放大色素内镜下非糜烂性反流病细微结构特征及其临床意义

Microstructural features of nonerosive reflux disease and their clinic value under magnifying chromoendoscopy

关键词:  放大色素内镜  非糜烂性反流病  细微结构

Key words:  magnifying chromoendoscopy  nonerosive reflux disease  microstructure

摘要:

［目的］ 探讨放大色素内镜下非糜烂性反流病（NERD）食管黏膜细微结构特征及其在临床诊断上的意义。［方法］ 根据症状学及内镜检查结果，对25 例反流性食管炎（RE）、35 例NERD及15 例健康对照者进行24 h食管pH监测、放大色素内镜观察及食管黏膜病理组织学检查，对比分析3 组间在食管黏膜细微形态学上的差异。［结果］ NERD组中，28.6%食管下段黏膜水肿、血管网模糊；齿状线形态呈三角型、锐齿型、破碎型、舌型分别为42.9%、28.6%、14.3%、11.4%；卢戈氏液染色后80.0%齿状线模糊、中断，34.3%齿状线上伴斑片样淡染粗糙；齿状线下方黏膜粗糙不平呈绒毛状、斑块状、粗大分枝状分别为12.0%、48.6%、34.3%，与正常对照组比较差异具有显著性意义（P<0.05）。［结论］ 放大色素内镜下可准确识别食管黏膜细微结构的改变。齿状线形态呈三角型及锐齿型，齿状线模糊、中断，伴斑片样粗糙，齿状线下方黏膜粗糙不平呈斑块状及粗大分枝状，有助于NERD的内镜下诊断。

Abstract:

［Objective］ This is a study to explore the microstructural features of nonerosive reflux disease under magnifying chromoendoscopy and their clinical diagnostic value. ［Methods］ Twenty-five patients with reflux esophagitis, 35 patients with nonerosive reflux disease and 15 asymptomatic controls were enrolled according to symptoms and endoscopy examination. All of the subjects were assessed with 24 hours ambulatory esophageal pH monitoring and magnifying chromoendoscopy. Biopsy specimens were taken from esophagus for histopathological examination. The features of microstructures were compared each other among the three groups. ［Results］ In the NERD group, mucosal edema and obscure vascular net in lower esophagus were shown in 28.6% of the patients. The percentages of triangular, serration, tattered and tongue-like Z-lines were 42.9%, 28.6%, 14.3% and 11.4% respectively. Stained with Lugol's iodine solution, the appearance of Z-lines was blurred or interrupted in 80.0%, rough block was shown in 34.3% above Z-lines. Roughness of mucosa below Z-lines, the percentages of villous, patchy and thickly branchy were 12.0%, 48.6% and 34.3% respectively. The difference was significant comparing with control group(P<0.05). ［Conclusion］ The microstructures of esophageal mucosa could be identified under magnifying chromoendoscopy accurately. Identification of these features, such as triangular and serration shape of Z-lines, blurred or interrupted of Z-lines, rough block shown above Z-lines, roughness of mucosa shown as patchy and thickly branchy below Z-lines, would facilitate the diagnosis of NERD under magnifying chromoendoscopy.