熊秋棠 王志峰 何 浪 张 娅

山西医科大学研究生院1(030012) 山西省人民医院内镜中心2

胃黄色瘤与萎缩性胃炎相关性的单中心回顾性研究

熊秋棠1*王志峰2#何 浪1张 娅1

山西医科大学研究生院1(030012)山西省人民医院内镜中心2

背景：胃黄色瘤是一种少见的胃部良性病变，确切病因不明。研究发现胃黄色瘤患者多合并萎缩性胃炎。目的：探讨胃黄色瘤与萎缩性胃炎的相关性及其临床意义。方法：连续纳入2015年4月—2016年3月在山西省人民医院行胃镜检查的10 645例患者，采集人口统计学、临床、内镜、组织学相关信息进行回顾性分析。结果：入组患者胃黄色瘤检出率为2.9%。胃黄色瘤患者的平均年龄和萎缩性胃炎检出率(47.9%对16.6%)显著高于非胃黄色瘤患者，且胃黄色瘤患者胃黏膜萎缩程度更为严重(P均<0.001)；多因素Logistic回归分析显示年龄≥50岁(校正OR=1.349, 95% CI: 1.042～1.747,P=0.023)和萎缩性胃炎(校正OR=3.892, 95% CI: 3.076～4.924,P<0.001)是胃黄色瘤的独立危险因素。萎缩性胃炎患者的胃黄色瘤检出率亦显著高于非萎缩性胃炎患者(7.9%对1.8%,P<0.001)。对性别、年龄匹配的胃黄色瘤与非胃黄色瘤患者的分析表明胃黄色瘤独立于性别、年龄而与萎缩性胃炎相关(P<0.001)。此外，胃黄色瘤患者中，合并萎缩性胃炎者的多发性胃黄色瘤检出率显著高于未合并萎缩性胃炎者(32.0%对13.8%,P<0.001)。结论：胃黄色瘤的发生与患者年龄以及萎缩性胃炎及其严重程度有关。萎缩性胃炎可能是胃黄色瘤的病因之一，而胃黄色瘤可能是萎缩性胃炎胃黏膜病变的另一种表现形式。

胃黄色瘤； 胃炎，萎缩性； 胃肿瘤； 危险因素

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

萎缩性胃炎(atrophic gastritis)尤其是中-重度萎缩性胃炎是胃癌的癌前病变，早期发现胃黏膜的萎缩改变有助于早期治疗和干预，以防病变进展。萎缩性胃炎是胃黏膜的炎症性萎缩性改变，在疾病进展过程中还可能引起其他黏膜病变。

胃黄色瘤(gastric xanthelasma)又称胃黄斑瘤或胃脂质岛(lipid island)，是一种发生于胃黏膜的脂质沉积性病变，临床上较少见，因外观呈黄白色斑块而得名[1]，组织病理学上由充满脂质的泡沫细胞在黏膜层或黏膜下层聚积而成[2]。胃黄色瘤是一种无症状的胃部良性病变，其确切病因和临床意义尚不明确，可能与黏膜炎症损伤、细胞老化、脂质代谢异常以及物理、化学刺激等有关。……