可分离式系线磁控胶囊内镜在肝硬化患者中的诊断价值  

Diagnostic value of detachable string magnetically controlled capsule endoscopy in patients with liver cirrhosis

作　　者：孙焕焕 卢桂芳[1] 任莉[1] 罗玉梅 和水祥[1] SUN Huanhuan;LU Guifang;REN Li;LUO Yumei;HE Shuixiang(Department of Gastroenterology,The First Affiliated Hospital of Xi'an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院消化内科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2024年第3期449-454,共6页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省重点研发计划社会发展领域一般项目(No.2019SF-171,No.2024SF-YBXM-131)。

摘　　要：目的探讨可分离式系线磁控胶囊内镜(detachable string magnetically controlled capsule endoscopy,ds-MCE)在肝硬化患者中的诊断价值。方法筛选肝硬化患者分别进行胃镜(esophagogastroduodenoscopy,EGD)及ds-MCE检查,以传统EGD结果为标准,评估ds-MCE在肝硬化患者食管胃静脉曲张、高出血风险食管静脉曲张、门脉高压性胃病的准确性,门脉高压性肠病的检出情况以及患者舒适度。结果在2021年5月至2022年7月期间,总共53例患者成功入组,以EGD的检查结果为金标准,ds-MCE检出食管静脉曲张的敏感度为95.45%、特异度为100%、校正阳性预测值为100%、校正阴性预测值为95.65%,Kappa值为0.877(P<0.001);ds-MCE检出胃底静脉曲张的敏感度为93.94%、特异度为90%、校正阳性预测值为90.38%、校正阴性预测值为93.69%,Kappa值为0.839(P<0.001);ds-MCE检出门脉高压性胃病的敏感度为80%、特异度为90.70%、校正阳性预测值为89.59%、校正阴性预测值为81.93%,Kappa值为0.657(P<0.001);ds-MCE检出高出血风险食管静脉曲张的敏感度为76%、特异度为100%、校正阳性预测值为100%、校正阴性预测值为77.43%,Kappa值为0.770(P<0.001)。26.0%(13/50)肝硬化患者检出门脉高压性小肠疾病,主要表现为黏膜水肿、红斑和血管发育异常。ds-MCE舒适度评分[3(2,4)]相较于普通EGD舒适度评分[1(0,3)]更高(P<0.0001)。结论相较于传统EGD,ds-MCE在肝硬化食管胃底静脉曲张、门脉高压性胃病诊断方面准确度较高、安全可行、舒适度高,是一项极具潜力的可替代传统EGD筛查及监测肝硬化食管胃底静脉曲张的检查方法。Objective To investigate the diagnostic value of detachable string magnetically controlled capsule endoscopy(ds-MCE)in patients with liver cirrhosis.Methods Patients with liver cirrhosis were screened for esophagogastroduodenoscopy(EGD)and ds-MCE examination to assess the accuracy of ds-MCE in identifying gastroesophageal varices,high-risk esophageal varices and portal hypertensive gastropathy using EGD as the gold standard,and evaluate the detection of portal hypertensive enteropathy and the comfort level of patients.Results From May 2021 to July 2022,a total of 53 patients with liver cirrhosis were successfully enrolled.With EGD as the gold standard,ds-MCE detected esophageal varices with 95.45%for sensitivity,100%for specificity and adjusted positive predictive value(PPV),95.65%for adjusted negative predictive value(NPV),and 0.877 for Kappa value(P<0.001).For detection of gastric varices,ds-MCE had sensitivity,specificity,adjusted PPV,and adjusted NPV of 93.94%,90%,90.38%and 93.69%,and Kappa value of 0.839(P<0.001).For detection of portal hypertension gastropathy,ds-MCE had sensitivity,specificity,adjusted PPV and adjusted NPV of 80%,90.70%,89.59%and 81.93%,and Kappa value of 0.657(P<0.001).In differentiating high-risk esophageal varices,the sensitivity,specificity,adjusted PPV,and adjusted NPV were 76%,100%,100%and 77.43%,respectively;Kappa value was 0.770(P<0.001).Of the patients with liver cirrhosis,26.0%(13/50)were diagnosed with portal hypertensive enteropathy.The main mucosal changes were edema,erythema,and vascular dysplasia.The ds-MCE comfort score of 3(2,4)was higher than that of the traditional EGD 1(0,3)(P<0.0001).Conclusion Compared with EGD,ds-MCE is an accurate,safe,feasible and comfortable method for detecting esophagogastric varices and portal hypertensive gastropathy in patients with liver cirrhosis.It is a potential alternative to EGD screening surveillance of gastroesophageal varices in patients with liver cirrhosis.

关 键 词：肝硬化 胃镜(EGD) 可分离式系线磁控胶囊内镜(ds-MCE) 食管胃静脉曲张 

分 类 号：R575.2[医药卫生—消化系统]