胃黃色瘤與萎縮性胃炎相關(guān)性的單中心回顧性研究

熊秋棠 王志峰 何 浪 張 婭

山西醫(yī)科大學(xué)研究生院1(030012) 山西省人民醫(yī)院內(nèi)鏡中心2

胃黃色瘤與萎縮性胃炎相關(guān)性的單中心回顧性研究

熊秋棠1*王志峰2#何 浪1張 婭1

山西醫(yī)科大學(xué)研究生院1(030012)山西省人民醫(yī)院內(nèi)鏡中心2

背景：胃黃色瘤是一種少見的胃部良性病變，確切病因不明。研究發(fā)現(xiàn)胃黃色瘤患者多合并萎縮性胃炎。目的：探討胃黃色瘤與萎縮性胃炎的相關(guān)性及其臨床意義。方法：連續(xù)納入2015年4月—2016年3月在山西省人民醫(yī)院行胃鏡檢查的10 645例患者，采集人口統(tǒng)計(jì)學(xué)、臨床、內(nèi)鏡、組織學(xué)相關(guān)信息進(jìn)行回顧性分析。結(jié)果：入組患者胃黃色瘤檢出率為2.9%。胃黃色瘤患者的平均年齡和萎縮性胃炎檢出率(47.9%對(duì)16.6%)顯著高于非胃黃色瘤患者，且胃黃色瘤患者胃黏膜萎縮程度更為嚴(yán)重(P均<0.001)；多因素Logistic回歸分析顯示年齡≥50歲(校正OR=1.349, 95% CI: 1.042～1.747,P=0.023)和萎縮性胃炎(校正OR=3.892, 95% CI: 3.076～4.924,P<0.001)是胃黃色瘤的獨(dú)立危險(xiǎn)因素。萎縮性胃炎患者的胃黃色瘤檢出率亦顯著高于非萎縮性胃炎患者(7.9%對(duì)1.8%,P<0.001)。對(duì)性別、年齡匹配的胃黃色瘤與非胃黃色瘤患者的分析表明胃黃色瘤獨(dú)立于性別、年齡而與萎縮性胃炎相關(guān)(P<0.001)。此外，胃黃色瘤患者中，合并萎縮性胃炎者的多發(fā)性胃黃色瘤檢出率顯著高于未合并萎縮性胃炎者(32.0%對(duì)13.8%,P<0.001)。結(jié)論：胃黃色瘤的發(fā)生與患者年齡以及萎縮性胃炎及其嚴(yán)重程度有關(guān)。萎縮性胃炎可能是胃黃色瘤的病因之一，而胃黃色瘤可能是萎縮性胃炎胃黏膜病變的另一種表現(xiàn)形式。

胃黃色瘤； 胃炎，萎縮性； 胃腫瘤； 危險(xiǎn)因素

Correspondenceto: WANG Zhifeng, Email: 642621881@qq.com

Background: Gastric xanthelasma is a benign and uncommon lesion with unknown etiology. It has been noted that atrophic gastritis is frequently seen in patients with gastric xanthelasma.Aims: To investigate the relationship between gastric xanthelasma and atrophic gastritis and its clinical significance.Methods: A total of 10 645 consecutive patients who had undergone gastroscopy from Apr. 2015 to Mar. 2016 at the Shanxi Provincial People’s Hospital were enrolled and analyzed retrospectively with respect to their demographic, clinical, endoscopic and histological features.Results: The prevalence of gastric xanthelasma in patients recruited in this study was 2.9%. The mean age and prevalence of atrophic gastritis (47.9%vs. 16.6%) were significantly higher and the gastric atrophy was more severe in patients with gastric xanthelasma than those without (Pall <0.001). Multivariate Logistic regression analysis revealed that age ≥50 years (adjusted OR=1.349, 95% CI: 1.042～1.747,P=0.023) and atrophic gastritis (adjusted OR=3.892, 95% CI: 3.076～4.924,P<0.001) were independently related to the presence of gastric xanthelasma. Likewise, the prevalence of gastric xanthelasma in patients with atrophic gastritis was significantly higher than those without (7.9%vs. 1.8%,P<0.001). Age- and sex-matched control analysis proved the correlation between gastric xanthelasma and atrophic gastritis (P<0.001). In addition, multiple xanthelasma was more prevalent in gastric xanthelasma patients with atrophic gastritis than those without (32.0%vs.13.8%,P<0.001).Conclusions: Gastric xanthelasma is correlated with age and presence and severity of atrophic gastritis. Atrophic gastritis might be one of the etiological factors of gastric xanthelasma, and gastric xanthelasma might be an atypical mucosal lesion caused by gastric atrophy.

KeywordsGastric Xanthelasma; Gastritis, Atrophic; Stomach Neoplasms; Risk Factors

萎縮性胃炎(atrophic gastritis)尤其是中-重度萎縮性胃炎是胃癌的癌前病變，早期發(fā)現(xiàn)胃黏膜的萎縮改變有助于早期治療和干預(yù)，以防病變進(jìn)展。萎縮性胃炎是胃黏膜的炎癥性萎縮性改變，在疾病進(jìn)展過程中還可能引起其他黏膜病變。

胃黃色瘤(gastric xanthelasma)又稱胃黃斑瘤或胃脂質(zhì)島(lipid island)，是一種發(fā)生于胃黏膜的脂質(zhì)沉積性病變，臨床上較少見，因外觀呈黃白色斑塊而得名[1]，組織病理學(xué)上由充滿脂質(zhì)的泡沫細(xì)胞在黏膜層或黏膜下層聚積而成[2]。胃黃色瘤是一種無癥狀的胃部良性病變，其確切病因和臨床意義尚不明確，可能與黏膜炎癥損傷、細(xì)胞老化、脂質(zhì)代謝異常以及物理、化學(xué)刺激等有關(guān)?！?br>