胃超声造影对老年人十二指肠胃反流的诊断价值
|
摘要
目的探讨胃超声造影在老年人病理性十二指肠胃反流(DGR)诊断中的应用价值。方法选取2017年1月—2017年12月湖南省人民医院32例病理性十二指肠胃反流老年患者(DGR组)和26例同期健康志愿者(对照组)行胃超声造影检查,动态观察两组幽门口的反流情况。比较两组幽门口内径、反流次数及反流时间段,绘制受试者工作特征(ROC)曲线;计算特异性、敏感性及曲线下面积,根据约登指数确定诊断截断点。结果①两组反流次数、幽门口内径及反流时间段比较,差异有统计学意义(P<0.05);②ROC曲线分析表明,幽门口内径特异性为96.2%,敏感性为87.5%,ROC曲线下面积为0.973;反流次数特异性为96.2%,敏感性为90.6%,ROC曲线下面积为0.979;反流时间段特异性为80.8%,敏感性为90.6%,ROC曲线下面积为0.905;两组各指标比较,差异有统计学意义(P<0.05)。结论胃超声造影可诊断DGR,能为临床对老年人,特别是有心肺等功能障碍的老年患者诊断DGR提供有效的诊断手段。
Objective To evaluate the value of contrast-enhanced ultrasound in the diagnosis of pathological duodenogastric reflux in the elderly. Methods A total of 32 elderly patients with duodenal gastric reflux disease(group DGR, 60 ～ 89 years old) and 26 healthy volunteers(control group, 60 ～ 89 years old) were examined by gastric ultrasound contrast examination. The reflux situation between the duodenum and the stomach in the two groups was observed dynamically, and the ROC curves of the pyloric diameter, reflux number and reflux time period were compared between the two groups. The area, sensitivity and specificity of the curve were calculated, and the diagnostic threshold was determined according to the Jordan index. Results ① There were statistically significant differences between the two groups in the pyloric diameter, the number of reflux and the reflux time period(P < 0.05).② In the comparison between DGR group and control group, area under curve(AUC), sensitivity and specificity of pyloric diameter were 0.973, 87.5% and 96.2% respectively; those of reflux number were 0.979, 90.6% and 96.2%;those of reflux time period were 0.905, 90.6% and 80.8%. The difference of each index between the two groups was statistically significant(P < 0.05). Conclusions Contrast-enhanced gastric ultrasound can diagnoses DGR, which can provide an effective method for the diagnosis of gastroduodenal reflux in the elderly, especially the elderly with cardiopulmonary dysfunction.
Objective To evaluate the value of contrast-enhanced ultrasound in the diagnosis of pathological duodenogastric reflux in the elderly. Methods A total of 32 elderly patients with duodenal gastric reflux disease(group DGR, 60 ～ 89 years old) and 26 healthy volunteers(control group, 60 ～ 89 years old) were examined by gastric ultrasound contrast examination. The reflux situation between the duodenum and the stomach in the two groups was observed dynamically, and the ROC curves of the pyloric diameter, reflux number and reflux time period were compared between the two groups. The area, sensitivity and specificity of the curve were calculated, and the diagnostic threshold was determined according to the Jordan index. Results ① There were statistically significant differences between the two groups in the pyloric diameter, the number of reflux and the reflux time period(P < 0.05).② In the comparison between DGR group and control group, area under curve(AUC), sensitivity and specificity of pyloric diameter were 0.973, 87.5% and 96.2% respectively; those of reflux number were 0.979, 90.6% and 96.2%;those of reflux time period were 0.905, 90.6% and 80.8%. The difference of each index between the two groups was statistically significant(P < 0.05). Conclusions Contrast-enhanced gastric ultrasound can diagnoses DGR, which can provide an effective method for the diagnosis of gastroduodenal reflux in the elderly, especially the elderly with cardiopulmonary dysfunction.
引文
[1]JONG JIN HYUN,SUK KEU YEOM,EUDDEUM SHIM,et al.Correlation between bile reflux gastritis and biliary excreted contrast media in the stomach[J].Journal of Computer Assisted Tomography,2017,41(5):696-701.
[2]THOMAS A,ELDREDG E,JENNIFER C,et al.Detecting bile reflux-the enigma of bariatric surgery[J].Obesity Surgery,2018,28(2):559-566.
[3]高金保,韩文.原发性十二指肠胃反流程度与胃部炎性反应关系的研究[J].胃肠病学和肝病学杂志,2014,23(110):1178-1151.
[4]JURGENS S,MEYER F,SPECHLER S J,et al.The role of bile acids in theneoplastic progression of Barrett’s esophagus a short representative overview[J].Z Gastroenterol,2012,50(9):1028-1034.
[5]MATSUHISA T,ARAKAWA T,WATANABE T,et al.Relation between bileacid reflux into the stomach and the risk of atrophic gastritis and intestinal metaplasia:a multicenter study of 2283cases[J].Dig Endosc,2013,25(5):219-225.
[6]张文缙,杨赞峰,刘旭静,等.胃窗超声造影在病理性十二指肠胃反流诊断中的应用[J].河北医药,2016,38(20):3154-3156.
[7]王晶晶.十二指肠胃反流病影像技术诊断[J].现代消化及介入诊疗,2015,20(1):43-44.
[8]任丽新.雷贝拉唑、莫沙必利联合治疗原发性胆汁反流性胃炎临床分析[J].中西医结合心血管病杂志,2018,6(21):196.
[9]赵亚男,许翠萍,等.胆汁反流性胃炎病因病机及诊治进展[J].世界华人消化杂志,2018,26(32):1886-1892.
[10]杜春.十二指肠胃反流性疾病内镜诊断及相关因素分析[J].胃肠病学和肝病学杂志,2012,21(9):813-815.
[11]徐治.老年人呼吸系统身心疾病的诊治进展[J].实用老年医学,2016,30(9):717-720.
[12]谭晓林,赵超,谢彩虹.胃PH联合胆红素监测诊断十二指肠胃反流的应用价值[J].临床消化病杂志,2015,27(4):204-208.
[13]FUJIEDA H,YOKOYAMA Y,HIRATA A,et al.Does braun anastomosis have an impact on the incidence of delayed gastric emptying and the extent of intragastric bile reflux following pancreatoduodenectomy?-a randomized controlled study[J].Digestive Surgery,2017,34(6):462-468.
[14]CHEN T F,YADAV,PRAVEEN K,et al.Comparative evaluation of intragastric bile acids and hepatobiliary scintigraphy in the diagnosis of duodenogastric reflux[J].World J Gastroenterol,2013,19(14):2187-2196.
[15]陆文明.临床胃肠疾病超声诊断学[M].西安:第四军医大学出版社,2004:108.
[16]汪惠鹏,王学梅,王云忠,等.超声测量幽门管内径对诊断十二指肠胃反流的临床意义[J].世界华人消化杂志,2013,21(35):4014-4018.
[2]THOMAS A,ELDREDG E,JENNIFER C,et al.Detecting bile reflux-the enigma of bariatric surgery[J].Obesity Surgery,2018,28(2):559-566.
[3]高金保,韩文.原发性十二指肠胃反流程度与胃部炎性反应关系的研究[J].胃肠病学和肝病学杂志,2014,23(110):1178-1151.
[4]JURGENS S,MEYER F,SPECHLER S J,et al.The role of bile acids in theneoplastic progression of Barrett’s esophagus a short representative overview[J].Z Gastroenterol,2012,50(9):1028-1034.
[5]MATSUHISA T,ARAKAWA T,WATANABE T,et al.Relation between bileacid reflux into the stomach and the risk of atrophic gastritis and intestinal metaplasia:a multicenter study of 2283cases[J].Dig Endosc,2013,25(5):219-225.
[6]张文缙,杨赞峰,刘旭静,等.胃窗超声造影在病理性十二指肠胃反流诊断中的应用[J].河北医药,2016,38(20):3154-3156.
[7]王晶晶.十二指肠胃反流病影像技术诊断[J].现代消化及介入诊疗,2015,20(1):43-44.
[8]任丽新.雷贝拉唑、莫沙必利联合治疗原发性胆汁反流性胃炎临床分析[J].中西医结合心血管病杂志,2018,6(21):196.
[9]赵亚男,许翠萍,等.胆汁反流性胃炎病因病机及诊治进展[J].世界华人消化杂志,2018,26(32):1886-1892.
[10]杜春.十二指肠胃反流性疾病内镜诊断及相关因素分析[J].胃肠病学和肝病学杂志,2012,21(9):813-815.
[11]徐治.老年人呼吸系统身心疾病的诊治进展[J].实用老年医学,2016,30(9):717-720.
[12]谭晓林,赵超,谢彩虹.胃PH联合胆红素监测诊断十二指肠胃反流的应用价值[J].临床消化病杂志,2015,27(4):204-208.
[13]FUJIEDA H,YOKOYAMA Y,HIRATA A,et al.Does braun anastomosis have an impact on the incidence of delayed gastric emptying and the extent of intragastric bile reflux following pancreatoduodenectomy?-a randomized controlled study[J].Digestive Surgery,2017,34(6):462-468.
[14]CHEN T F,YADAV,PRAVEEN K,et al.Comparative evaluation of intragastric bile acids and hepatobiliary scintigraphy in the diagnosis of duodenogastric reflux[J].World J Gastroenterol,2013,19(14):2187-2196.
[15]陆文明.临床胃肠疾病超声诊断学[M].西安:第四军医大学出版社,2004:108.
[16]汪惠鹏,王学梅,王云忠,等.超声测量幽门管内径对诊断十二指肠胃反流的临床意义[J].世界华人消化杂志,2013,21(35):4014-4018.