胃超声造影对胃食管反流解剖学病因的临床诊断价值
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摘要
目的:采用胃超声造影探寻胃食管反流病人可能存在的解剖学异常,以期为临床诊疗提供影像学依据。方法:选择48例胃食管反流病人作为观察组,另择同期健康体检者51名作为对照组。分别采用胃充盈超声造影和消化道钡餐评估并比较2组研究对象的His角和腹段食管长度;并探讨His角与腹段食管长度的关系及二者对胃食管反流的诊断价值。结果:观察组采用胃充盈超声造影与消化道钡餐2种检查方法对His角及腹段食管长度的检测结果比较差异均无统计学意义(P>0.05)。超声检查,观察组腹段食管长度小于对照组,而His角大于对照组(P<0.01)。以59.03°为截点值,His角诊断胃食管反流敏感性为80.00%,特异性为85.71%,ROC曲线下面积为0.886;以2.743 cm为截点值,腹段食管长度诊断胃食管反流的敏感性为72.86%,特异性为74.29%,ROC曲线下面积为0.800。超声检测腹段食管长度与His角呈负相关关系(r=-0.681,P<0.01)。结论:胃充盈超声造影能够准确评价胃食管反流病人的His角,且操作安全无创,对辅助寻找胃食管反流解剖学病因具有一定价值。
Objective:To investigate the abnormal anatomy of gastroesophageal reflux using gastric ultrasound contrast,and provide the imaging evidence for the clinical diagnosis and treatment.Methods:Forty-eight patients with gastroesophageal reflux and 51 healthy people were divided into the observation group and control group,respectively.The His angle and length of the esophagus in two groups were detected using contrast-enhanced ultrasonography of gastric filling and gastrointestinal meal barium,respectively,and which was compared between two groups.The relationship between the His angle and esophageal length of abdomen was investigated,and the diagnostic value of which in gastroesophageal reflux was evaluated.Results:The differences of the diagnositic results of His angle and abdominal esophageal length between two methods were not statistically significant(P>0.05).The results of ultrasonic examination showed that the esophagus length of abdominal section and His angle in observation group were lower and more than those in control group,respectively(P<0.01).Taking 59.03° as the cut-off value,the sensitivity and specificity of His angle in the diagnosis of gastroesophageal reflux were 80.00% and 85.71%,respectively,and the area under ROC curve was 0.886.Taking 2.743 cm as the cut-off value,the sensitivity and specificity of abdominal esophageal length in the diagnosis of gastroesophageal reflux were 72.86% and 74.29%,respectively,and the ROC curve was 0.800.The abdominal esophageal length detected by ultrasound was negatively correlated with His angle(r=-0.681,P<0.01).Conclusions:The contrast-enhanced ultrasonography of gastric filling can accurately evaluate the His angle of patients with gastroesophageal reflux,and is safe and non-invasive operation,which has a certain diagnostic value for gastroesophageal reflux disease.
Objective:To investigate the abnormal anatomy of gastroesophageal reflux using gastric ultrasound contrast,and provide the imaging evidence for the clinical diagnosis and treatment.Methods:Forty-eight patients with gastroesophageal reflux and 51 healthy people were divided into the observation group and control group,respectively.The His angle and length of the esophagus in two groups were detected using contrast-enhanced ultrasonography of gastric filling and gastrointestinal meal barium,respectively,and which was compared between two groups.The relationship between the His angle and esophageal length of abdomen was investigated,and the diagnostic value of which in gastroesophageal reflux was evaluated.Results:The differences of the diagnositic results of His angle and abdominal esophageal length between two methods were not statistically significant(P>0.05).The results of ultrasonic examination showed that the esophagus length of abdominal section and His angle in observation group were lower and more than those in control group,respectively(P<0.01).Taking 59.03° as the cut-off value,the sensitivity and specificity of His angle in the diagnosis of gastroesophageal reflux were 80.00% and 85.71%,respectively,and the area under ROC curve was 0.886.Taking 2.743 cm as the cut-off value,the sensitivity and specificity of abdominal esophageal length in the diagnosis of gastroesophageal reflux were 72.86% and 74.29%,respectively,and the ROC curve was 0.800.The abdominal esophageal length detected by ultrasound was negatively correlated with His angle(r=-0.681,P<0.01).Conclusions:The contrast-enhanced ultrasonography of gastric filling can accurately evaluate the His angle of patients with gastroesophageal reflux,and is safe and non-invasive operation,which has a certain diagnostic value for gastroesophageal reflux disease.
引文
[1] 朱宝宇,宋德锋,施春雨,冯野.胃食管反流病发病机制研究进展[J].中国实验诊断学,2015,5(2):344.
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[3] 周丽雅,郝建宇,李兆申,等.胃食管反流病量表和质子泵抑制剂试验对胃食管反流病的诊断价值的多中心研究[J].中华消化杂志,2016,36(4):241.
[4] 陈甜子,柴佩,叶秀芳.超声在胃食管反流病因诊断中的应用研究[J].宁夏医学杂志,2011,33(10):949.
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[6] 胡志伟,汪忠镐,吴继敏,等.胃食管反流病:胃食管气道反流的多学科研究和实践[J/CD].中华胃食管反流病电子杂志,2015,2(3):165.
[7] KATZ PO,GERSON LB,VELA MF.Guidelines for the diagnosis and management of gastroesophageal reflux disease[J].Am J Gastroenterol,2013,108(3):308.
[8] BOHNHORST I,JAWAD S,LANGE B,et al.Prevalence of chronic rhinosinusitis in a population of patients with gastroesophageal reflux disease[J].Am J Rhinol Allergy,2015,29(3):70.
[9] 胡志伟,吴继敏,汪忠镐.胃食管反流病:知己知彼,百战不殆[J].临床外科杂志,2017,25(1):8.
[10] SAVARINO E,ZENTILIN P,SAVARINO V.NERD:an umbrella term including heterogeneous subpopulations[J].Nat Rev Gastroenterol Hepatol,2013,10(6):371.
[11] 罗建梅,达婷,崔煜,等.胃肠超声造影在胃十二指肠疾病诊断中的应用[J].胃肠病学和肝病学杂志,2016,25(6):681.
[2] 罗璇.胃食管反流病发病机制研究进展[J].微量元素与健康研究,2015,32(4):60.
[3] 周丽雅,郝建宇,李兆申,等.胃食管反流病量表和质子泵抑制剂试验对胃食管反流病的诊断价值的多中心研究[J].中华消化杂志,2016,36(4):241.
[4] 陈甜子,柴佩,叶秀芳.超声在胃食管反流病因诊断中的应用研究[J].宁夏医学杂志,2011,33(10):949.
[5] 汪忠镐,胡志伟.胃食管反流病及其食管外反流:一个常被忽视的重大公共卫生问题[J].临床外科杂志,2016,24(1):5.
[6] 胡志伟,汪忠镐,吴继敏,等.胃食管反流病:胃食管气道反流的多学科研究和实践[J/CD].中华胃食管反流病电子杂志,2015,2(3):165.
[7] KATZ PO,GERSON LB,VELA MF.Guidelines for the diagnosis and management of gastroesophageal reflux disease[J].Am J Gastroenterol,2013,108(3):308.
[8] BOHNHORST I,JAWAD S,LANGE B,et al.Prevalence of chronic rhinosinusitis in a population of patients with gastroesophageal reflux disease[J].Am J Rhinol Allergy,2015,29(3):70.
[9] 胡志伟,吴继敏,汪忠镐.胃食管反流病:知己知彼,百战不殆[J].临床外科杂志,2017,25(1):8.
[10] SAVARINO E,ZENTILIN P,SAVARINO V.NERD:an umbrella term including heterogeneous subpopulations[J].Nat Rev Gastroenterol Hepatol,2013,10(6):371.
[11] 罗建梅,达婷,崔煜,等.胃肠超声造影在胃十二指肠疾病诊断中的应用[J].胃肠病学和肝病学杂志,2016,25(6):681.