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目的评价自体荧光(AFI)联合窄带成像(NBI)技术对早期胃癌及癌前病变的诊断价值。方法 2011年2月至2012年10月新华医院门诊及住院患者140例患者常规内镜观察下有胃黏膜粗糙、糜烂、斑块、颜色异常、隆起或凹陷等改变的病灶。应用自体荧光内镜(Olympus GIF FQ260Z)进行观察,根据内镜AFI模式下荧光形态及NBI模式下黏膜微血管及胃小凹的改变,进行内镜下诊断。并于相应病变区取活检送病理检查。结果胃炎(包括浅表及萎缩性)78例,肠化45例,低级别上皮内瘤变2例,高级别瘤变4例,早期胃癌11例。自体荧光内镜联合NBI技术对肠上皮化生诊断的敏感性及特异性分别为88.89%和91.58%;对上皮内瘤变分别为83.33%和98.51%,对早期胃癌分别为90.91%和99.22%,均明显高于单纯荧光内镜。自体荧光内镜联合NBI技术诊断早期胃癌的阳性预测值为90.91%,阴性预测值为99.22%。AFI联合NBI的内镜诊断与病理诊断的一致性kappa系数为0.928,两者的一致性好。结论自体荧光联合NBI技术可提高早期胃癌和癌前病变的检出率。
Objective To evaluate the value of autofluorescence (AFI) combined with narrowband imaging (NBI) in the diagnosis of early gastric cancer and precancerous lesions. Methods From February 2011 to October 2012, 140 patients with outpatients and inpatients from Xinhua Hospital underwent routine endoscopic observation of gastric mucosal rough, erosion, plaque, color abnormalities, uplift or depression and other changes in the lesions. Application of autofluorescence endoscopy (Olympus GIF FQ260Z) were observed, according to endoscopic AFI mode fluorescence morphology and NBI mode mucosal microvessels and gastric fovea changes, endoscopic diagnosis. And take the biopsy pathological examination in the corresponding lesion. Results 78 cases of gastritis (including superficial and atrophic), 45 cases of intestinal metaplasia, 2 cases of low grade intraepithelial neoplasia, 4 cases of high grade neoplasia and 11 cases of early gastric cancer. The sensitivity and specificity of autofluorescence endoscopy combined with NBI for the diagnosis of intestinal metaplasia were 88.89% and 91.58%, respectively, 83.33% and 98.51% for intraepithelial neoplasia, and 90.91% and 99.22% for early gastric cancer, respectively , Were significantly higher than pure fluorescence endoscopy. The positive predictive value of autofluorescence endoscopy combined with NBI in the diagnosis of early gastric cancer was 90.91% and the negative predictive value was 99.22%. The consistent kappa coefficient between endoscopic diagnosis and pathological diagnosis of AFI combined with NBI was 0.928, and the consistency between them was good. Conclusion Autofluorescence combined with NBI can improve the detection rate of early gastric cancer and precancerous lesions.