[1]张帆,李岩,刘畅,等.反流性食管炎患者贲门区域腺体形态表现及轴向分布特征[J].陕西医学杂志,2025,54(12):1711-1716.[doi:DOI:10.3969/j.issn.1000-7377.2025.12.022]
　ZHANG Fan,LI Yan,LIU Chang,et al.Morphological manifestations and axial distribution characteristics of glands in cardia region of patients with reflux esophagitis[J].,2025,54(12):1711-1716.[doi:DOI:10.3969/j.issn.1000-7377.2025.12.022]
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反流性食管炎患者贲门区域腺体形态表现及轴向分布特征

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
54
期数:
2025年12期
页码:
1711-1716
栏目:
临床病理
出版日期:
2025-12-05

文章信息/Info

Title:
Morphological manifestations and axial distribution characteristics of glands in cardia region of patients with reflux esophagitis
作者:
张帆1; 李岩1; 刘畅1; 花海洋2; 郝欣2; 李常洲2; 齐静2; 张雅欣2; 王爱民2; 姜海斌2; 李建辉2
（1.承德医学院，河北 承德 067000；2.承德市中心医院消化内科，河北 承德 067000）
Author(s):
ZHANG Fan1; LI Yan1; LIU Chang1; HUA Haiyang2; HAO Xin2; LI Changzhou2; QI Jing2; ZHANG Yaxin2; WANG Aimin2; JIANG Haibin2; LI Jianhui2
(1.Chengde Medical University,Chengde 067000,China;2.Department of Gastroenterology,Chengde Central Hospital,Chengde 067000,China)
关键词:
反流性食管炎; 贲门区域腺体; 轴向分布; 食管胃连接部; 放大内镜; 蓝激光成像技术
Keywords:
Reflux esophagitis; Glands in cardia area; Axial distribution; Esophageal-gastric junction; Magnifying endoscopy; Blue laser imaging technology
分类号:
R 571
DOI:
DOI:10.3969/j.issn.1000-7377.2025.12.022
文献标志码:
A
摘要:
目的：探讨反流性食管炎（RE）患者贲门区域腺体形态表现及轴向分布特征。方法：回顾性收集接受蓝激光放大胃镜检查的532例患者的临床、内镜和病理资料，根据内镜下情况分为实验组（即RE组，313例）和对照组（219例）。探究两组在放大内镜下贲门区域腺体形态表现，并归纳总结其腺体形态分型，比较两组腺体形态分型及轴向分布差异。结果：①基于图像增强内镜下腺体形态表现，贲门区域腺体形态大致分为四种类型。a型：贲门腺腺管呈短棒状，数量少，范围小，沿齿状线散在分布，不能连接成排，呈“点、线”分布，大部分区域由多边形胃底腺直接与齿状线相连接，与胃底腺分界清楚。b型：贲门腺腺管呈短棒状，沿齿状线呈纵行栅栏样规则排列，呈“排”分布，与胃底腺分界清楚，宽度较窄。c型：贲门腺腺管呈弧状或线圈状，形态类似于幽门腺，数量多，范围广，排列杂乱不规则，呈“片”分布，与胃底腺分界不清楚，宽度较宽。d型：贲门腺腺管形态不规整，排列杂乱不规则，血管扩张，腺体数量更多，范围更广。②实验组d型占比高于对照组（P<0.05），两组a、b、c型占比比较差异无统计学意义（均P＞0.05）。③依据洛杉矶分级（LA分级）将RE患者分为A、B、C、D级，LA-C级和LA-D级RE患者四型占比比较差异有统计学意义（均P<0.05）。d型RE患者LA分级占比比较差异有统计学意义（P＜0.05），a、b、c型LA分级占比比较差异无统计学意义（均P＞0.05）。④实验组RE患者不同LA分级下贲门腺体宽度随着级别的加重，贲门腺体宽度增加。⑤根据不同象限腺体宽度分布绘制雷达图分布，发现腺体宽度以小弯侧、小弯偏后壁及后壁侧较宽；根据不同象限RE糜烂长度分布绘制雷达图分布，发现糜烂长度以小弯侧、小弯偏后壁及后壁侧较长；两者分布基本一致。结论：贲门腺区域腺体形态表现为d型时对RE有诊断提示意义；反流级别越重，d型占比越大，贲门区域腺体越宽；反流糜烂长度分布与贲门腺体宽度分布轴向基本一致。
Abstract:
Objective:To investigate the glandular morphology and axial distribution patterns in the cardia region of patients with reflux esophagitis (RE).Methods：Clinical,endoscopic,and pathological data from 532 patients undergoing blue laser magnifying endoscopy were retrospectively collected.Based on endoscopic findings,patients were divided into the experimental group (RE group,313 cases) and the control group (219 cases).The glandular morphology in the cardia region under magnifying endoscopy was explored in both groups.The morphological types were classified,and differences in glandular type classification and axial distribution between the two groups were compared.Results:①Based on image-enhanced endoscopic features,the glandular morphology in the cardia region was classified into four main types.Type a:Cardiac glands appear as short rod-like structures.Sparse in number and limited in extent,they are scattered along the dentate line,failing to form continuous rows (“dot-like or linear” distribution).Type b:Cardiac glands appear as short rod-like structures,arranged in a regular,longitudinal palisade pattern along the dentate line ("row-like" distribution).Boundaries with fundic glands are clear,and the width is narrow.Type c:Cardiac glands appear as arc-shaped or coil-like structures,resembling pyloric glands.They are numerous,extensive in area,and arranged irregularly ("patchy" distribution).Boundaries with fundic glands are indistinct,and the width is broader.Type d:Cardiac glands exhibit irregular morphology and chaotic,disorganized arrangement.Vascular dilation is present.Glands are even more numerous and extensive in area.②The proportion of type d in the experimental group was higher than that in the control group (P<0.05),while there was no statistically significant difference in the proportions of types a,b,and c between the two groups (all P>0.05).③According to the Los Angeles classification (LA classification),patients with RE were divided into grades A,B,C,and D.There was a statistically significant difference in the proportion of the four types of LA-C and LA-D grade RE patients (all P<0.05).There was a statistically significant difference in the proportion of LA classification among type d RE patients (P<0.05),while there was no statistically significant difference in the proportion of LA classification among types a,b,and c (all P>0.05).④Within the experimental group,the width of cardia glands increased progressively with worsening LA classification.⑤Radar chart visualization of gland width distribution across different quadrants showed greater width on the lesser curvature side,lesser curvature/posterior wall junction,and posterior wall side.Radar chart visualization of RE erosion length distribution across quadrants also showed longer erosions on the lesser curvature side,lesser curvature/posterior wall junction,and posterior wall side.The distribution patterns were largely consistent.Conclusion:The presence of type d glandular morphology in the cardia region has suggestive diagnostic significance for RE.The prevalence of type d increases with reflux severity (higher LA grade),and the cardia gland width also increases.The axial distribution of reflux erosion length largely corresponds to the distribution of cardia gland width.

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备注/Memo

备注/Memo:
河北省承德市科技计划项目（202501A005，202303A017）
更新日期/Last Update: 2025-12-05