显微镜检查胃液对上消化道出血诊断的临床价值

Clinical Significance of the Microscopic Examination of Gastric Juice for Diagnosis of Upper Gastrointestinal Bleeding

目的采用胃液隐血检测血红蛋白法及转铁蛋白法并与胃液标本显微镜检法进行比较,探讨胃液标本显微镜检查对上消化道出血的诊断价值。方法用两种免疫胶体金法即血红蛋白及转铁蛋白法对临床收集的胃液标本进行检测,同时进行显微镜检查,对所得结果进行统计分析。结果用两种免疫胶体金法及显微镜检法检测的113例胃液标本中,其中经临床确诊消化道出血82例,以临床诊断为标准,胃液潜血血红蛋白法、转铁蛋白法、显微镜检法对消化道出血检测的灵敏度分别为63.4%、64.6%、87.8%,特异度分别为80.6%、71.0%、87.1%,阳性预测值分别为89.6%、85.5%、94.7%,阴性预测值分别为45.5%、43.1%、73.0%,诊断效率分别为68.1%、66.4%、87.6%。与临床诊断进行对比,显微镜检法的差异无统计学意义(P>0.05),血红蛋白法、转铁蛋白法的差异均有统计学意义(P<0.01)。结论显微镜检法检测胃液对上消化道出血有很好的灵敏度、特异度,对指导临床诊断具有重要的参考价值。

Objective To compare the gastric juice occult blood test for hemoglobin and transferrin with microscope examination of specimens of gastric juice,to explore the value of the microscopic examination as an auxiliary method for diagnosis of upper gastrointestinal bleeding.Methods Two immune colloidal gold methods of hemoglobin and transferrin were used to test the clinical specimens of the gastric juice and compared with microscopic examination.Results Eighty two cases of gastrointestinal bleeding,from113 specimens of gastric juice,were clinically diagnosed.The sensitivity of hemoglobin,transferrin detection methods and microscopy method for gastric juice tests were63.4%,64.6%and87.8%, respectively：the specificity of the three methods was80.6%,71.0% and87.1%,with the positive predictive value of 89.6%,85.5% and94.7%,respectively. The negative predictive value was found to be45.5%,43.1% and73.0%,with the efficiency of diagnosis of68.1%,66.4% and87.6%. No significant statistical difference was noted between the clinical diagnosis and microscopic method. m（P〉0.05）.The two immune colloidal gold methods for hemoglobin and transferrin tests,however,were statistically significant（P〈0.01）.Conclusion Microscopic examination of gastric juice presents the promising sensitivity and specificity,and auxiliary diagnostic value for upper gastrointestinal bleeding.