胶囊内镜对不明原因消化道出血诊断及其预后的影响

Clinical value of capsule endoscopy in obscure gastrointestinal bleeding

目的评估胶囊内镜对不明原因消化道出血（OGIB）的诊断率及其对进一步诊治所起的指导作用，分析因此对OGIB患者预后结局产生的影响。方法选择2002年6月至2010年10月间因OGIB行胶囊内镜检查，符合入组标准、获得随访的患者307例，通过查阅患者资料库、住院病史以及在取得患者知情同意后，获取临床和随访数据。根据胶囊内镜检查结果，用其他方法进一步检查，并指导治疗。通过设置验证标准计算胶囊内镜检查的诊断率、敏感度、特异度、阳性预测值、阴性预测值、确诊率，以及根据胶囊内镜诊断指导治疗的有效干预率。结果307例患者随访13～112个月，中位随访时间52个月。胶囊内镜诊断率65．8％、敏感度81．7％、特异度91．4％、阳性预测值95．2％、阴性预测值70．5％、确诊率84．8％。胶囊内镜阳性患者中特异性治疗的有效干预率94．5％、总体有效干预率为94．7％。结论胶囊内镜检查对OGIB诊断是有效的，具有较高的诊断率及准确性，可指导临床医师对患者采取进一步的诊治措施，从而较大程度上改善这些患者的预后。

Objective Assessed the efficiency of capsule endoscopy in obscure gastrointestinal bleeding （OGIB） diagnosis and the reference value of diagnosis results in further clinical treatment, analyzed how capsule endoscopy results can affect patients＇ prognosis. Methods 307 consecutive patients who under- went capsule endoscopy for OGIB from June 2002 to October 2010 were enrolled. Follow-up data were ob- tained by reviewing medical records, capsule endoscopy database and contacting the patients or their relatives by telephone. We set validation criteria to calculate the capsule endoscopy inspection sensitivity, specificity, positive predictive value, negative predictive value, the accuracy. And by comparing the clinical treatment and prognosis of capsule endoscopy-positive patients with those of capsule endoscopy-negative ones, we ana- lyzed bow capsule endoscopy results can guide clinical treatment and its effect on prognosis. Results Among the patients who perform capsule endoscopy for OGIB, 307 patients follow-up data were available, with a medium follow-up of 52. 0 （range 13 -112, interquartile range 33 -74 ） months. In this study, the diagnostic yield of capsule endoscopy is 65.8% , and the accuracy is 84. 8%. Sensitivity, specificity, posi- tive predictive value and negative predictive value of capsule endoscopy were 81.7% , 91.4% , 95.2% and 70. 5%, respectively. The effective intervention rate of specific treatments in capsule endoscopy-postive pa- tients was 94. 5%, while the total effective intervention rate was 94. 7%. Conclusion Capsule endoscopy for OGIB is an effective and safe method with excellent tolerability as well as high diagnostic yield and accu- racy, able to effectively guide the clinicians to proper diagnosis and treatment, thus greatly improving the prognosis of these patients.