目的探讨胃窦黏膜不平不同表现对慢性萎缩性胃炎(CAG)的诊断价值。方法将胃窦黏膜不平胃镜下分4型,比较各型对CAG的诊断价值。对病理CAG检出率不太高的类型通过细分亚型,筛选出CAG的胃镜特征。为避免漏检,对每一患者病变不同特征表现处分别取材送病理检查,对镜下非病变处同样取材送病理检查。结果粗糙不平型、结节不平型、凹陷不平型、凹凸不平型病理CAG检出率分别是10.7%、62.1%、84.0%和96.8%;结节不平型、凹凸不平型较凹陷不平型肠化检出率高(P<0.05);结节不平型分均匀结节、非均匀结节、散发灰色结节和红色结节4亚型,其中均匀结节型只有5.3%(1/19)有轻度萎缩,而非均匀结节型病理CAG检出率高达96.3%(26/27),散发的灰色结节和红色结节也分别有83.3%和57.1%较高的CAG检出率;凹陷不平型分明显凹陷和轻微凹陷2亚型,其中4例非萎缩性胃炎全部在轻微凹陷型;凹凸不平型凹陷处病理CAG检出率(96.8%)稍高于凸起处(87.1%),而凸起处黏膜病理肠上皮化生检出率(41.9%)较凹陷处高(12.9%)(P<0.05)。结论胃窦黏膜凹凸不平、明显灰白凹陷不平和非均匀结节状不平是CAG的重要胃镜特征,可作为CAG的胃镜诊断依据。 Objective To investigate the diagnostic value of different manifestations of gastric antral mucosa on chronic atrophic gastritis (CAG). Methods Antral mucosa of gastric antrum was divided into 4 types, the diagnostic value of each type of CAG was compared. The type of pathological CAG detection rate is not too high by subdividing the subtype, screening out gastroscopy features of CAG. In order to avoid missed inspection, the lesions of different characteristics of each patient were taken separately for pathological examination, the same non-lesion at the same microstructure was taken for pathological examination. Results Rough and uneven, nodular uneven type, concave uneven type, uneven CAG pathological detection rate was 10.7%, 62.1%, 84.0% and 96.8%; uneven nodules, uneven type of depression than the uneven intestinal metaplasia The detection rate was high (P <0.05). The uneven nodules had uniform nodules, non-uniform nodules, gray nodules and red nodules 4 subtypes. Only 5.3% (1/19) had uniform nodules Mild atrophy, while non-uniform nodular pathology CAG detection rate as high as 96.3% (26/27), distributed gray nodules and red nodules were also 83.3% and 57.1% higher CAG detection rate; depression The uneven subtypes were significantly depressed and subtle subtype 2, of which 4 were non-atrophic gastritis all slightly concave; the positive rate of pathological CAG (96.8%) was slightly higher than that of the convex (87.1%), However, the mucosal pathological change of intestinal metaplasia (41.9%) was higher than that of the depression (12.9%) (P <0.05). Conclusions Antral mucosa with uneven appearance, obvious gray pits and uneven nodules is an important gastroscopic feature of CAG and can be used as a diagnostic basis of gastroscopy for CAG.