口腔中唾液胃蛋白酶检测对胃食管反流病的诊断价值

The diagnostic value of measured-pepsin in oral salivary for GERD patients

目的检测口腔中唾液胃蛋白酶是否能辅助诊断非典型症状的胃食管反流病(gastroesophageal reflux disease,GERD)患者。方法分别收集有疑似症状患者的口腔唾液,时间为睡前、症状发作时、晨起。用蛋白印迹法测量其中的胃蛋白酶,同时所有病例接受24 h PH值监测。然后口服埃索美拉唑,40 mg/次,2次/d,持续2周,即PPI试验。结果 80例患者中43例胃蛋白酶检测阳性,主要是症状发作时采集的唾液样本呈阳性(53.75%),健康对照组65例全部阴性。80例患者中24 h PH值监测阳性者38例(47.5%)。以24 h PH值为金标准,则胃蛋白酶检测的敏感性和阴性预测值较为理想。然而,特异性和阳性预测值欠佳。结论收集胃食管反流病(GERD)非典型症状患者症状发作时的口腔唾液,检测其中的胃蛋白酶为疑似GERD患者提供了一种敏感、非侵入性的检测方法。

Objective To measure the pepsin in oral salivary in order to diagnose the GERD patients with non-typical symptoms.Methods Oral salivary of the patients with suspective symptoms were collected,according to the time of before-sleeping,going-symptoms and waking.Pepsin was measured by protease-labeled,meantime,all suspective patients were measured by 24 h PH,then taking Esomeprazole 40 mg Bid,2 weeks（PPI trials）.Results Forty-three patients’pepsin in oral salivary trials were positive in 80 suspective patients,salivary samples were positive（53.75%） during mainly going-symptoms time.All 65 controls were negative.Thirty-eight patients（47.5%） measured by 24 h PH were positive in 80 suspective patients.Follow 24 h PH gold standard,pepsin in oral salivary trials’sensitivity and negative predictive value were very good,but specificity and positive predictive value were bad.Conclusion Through collecting oral salivary of the GERD patients during going-symptoms time,then measuring pepsin,it will supply a sensitive and non-invaded measure method for the patients with suspective symptoms.