共聚焦激光显微内镜对原发性胆汁反流性胃炎的诊断价值

Diagnostic value of confocal laser endomicroscopy in primary bile reflux gastritis

目的：评估共聚焦激光显微内镜（CLE）诊断原发性胆汁反流性胃炎（BRG）的准确性。方法选取2015年11月10日至12月15日行 CLE 检查且普通白光内镜下初步诊断为 BRG 的患者55例。制订 BRG 的 CLE 评分标准，以 Dixon 的病理评分标准作为诊断金标准，绘制 ROC 曲线评价CLE 评分诊断 BRG 的准确性，计算敏感度和特异度，以及95%CI ，并利用 Kappa 分析评价观察者间的一致性。结果根据 Dixon 的病理评分标准，55例患者中原发性 BRG 29例（52.7%）。在42例 H．pylo狉i 阴性患者中，CLE 诊断 BRG 的 AUC 值为0.90（95%CI 0.81～1.00），以 CLE 评分＊6分为诊断界值时，其敏感度和特异度分别为84.00%（95%CI 65.35%～93.60%）和82.35%（95%CI 58.97%～93.81%）。诊断 BRG 的观察者间一致性分析的 Kappa 值为0.60（95%CI 0.24～0.95）。结论 CLE 可较准确地诊断 H ．pylo狉i 阴性患者的原发性 BRG，其敏感度和特异度均较高。

Objective To evaluate the accuracy of confocal laser endomicroscopy （CLE）in primary bile reflux gastritis （BRG）.Methods From November 10th to December 15th,2015 ,55 patients underwent CLE examination and preliminarily diagnosed as BRG with traditional white-light endoscopy were enrolled.CLE score standard was designed.Dixon pathologic score was considered as gold standard. Receiver operating characteristic （ROC）curve was drawn to evaluate the accuracy of CLE score in BRG diagnosis.Sensitivity,specificity and 95 % confidence interval （CI ）were calculated.Kappa analysis was performed to assess the inter-observer agreement of CLE score.Results According to Dixon pathologic score standard,29 patients （52.7%）were diagnosed as primary BRG among the 55 enrolled patients. Among the 42 Helicobacter pylori （H .pylori ）negative patients,the area under receiver operating characteristic curve （AUC）of CLE in BRG diagnosis was 0.90 （95 %CI 0.81 —1 .00）.Taking CLE score over six as the cut-off value for diagnosis,the sensitivity and specificity was 84.00% （95 %CI 65 .35 %—93.60%）and 82.35 % （95 %CI 58.97%—93.81 %）,respectively.The Kappa value for inter-observer agreement in BRG diagnosis was 0.60 （95 %CI 0.24—0.95）.Conclusion Primary BRG can be accurately diagnosed by CLE in H .pylori negative patients with high sensitivity and specificity.