胶囊内镜对非甾体类抗炎药致小肠黏膜损伤的诊断价值研究  

The diagnostic value of capsule endoscopy for asymptomatic NSAID-induced enteropathy

作　　者：薄陆敏[1] 杨俊驰[2] 廖专[1] 徐灿[1] 辛磊[1] 陈洁[1] 方艾乔 李兆申[1] 

机构地区：[1]第二军医大学长海医院消化内科,上海200433 [2]第二军医大学长海医院普外一科,上海200433

出　　处：《中华消化内镜杂志》2015年第1期6-9,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨胶囊内镜对无典型临床表现的非甾体类抗炎药（NSAID）致小肠黏膜损伤的诊断价值。方法纳入2006年10月至2013年12月进行胶囊内镜检查患者110例，其中服用NSAID者38例，比较NSAID服用者与不服用者、服药持续时间≥3个月者与〈3个月者、服用低剂量阿司匹林者与服用非阿司匹林NSAID者的小肠黏膜损伤的发现率，以及小肠黏膜损伤发生的部位和随访情况。结果小肠黏膜损伤发现率服药组为55．3％（21／38），未服药组为5．6％（4／72），2组差异有统计学意义（P〈0．01）；服药持续时间≥3个月者小肠黏膜损伤发现率显著高于服药持续时间〈3个月者（7／24比4／14，P=0．01）；服用非阿司匹林NSAID者小肠黏膜损伤发现率显著高于服用低剂量阿司匹林者（11／14比10／24，P〈0．05）。在服用低剂量阿司匹林的患者中，服药持续时间≥3个月者小肠黏膜损伤发现率显著高于服药持续时间〈3个月者（10／16比0／8，P=0．00）。服用NSAID者小肠黏膜溃疡主要发生在回肠（10／11），而小肠黏膜糜烂主要发生在空肠（8／10）。8例小肠溃疡患者在停服NSAID或加用黏膜保护剂后，复查胶囊内镜显示小肠溃疡明显改善；4例小肠黏膜糜烂患者加用黏膜保护剂后，复查胶囊内镜显示小肠黏膜糜烂基本消失。结论胶囊内镜对无典型临床表现的NSAID致小肠黏膜损伤具有较好的诊断及指导治疗的作用。Objective To study the diagnostic value of capsule endoscopy for asymptomatic nonsteroid antiinflammatory drugs （NSAID）-induced enteropathy. Methods A total of 110 health exam cases （38 cases taking NSAID orally）were recruited to the study and underwent capsule endoscopy. The incidence of small intestine lesion of NSAID takers and non-NSAID takers, that of those whose medication time longer than 3 months and less than 3 months, and who took low dose asprin and who took non-asprin NSAID were compared. The location of mucosal lesions and recovery status were followed up. Results The incidence of small intestine lesions was significantly different between NSAID group（ 55.3%, 21/38 ） and non-NSAID group （5.6% ,4/72） （ P 〈 0.01 ）. The incidence of small intestine lesion was significantly higher in the overthree-month-medication group than in the less-than-three-month group（7/24 VS 4/14,P = 0. 01 ）. The incidence of small intestine lesions was also significantly higher in the non-asprin group than asprin group（ 11/14 VS 10/24,P 〈0. 05）. The ulcerative lesions were predominantly located in the ileum（ 10/11 ）, while the erosive lesions were predominantly found in the jejunum（8/10）. Eight ulceration cases recovered after stopping taking NSAID or the use of rebamipide. Four erosion cases recovered after the use of rebamipide. Conclusion Capsule endoscopy is of favourable diagnostic and therapeutic value for asymptomatic NSAIDinduced enteropathy.

关 键 词：小肠 非甾体类抗炎药 阿司匹林 胶囊内镜检查 内窥镜检查 

分 类 号：R574.5[医药卫生—消化系统]