| 李嘉怡,沈鹏,朱章航,唐梦龄,水黎明,孙烨祥,江志琴,林鸿波,王建炳,金明娟,陈坤.不同胃黏膜病变的胃镜检查起始年龄和间隔的探索研究[J].中华流行病学杂志,2024,45(9):1244-1250 |
| 不同胃黏膜病变的胃镜检查起始年龄和间隔的探索研究 |
| Exploratory study of starting age and interval of gastroscopy for different gastric mucosal lesions |
| 收稿日期:2024-03-22 出版日期:2024-09-14 |
| DOI：10.3760/cma.j.cn112338-20240322-00147 |
| 中文关键词: 胃镜 胃黏膜病变 胃癌 起始年龄 检查间隔 |
| 英文关键词: Gastroscopy Precancerous gastric lesion Gastric cancer Starting age Gastroscopy interval |
| 基金项目:国家自然科学基金（82073629） |
| 作者 | 单位 | E-mail | | 李嘉怡 | 浙江大学公共卫生学院流行病与卫生统计学系, 杭州 310058 | | | 沈鹏 | 宁波市鄞州区疾病预防控制中心, 宁波 315199 | | | 朱章航 | 浙江大学公共卫生学院流行病与卫生统计学系, 杭州 310058 | | | 唐梦龄 | 浙江大学公共卫生学院流行病与卫生统计学系, 杭州 310058 | | | 水黎明 | 宁波市鄞州区卫生健康局, 宁波 315100 | | | 孙烨祥 | 宁波市鄞州区疾病预防控制中心, 宁波 315199 | | | 江志琴 | 宁波市鄞州区疾病预防控制中心, 宁波 315199 | | | 林鸿波 | 宁波市鄞州区疾病预防控制中心, 宁波 315199 | | | 王建炳 | 浙江大学公共卫生学院流行病与卫生统计学系, 杭州 310058 | | | 金明娟 | 浙江大学公共卫生学院流行病与卫生统计学系, 杭州 310058 | | | 陈坤 | 浙江大学公共卫生学院流行病与卫生统计学系, 杭州 310058 | ck@zju.edu.cn |
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| 中文摘要: |
| 目的 了解一般人群胃镜下胃黏膜病变的检查现状，提出首次胃镜检查的推荐年龄与重复胃镜检查的时间间隔。方法 回顾性分析2010年4月至2021年12月浙江省宁波市鄞州区18~80岁人群的胃镜检查资料。描述胃黏膜病变在不同年份、不同年龄、不同性别人群中的检出情况；应用拟合优度检验，比较不同年龄和不同性别人群首次胃镜检查的不同病变检出率差异；构建广义加性模型，拟合胃黏膜病变检出率的年龄变化趋势，探索胃镜检查的最佳起始年龄；根据重复胃镜检查过程中病变进展情况，探索胃镜检查的适宜时间间隔。结果 共纳入237 751名研究对象的344 398条胃镜检查记录。首次胃镜检查共检出慢性萎缩性胃炎（CAG）5 597名，肠上皮化生（IM）9 796名，低级别上皮内瘤变（LGIN）165名，高级别上皮内瘤变（HGIN）52名和胃癌435名。胃黏膜病变的总体检出率在45~70岁显著上升，70岁之后趋于平缓，LGIN和HGIN的检出率分别在50岁和55岁时显著增加。相比于一次胃镜检查，重复胃镜检查能提高CAG、IM、LGIN和HGIN的检出率。正常/浅表性胃炎发展至病变的时间为3~5年，而CAG及更高级别病变进展的时间为1~6年。结论 推荐≥45岁的一般人群进行胃镜检查。建议胃镜检查结果无异常者每3~5年进行一次胃镜检查，CAG及更高级别病变患者每年进行胃镜检查。 |
| 英文摘要: |
| Objective To understand the current status of gastroscopy in diagnosing gastric lesions in general population, and to recommend the optimal age for the first gastroscopy and intervals for repeated gastroscopy. Methods The gastroscopy records of residents aged 18-80 years in Yinzhou District of Ningbo, Zhejiang Province, between April 2010 and December 2021 were analyzed retrospectively. The detections of gastric lesions across different years, age and genders were described. Goodness of fit tests were applied to compare the differences in detection rates of different lesions in first-time endoscopy in different age groups and different populations. Generalized additive models were used to fit the trend of age specific gastric lesion detection rate explore the optimal age for gastroscopy. The appropriate gastroscopy intervals were determined according to the progress of the gastric lesions detected in repeated gastroscopy. Results A total of 237 751 participants with 344 398 gastroscopy records were included in analyses. A total of 5 597 cases of chronic atrophic gastritis (CAG), 9 796 cases of intestinal metaplasia (IM), 165 cases of low-grade intraepithelial neoplasia (LGIN), 52 cases of high-grade intraepithelial neoplasia (HGIN) and 435 cases of gastric cancer were detected by the first gastroscopy. The overall detection rate of gastric lesions increased significantly in age group 45-70 years, and remained stable after 70 years old, with LGIN and HGIN showing notable increases at 50 and 55 years old, respectively. Repeated gastroscopy detected CAG, IM, LGIN, and HGIN at a higher rate compared with the first gastroscopy. Normal/superficial gastritis progressed in 3-5 years, whereas CAG or more severe lesions progressed in 1-6 years. Conclusion Gastroscopy is recommended for general population aged 45 years and above. Furthermore, gastroscopy can be performed every 3-5 years for individuals with normal endoscopy Results and once a year for patients with CAG or more severe gastric lesions. |
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