| Background and aims:Peptic ulcer is the most common diseases of digestive department, It usually take place in the lesser curvature of the stomach and duodenal. The vast majority of ulcers can be cured by drug, but its easy to recur. The quality of ulcer healing is vital to the ulcer recurrence, so assessing the QOUH ha ve a great significance for guiding the treatment of PU and predicting recurrence. However, assessing the QOUH remain depends on endoscopic grades and pathological biopsy worldwide. Endoscopic grades just according the observing of the surface morphology of ulcers, its accuracy is full of controversy. Pathological biopsy is known as the gold standard, it can be accurately reflect the regenerative mucosal maturity, but the biopsy operation is trauma, time-consuming and the selection of biopsy site is influenced by subjective factors. Confocal laser endomicroscopy is a noninvasive, instant new type of endoscopic micro technology, it can realize the cell level of precision to enlarge since the promotion effect is remarkable. But the C LE in the DU research is blank. This research adopts the CLE aimed to explore its value in the assessment after DU cure QOUH and preliminary evaluation criteria.Methods:Patients who visited Department of Gastroenterology, the First Affiliated Hospital of Nanchang University for upper gastrointestinal symptoms(abdominal pain, abdominal distension, blood in the stool, belching, nausea, vomiting, anti acid), and as active duodenal ulcer by WLE from April 2013 to August 2013 were selected. After the treatment of the h. pylori resistance, acid suppression, protecting gastric mucosa 6 weeks, the patients were selected by C13 urea breath test, after it is a WLE text for assessing observation and classification of QOUH, at last CLE was used to observation microstructure and image acquisition. The scar tissue and normal tissue of duodenal ulcer is taken two piece of tissue each for biopsy. Histological diagnosis of tissue would be completed in our digestive research institute, at the same time the expression of TGF-β1 and FGF-2 would be text by immunohistochemical. With pathological diagnosis as the gold standard, compare WLE with C LE in the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of endoscopic grading. Explore whether TGF-β1 and FGF-2 and grading of QOUH is relevant.Results:1. In this study, a total of 76 people completed the inspection of CLE. 55 patients specimen joined the pathologic and immunohistochemical detection, which ulcer was proved to be the scar by WLE. 17240 confocal images were obtained, 87.6 percents were good and moderate of all.2. Compared with histological grade, WLE diagnosis of duodenal ulcer healing for quality grading: the sensitivity of Sa- level were 57.14%, the specificitie were 87.80%, the positive predictive value were 61.54%, the negative predictive value were 85.71% and the accuracies were 80%; the sensitivity of Sb-level were 50%, the specificitie were 52.38%, the positive predictive value were 62.96%, the negative predictive value were 39.29% and the accuracies were 50.91%; the sensitivity of Sc-level were 47.06%, the specificitie were 81.58%, the positive predictive value were 53.33%, the negative predictive value were 77.50% and the accurac y were 70.91%. The kappa value of the correlation with endoscopic images and grading of pathological diagnosis was 0.38, P<0.01 the difference was statistically significant.3. Compared with histological grade, CLE diagnosis of duodenal ulcer healing for quality grading: the sensitivity of 1- level were 73.33%, the specificitie were 95%, the positive predictive value were 84.62%, the negative predictive value were 90.48% and the accuracies were 89.09%; the sensitivity of 2- level were 85.19%, the specificitie were 85.71%, the positive predictive value were 85.19%, the negative predictive value were 85.71% and the accuracies were 85.45%; the sensitivity of 3-level were 92.31%, the specificitie were 92.86%, the positive predictive value were 80%, the negative predictive value were 97.50% and the accurac y were 92.73%. The kappa value for the correlation with confocal images and grading of pathological diagnosis was 0.74, P<0.01 the difference was statistically significant.4. The image classifications of CLE has no relevance with the immunohistochemical expression of TGF-β1 and FGF-2 by Spearman rank correlation(P>0.05), no statistical significance of the two groups.Conclusion:1. According to the epithelial cells, glands quantity, structure, capillary network configuration, inflammatory cells infiltration, the C LE image classification standard was set up, its sensitivity, specificity, positive predictive value, negative predictive value and accuracy of pathological grading consistency were higher than WLE image classification. Providing a new diagnostic technique with a high clinical value of evaluationing QOUH in a instant, noninvasive and rapid way.2. The image classifications of confocal laser endomicroscopy has no relevance compared to the immunohistochemical expression of TGF-β1 and FGF-2. |
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