京都胃炎分类剖析精析.ppt

京都胃炎分类探析 威远县人民医院刘林玲 背景 ●1969年,木村竹本分类确立了萎缩性胃炎的诊断标准 1983年, Warren及 Marshell发现 H pylori,明确H是组 织学胃炎的病因。根据内镜表现诊断有无Hp感染的重 要性增加,并且需要对胃癌高危状态的胃炎做出诊断。 ●1990年,悉尼系统胃炎分类被制定,1996年修订为新 悉尼系统,该系统考虑了Hp的有无,但其内镜表现有 些难以客观诊断,未采纳用于评价萎缩的木村竹本分 类 背景 ·横山泉,竹本忠良,木村健:肠上皮化生O内视镜诊断胃匕肠,1971:6: 869-874 Miyamoto Y, Ahinomuta Y, Kanayama S, et al Nodual gastritis in adults is caused by Hp infection. Dig Endosc 2003: 48: 968-975 Nagata N, Shimbo T Akiyama J, et al Predictability of Gastric Intestinal Metaplasia by Mottled Patchy Erythema Seen on Endoscopy Gastroenterology Research.2011;4:203-209 Nomura S, Terao S, Adachi K,et al: Endoscopic diagnosis of gastic mucosal activity and inflamation Dig Endosc 2013: 25: 136-146 Watanabe K, Nagata N, Nakashima R,et al: Predictive findings for Helicobacter d -eradicated gast Gastroenterol 2013: 19: 4374-4379 Kato M,Terao S. Adachi K, et al: Changes in endoscopic findings of gastritis after cure of H. pylori infection: Multicenter prospective trial. Dig Endosc 2013: 25: 264- 273 此处省略许多文献。。。。。。 RAC、出血斑、胃底腺息肉、妾缩、MPE有助于判定Hp感染状态。 Table 1 Diagnostic odds ratios of endoscopic findings in the di Inter-observer agreenent for the 11 endoscopic find agnosis of three groups of Helicobacter pylon infection status Endoscopic andin Endoscopic Anding Eradicated Linear erythema245(412146018(00120 Linear erythema Punduc gland polyp 41.5(1.389632)0.10(0.01-1. 0.15(0.01-2. 2) Pundi gland polyp Atrophic change oon(0.00-0.00)807(2.11-35. 324(187-562y Atopic ciano/p ugal hyperplasia 0x2(003)158(486514)06(2205) Rugal hyperplasia dema 010(003051)142(45241)°066(024181)Edm 0(00006011560347°035(0154) Spotty erythema Exudate 2011935201616)y0m(021293) Exudate Xanthoma 08(022346)245(064929)0.30(00202) Xanthoma 019 Mottedpatcy erythema 0.07( 该研究纳入了77名患者行胃镜检查及检测。一共列举了11种内镜表现。采用统计学方法计算出这11 种表现的诊断优势比和 Kappa值 Predictive findings for Helicobacter pylori uninfected, - infected and -eradicated gastric mucosa: Validation study, 2013 京都胃炎分类应运而生 ●2013年5月,在京都召开的日本消化内镜学会上,将胃 炎的内镜诊断及其意义作为两个主