萎缩性胃炎的更新版木村-竹本分类法。
Updated Kimura-Takemoto classification of atrophic gastritis.
作者信息
Kotelevets Sergey M, Chekh Sergey A, Chukov Sergey Z
机构信息
Department of Therapy, Medical Institute, North Caucasus State Academy for Humanities and Technologies, Cherkessk 369000, Russia.
Department of Software Development, Institute of Applied Mathematics and Information Technology, North Caucasus State Academy of Humanities and Technologies, Cherkessk 369000, Russia.
出版信息
World J Clin Cases. 2021 May 6;9(13):3014-3023. doi: 10.12998/wjcc.v9.i13.3014.
BACKGROUND
The Updated Sydney system for visual evaluation of gastric mucosal atrophy endoscopic observation is subject to sampling error and interobserver variability. The Kimura-Takemoto classification system was developed to overcome these limitations.
AIM
To compare the morphological classification of atrophic gastritis between the Kimura-Takemoto system and the Updated Sydney system.
METHODS
A total of 169 patients with atrophic gastritis were selected according to diagnosis by the visual endoscopic Kimura-Takemoto method. Following the Updated Kimura-Takemoto classification system, one antrum biopsy and five gastric corpus biopsies were taken according to the visual stages of the Kimura-Takemoto system. The Updated Kimura-Takemoto classification system was then applied to each and showed 165 to have histological mucosal atrophy; the remaining 4 patients had no histological evidence of atrophy in any biopsy. The Updated Kimura-Takemoto classification was verified as a reference morphological method and applied for the diagnosis of atrophic gastritis. Adding one more biopsy from the antrum to the six biopsies according to the Updated Kimura-Takemoto classification, constitutes the updated combined Kimura-Takemoto classification and Sydney system.
RESULTS
The sensitivity for degree of mucosal atrophy assessed by the Updated Sydney system was 25% for mild, 36% for moderate, and 42% for severe, when compared with the Updated Kimura-Takemoto classification of atrophic gastritis for morphological diagnosis. Four types of multifocal atrophic gastritis were identified: sequential uniform (type 1; in 28%), sequential non-uniform (type 2; in 7%), diffuse uniform (type 3; in 23%), diffuse non-uniform (type 4; in 24%), and "alternating atrophic - non-atrophic" (type 5; in 18%). The pattern of the spread of atrophy, sequentially from the antrum to the cardiac segment of the stomach, which was described by the Updated Kimura-Takemoto system, was histologically confirmed in 82% of cases evaluated.
CONCLUSION
The Updated Sydney system is significantly inferior to the Updated Kimura-Takemoto classification for morphological verification of atrophic gastritis.
背景
用于胃黏膜萎缩内镜观察的更新悉尼系统易受抽样误差和观察者间差异的影响。木村 - 竹本分类系统旨在克服这些局限性。
目的
比较木村 - 竹本系统和更新悉尼系统对萎缩性胃炎的形态学分类。
方法
根据内镜直视下木村 - 竹本法诊断，共选取169例萎缩性胃炎患者。按照更新的木村 - 竹本分类系统，根据木村 - 竹本系统的直视阶段，取一块胃窦活检组织和五块胃体活检组织。然后将更新的木村 - 竹本分类系统应用于每例患者，结果显示165例有组织学黏膜萎缩；其余4例患者的任何活检组织均无萎缩的组织学证据。将更新的木村 - 竹本分类法作为参考形态学方法进行验证，并应用于萎缩性胃炎的诊断。按照更新的木村 - 竹本分类法，在六块活检组织基础上，再从胃窦多取一块活检组织，构成更新的木村 - 竹本分类法与悉尼系统的联合分类法。
结果
与更新的木村 - 竹本分类法对萎缩性胃炎进行形态学诊断相比，更新悉尼系统评估黏膜萎缩程度的敏感度为轻度25%、中度36%、重度42%。确定了四种多灶性萎缩性胃炎类型：连续性均匀型（1型；占28%）、连续性非均匀型（2型；占7%）、弥漫性均匀型（3型；占23%）、弥漫性非均匀型（4型；占24%）以及“萎缩 - 非萎缩交替型”（5型；占18%）。更新的木村 - 竹本系统所描述的萎缩从胃窦依次蔓延至胃贲门段的模式，在82%的评估病例中得到组织学证实。
结论
在萎缩性胃炎的形态学验证方面，更新悉尼系统明显不如更新的木村 - 竹本分类法。
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