慢性胃炎和胃癌高危患者的临床和形态特征

A. Tertychnyy, D. D. Protsenko, N. Pachuashvili, D. P. Nagornaya, P. V. Pavlov, A. P. Kiruhin, A. A. Fedorenko
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摘要

本研究旨在对具有胃癌(GC)高风险的慢性胃炎病例进行临床和形态学分析。材料和方法。本研究纳入了 26 例慢性萎缩性胃炎 3 期和 4 期病例,根据 OLGA 系统(胃炎评估手术链接)进行评估,这些病例具有患胃癌的高风险。这些病例是根据 2022 年的胃组织活检材料确诊的。这一年共进行了 678 次组织学研究。慢性胃炎高危病例占所有慢性胃炎病例的3.8%。研究结果高危慢性胃炎病例多见于老年男性(平均年龄为 67±12 岁,比例为 2.25:1)。多灶性萎缩性胃炎的发病率居首位(61.5%),只有三分之一的病例(34.6%)证实与螺旋杆菌感染有关。形态学变化的特征是胃窦部的主要病变以及混合性完全和不完全肠化生。除一例在胃窦部发现假性胰腺化生外,所有自身免疫性胃炎病例(26 例)均被归入第二阶段,发展为 GC 的风险较低,这在我们看来是有争议的。结论我们的研究结果表明,在慢性胃炎组中,胃部原有肿瘤病变的比例较高,患 GC 的风险也较高。在 26 个病例中,有 5 个病例被诊断为增生异常;在 26 个病例中,有 3 个病例被诊断为曾进行过粘液切除术的 GC。此外,患者还伴有其他胃肠道肿瘤和癌前病变。这些数据表明,使用OLGA系统识别高危人群的有效性和实用价值,不仅可以识别胃部肿瘤,还可以识别其他部位的胃肠道肿瘤。
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Clinical and morphological characteristics of patients with chronic gastritis and high risk of gastric cancer
The purpose of this study is to conduct a clinical and morphological analysis of cases of chronic gastritis with a high risk of gastric cancer (GC). Materials and methods. The study included 26 cases of chronic atrophic gastritis of stages 3 and 4 with a high risk of developing GC according to the assessment using the OLGA system (Operative Link for Gastritis Assessment). The cases were diagnosed on material of gastric tissue biopsy in 2022. In total, 678 histological studies were performed during the year. Cases of chronic gastritis with a high risk of developing GC accounted for 3.8% of all chronic gastritis. Results. Cases of chronic gastritis with a high risk of developing GC were more often observed in older men (average age 67±12 years, ratio 2.25:1). Multifocal atrophic gastritis was in the first place in frequency of occurrence (61.5%), the connection with helicobacter infection was confirmed only in a third of cases (34.6%). Morphological changes were characterized by a predominant lesion of the antrum of the stomach and mixed complete and incomplete intestinal metaplasia. With the exception of one case in which pseudopancreatic metaplasia was detected in the antrum of the stomach, all cases of autoimmune gastritis (n=26) were assigned to stage 2 with a low risk of developing GC, which seems controversial to us. Conclusion. The results of our study showed a high percentage of pre-existing tumor lesions of the stomach in the group of chronic gastritis with a high risk of developing GC. Dysplasia was diagnosed in 5 out of 26 cases, GC with previously performed mucosectomy in 3 out of 26 cases. In addition, the patients had other tumor and precancerous lesions of the gastrointestinal tract. These data show the validity and practical value of using the OLGA system to identify high-risk groups for the development of tumors not only of the stomach, but also of gastrointestinal tumors of other localizations.
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