胃pH联合胆红素监测对病理性十二指肠胃反流的诊断价值  

Diagnostic value of combined gastric pH and bilirubin monitoring in pathologic duodenogastric reflux

作　　者：谭晓林[1] 谢彩虹[1] 赵超[1] 陈冬妹[1] 肖文[1] 尹泉[1] 施为建[1] 汪建华[1,2] 罗世康[1,2] 石冬梅[1,3] 

机构地区：[1]南方医科大学附属中山市博爱医院消化内科,广东省中山市528403 [2]南方医科大学附属中山市博爱医院放射科,广东省中山市528403 [3]南方医科大学附属中山市博爱医院检验科,广东省中山市528403

出　　处：《世界华人消化杂志》2014年第12期1713-1719,共7页World Chinese Journal of Digestology

摘　　要：目的：探讨胃pH联合胆红素监测对病理性十二指肠胃反流（duodenogastricreflux，DGR）的诊断价值．方法：本文对20例对照组和90例具有DGR症状的胃炎组分别进行胃镜及组织学检查、总胆汁酸测定、核素显像、胃pH联合胆红素监测诊断DGR，并进行对比性分析．结果：（1）四种方法检查20例对照组DGR（＋）检出率，结果显示：胃镜及组织学检查30．0％（6／20），总胆汁酸量测定15．0％（3／20）．核素显像10．0％（2／20），胃PH联合胆红素监测0％（0／20），胃PH联合胆红素监测DGR（＋1检出率与胃镜及组织学比较，有显著性统计学差异（P〈0.01），与其他检查比较无统计学差异（P〉0．05）；（2）四种方法检查90例胃炎组DGR（＋）检出率，结果显示：胃镜及组织学检查76．7％（69／90），总胆汁酸测定60％（54／90）．核素显像47．8％（43／90），胃pH联合胆红素监测53．3％（48／90），胃pH联合胆红素监测DGRf＋）检出率与胃镜及组织学比较，有显著性统计学差异（P〈0．01），与其他检查比较无统计学差异（P〈0．05）；（3）3种方法检查胃炎组准确性与核素显像比较，结果显示：胃镜及组织学检查62．2％，有显著统计学差异（P〈0．01），总胆汁酸测定81．1％（P〈0．05），有统计学差异，胃pH联合胆红素监测90．0％，无统计学差异（P〈0．05、（4）根据准确性、敏感性、特异性、假阳性、假阴性几项指标的综合评估，反映DGR诊断准确性程度高低的检查顺序为胃pH联合胆红素监测、核素显像、总胆汁酸测定、胃镜及组织学检查．结论：胃pH联合胆红素监测是诊断DGR最准确的方法，是非常有价值的科研及临床确诊DGR的手段，值得推广应用．AIM： To explore the diagnostic value of combined gastric pH and bilirubin monitoring in pathologic duodenogastric reflux （DGR） METHODS： In this study, we randomly included 90 gastritis patients and 20 controls. For detection of DGR, all subjects underwent gas-troscopy and histological examination, total bile acid test, radionuclide imaging, gastric pH and bilirubin monitoring. A comparative analysis was then performed between the two groups. RESULTS： In the control group, the percenta of DGR （＋） patients detected by gastroscopy and histological examination, total bile acid test, radionuclide imaging and combined gastric pH and bilirubin monitoring were 30.0% （6/20）, 15.0%（3/20）, 10.0% （2/20） and 0% （0/20）, respectively. Compared with gastroscopy and histological examination, the detection rate of combined gastric pH and bilirubin monitoring was significantly lower （P 〈 0.01）, although no statistical significance was observed between combined gastric pH and bilirubin monitoring and other examinations （P 〉 0.05）. In the gastritis group, the percentages of DGR （＋） patients detected by gastroscopy and histological examination, total bile acid test, radionuclide imaging and combined gastric pH and bilirubin monitoring were 76.7% （69/90）, 60.0% （54/90）, 47.8% （43/90） and 53.3% （48/90）, respectively. Compared with the gastroscopy and histological examination, the detection rate of combined gastric pH and bilirubin monitoring was significantly lower （P 〈 0.01）, although no statistical significance was observed between combined gastric pH and bilirubin monitoring and other examinations （P 〉 0.05）. The accuracy rates of gastroscopy and histological examination （62.2%） and total bile acid test （81.1%） were significantly lower than that of radionuclide imaging （P 〈 0.01, P 〈 0.05）, but there was no significant difference between combined gastric pH and bilirubin monitoring （90.0%） and radionuclide imaging （P 〉 0.05）. Based

关 键 词：十二指肠胃反流 PH监测 胆红素监测 核素显像 总胆汁酸量测定 胃镜 胆汁反流 对比研究 

分 类 号：R573[医药卫生—消化系统]