摘要
目的通过高清晰放大胃镜观察胃食管反流病（GERD）的改变，探讨放大胃镜下非糜烂性食管炎（NERD）的细微改变及其对NERD的诊断价值。方法2007年4月至2008年1月门诊就诊的有反酸、烧心等典型表现至少3个月的患者及正常志愿者，根据症状及内镜检查结果将研究对象分为正常组48例、NERD组70例、糜烂性食管炎（EE）组70例和Barrett食管（BE）组48例。对所有病例进行放大内镜观察，主要观察齿状线形态、黏膜小凹形态、贲门黏膜粗糙程度、齿状线下血管走形。比较各组之间差异，并采用最优尺度分析NERD相关的放大内镜改变。结果放大胃镜下NERD组的齿状线分布与EE组、BE组差异有统计学意义（P〈0．01），而与正常组差异无统计学意义（P〉0．01）；黏膜小凹的形态，NERD组与EE组、BE组差异有统计学意义（P〈0．01），而与正常组差异无统计学意义（P〉0．01）；贲门黏膜粗糙程度NERD组与其它3组相比差异均有统计学意义（P〈0．05）；齿状线上血管走形NERD组与正常组差异有统计学意义（P〈0．05）。但与EE组、BE组差异无统计学意义；通过最优尺度分析与NERD相关的放大胃镜图像特点依次为：细直型和螺旋型的血管、短棒型小凹、平坦型黏膜、圆滑型和宽齿型齿状线、白色颗粒样增生的黏膜。结论大部分NERD患者在放大内镜下具有特殊表现如黏膜表面浑浊、发白、粗糙不平，且一部分有白色颗粒样增生，血管扩张、呈螺旋型，延伸至齿状线下方区，可作为非糜烂性食管炎放大内镜下诊断提示。
Objective To detect the changes of gastroesophageal reflux disease （GERD） with high resolution endoscopy, and to explore its diagnostic value for nonerosive reflux disease （NERD）. Methods From April 2007 to January 2008, consecutive out-patients visiting the Department of Gastroenterology due to continuous or recurrent symptoms of acid reflux, heartburn, cardiac-like chest pain for at least three months and volunteer healthy controls were recruited to the study. The subjects were classified into the normal group （n =48）, the NERD group （n =70）, the erosive esophagitis （EE） group （n =70）, and the Barrett esoph- agus （BE） group （ n = 48）. All subjects underwent endoscopy, and the shape of Z-lines, the shape of mu- cosal pits, mucosa roughness above Z-line and the shape of mucosal blood vessels were observed. The NERD changes were analyzed with optimal scale. Results Z-line shape of NERD group showed a significant differ- ence from that of EE and BE groups （P 〈 0. 01 ）, which was not different from that of normal controls （P 〉 0.01 ）. The shape of mucosal pits of NERD group was different from that of EE and BE （P 〈0.01 ）, which also was not different from that of control （P 〉 0.01 ）. Roughness of the mucosa above Z-line of NERD group was different from other 3 groups （P 〈 0. 05）. And the shape of mucosal blood vessels of NERD was different from the control （P 〈 0.05 ）, but was not from two others. Features of NERD relative images were thin, straight and spiral blood vessels, bar-like pits, plat mucosa, round, smooth and wide tooth-like Z-line and mucosa of white particle hypertrophy. Conclusion High resolution endoscopic features of most NERD patients are cloudy, white and rough mucosal surface, with white particular hypertrophy, spiral vascular dilation, extending to Z-line. These features can be indicators of NERD.
出处
《中华消化内镜杂志》
北大核心
2011年第9期506-511,共6页
Chinese Journal of Digestive Endoscopy
关键词
非糜烂性食管炎
放大胃镜
胃镜分级
微小病变
Nonerosive reflux disease
High resolution endoscopic
Endoscopic classification
Minimal changes
