[J].上海交通大学学报（医学版）2013, 33(1).50-55

Barrett食管 内镜检查 肠上皮化生 胃食管反流病

尹霞[1],徐艳丽[1],周隽[2],常英[3]

苏州大学医学部，苏州，215123,上海交通大学附属第六人民医院病理科，上海交通大学附属第六人民医院

2013

50-55

知网,万方

目的 研究Barrett食管(BE)患者的症状、内镜下分型与病理特征的关系.方法 采用胃食管反流病(GERD)问卷(GerdQ)调查7 150例因上消化道症状而行胃镜检查的患者,GerdQ总分≥8分诊断为GERD.将胃镜检查诊断为BE的患者,根据胃镜下形态分为长节段BE (LSBE)组(n=27)和短节段BE (SSBE)组(n=65)；并以贲门肠化(CIM)组(n=78)作为对照,记录各组内镜下齿状线位置及有无食管炎症.取各组食管活检标本,采用HE、AB及Giemsa染色观察组织病理学特征、不典型增生和幽门螺杆菌(H.pylori)感染等情况.结果 内镜检查者中BE患者共92例,检出率1.29％.LSBE、SSBE和CIM组中GERD和食管炎发病率分别为92.59％、69.23％、41.03％和100.00％、78.46％、29.49％,不典型增生发生率分别为66.67％、24.62％和10.26％,组间比较差异均有统计学意义(P＜0.05或P＜0.01).LSBE组肠上皮化生(IM)的发生率为74.07％,高于SSBE组的50.77％ (P ＜0.05).LSBE组和SSBE组Hp感染率分别为18.52％、21.54％,均显著低于CIM组的47.44％ (P ＜0.05).与CIM组比较,BE患者更易见隐窝萎缩紊乱、鳞状上皮叠压于柱状上皮、肠化、食管导管及多层上皮(均P＜0.05)；鳞状上皮叠压于柱状上皮和食管导管仅见于BE患者.结论 BE患者容易产生GERD和食管炎症状以及发生IM和不典型增生,其中LSBE患者更明显；BE患者的Hp感染率较低.隐窝萎缩紊乱、鳞状上皮叠压于柱状上皮、肠化、食管导管及多层上皮与BE诊断有关,其中鳞状上皮叠压于柱状上皮和食管导管为BE患者特有. [Abstract] Objective To investigate the relationship among symptoms, endoscopic classification and pathological characteristics of Barren esophagus（BE）。Methods A total of 7 150 patients undergoing gastroscopic examinations for upper gastrointestinal tract symptoms were investigated with gastroesophageal reflux disease（GERD）questionnaire （GerdQ），and GERD was diagnosed when GerdQ sum……ore was）8. Among those diagnosed as BE by gastroscopic examinations, long-segment BE（LSBE） group（n.=27 ） and short-segment BE（SSBE ） group（n=65 ） were divided according to the morphology under gastroscope, and 78 patients with cardia intestinal metaplasia（CIM） were served as controls（CIM group）。The esophagitis was observed under endoscope in each group. The biopsy specimens were obtained, and the histopathological features, dysplasia and helicobacter pylori（H. pylori） infection were observed with HE, AB and Giemsa staining respectively. Results Endoscopic examinations revealed that the prevalence of BE was 1.29 %.The prevalences of GERD in LSBE group, SSBE group and CIM group were 92. 59%，69. 23%and 41. 03 % respectively, the prevalences of esophagitis were 100.00%，78.460Io and 29.490}o respectively, and the prevalences of dysplasia were 66. 67 %，24.62% and 10.26% respectively, with significant differences among groups（P