血清尿素氮与肌酐比值对小肠出血者小肠镜检查进镜途径的指导价值  

Value of blood urea nitrogen and creatinine ratio for guiding the access route of double-balloon enteroscopy for small intestinal bleeding

作　　者：张燕双 李白容 孙涛 肖年军 李蒙 陈虹羽 宁守斌 Zhang Yanshuang;Li Bairong;Sun Tao;Xiao Nianjun;Li Meng;Chen Hongyu;Ning Shoubin(Graduate School,Hebei North University,Zhangjiakou 075061,China;Department of Gastroenterology,Air Force Medical Center,Beijing 100142,China)

机构地区：[1]河北北方学院研究生院,张家口075061 [2]空军特色医学中心消化科,北京100142

出　　处：《中华消化内镜杂志》2021年第1期52-56,共5页Chinese Journal of Digestive Endoscopy

基　　金：首都卫生发展科研专项(2020-4-5123)。

摘　　要：目的探讨血清尿素氮(blood urea nitrogen,BUN)与肌酐(creatinine,Cr)比值(BUN/Cr)对小肠出血患者行小肠镜检查时进镜途径选择的指导价值。方法2015年1月—2019年10月期间,因潜在小肠出血在空军特色医学中心接受双气囊小肠镜检查,并在出血48 h内行BUN和Cr检测的105例患者纳入回顾性分析,根据BUN/Cr比值是否大于81分成升高组(n=52)和正常组(n=53),使用χ^2检验比较两组经口进镜和经肛进镜病变检出率。结果105例潜在小肠出血患者中,79例经双气囊小肠镜检查明确出血原因,总体病变检出率为75.24%(79/105)。升高组52例,总体病变检出率为76.92%(40/52),经口进镜病变检出率为79.49%(31/39),经肛进镜病变检出率为47.37%(9/19);正常组53例,总体病变检出率为73.58%(39/53),经口进镜病变检出率为63.64%(21/33),经肛进镜病变检出率为51.43%(18/35)。经口进镜病变检出率升高组明显高于正常组(χ^2=6.576,P=0.010),经肛进镜病变检出率升高组与正常组比较差异无统计学意义(χ^2=2.230,P=0.135)。结论对于潜在小肠出血的患者,在活动性出血48 h内,BUN/Cr>81时可首先考虑行经口小肠镜检查。Objective To evaluate the value of blood urea nitrogen(BUN)/creatinine(Cr)ratio for guiding the access route of double balloon enteroscopy(DBE)for small intestinal bleeding.Methods The clinical information was collected from 105 patients who underwent DBE for suspected small intestinal bleeding at Air Force Medical Center from January 2015 to October 2019.Patients were divided into the elevated BUN/Cr group(n=52)and the normal BUN/Cr group(n=53),with a cut-off value of 81.Comparison was made for the detection rate of lesions between the oral route and anal route separately in the two groups using Chi-square test.Results Among the 105 patients with suspected small intestinal bleeding,definite causes of bleeding were identified in 79 patients by DBE,and the overall lesion detection rate was 75.24%(79/105).In the elevated BUN/Cr group,the overall lesion detection rate was 76.92%(40/52),among which 79.49%(31/39)was through oral and 47.37%(9/19)through anal enteroscopy.In the normal BUN/Cr group,the overall lesion detection rate was 73.58%(39/53),and 63.64%(21/33)was transoral and 51.43%(18/35)transanal.The lesion detection rate of transoral enteroscopy in the elevated group was significantly higher than that in the normal group(χ^2=6.576,P=0.010).There was no significant difference in the lesion detection rate of transanal enteroscopy between the two groups(χ^2=2.230,P=0.135).Conclusion For patients with active small intestinal bleeding(active bleeding within 48 hours),the BUN/Cr ratio higher than 81 may indicate that DBE should be performed firstly via oral route.

关 键 词：胃肠出血 小肠出血 血尿素氮/肌酐比值 双气囊小肠镜 

分 类 号：R574.5[医药卫生—消化系统]