胶囊内镜在慢性腹痛中的诊断价值和预测因素探讨

Diagnostic value and predictive factors of capsule endoscopy for chronic abdominal pain

目的探讨胶囊内镜(CE)对慢性腹痛的诊断价值和影响因素。方法回顾性分析本中心2008年6月~2014年10月因慢性腹痛行CE检查的206例患者资料,其中男性125例,女性81例。结果 206例中,76例检出病变,检出率为36.9%;病变主要为:可疑克隆恩病(CD)8例,小肠非特异性溃疡10例,非特异性炎症16例,小肠寄生虫7例,小肠息肉9例,小肠肿瘤3例,小肠憩室2例,血管畸形21例。CE通过幽门时间为1~517 min,平均56.8 min;小肠转运时间为49~568 min,平均273.3 min。单因素分析显示,伴或不伴腹泻的病变检出率分别为30%和38%(P>0.05);年龄≥50岁和<50岁患者检出率分别为41.1%和33.6%(P>0.05);出现报警症状与未出现的检出率分别为58.1%和33.1%(P<0.01)。多因素Logistic回归分析显示,出现报警症状是提高CE阳性诊断率的独立预测因素(OR=2.611;95%CI为1.129~6.039)。共出现3例胶囊滞留,均自行排出。结论 CE对慢性腹痛具有一定的诊断价值,特别是对于存在报警症状的患者,但其应用价值仍有待于进一步的研究证实。

Objective To explore the diagnostic value and predictive factors of capsule endoscopy（CE） for chronic abdominal pain. Methods Retrospective analysis was made on the clinical data on 206 patients who had been suffering chronic abdominal pain and had received CE examination in our hospital from Jun. 2008 to Oct. 2014（males =125; females =81）. Results In 206 cases,pathologic changes were found in 76 ones, with a detection rate of 36.9%, including suspected Crohn＇s disease（CD） in 8 cases, non-specific small-intestinal ulcer in 10 cases, non-specific inflammation in 16 cases, small-intestinal parasites in 7 cases, small-intestinal polyp in 9 cases, small-intestinal tumor in 3 cases, small-intestinal diverticulum in 2 cases, and vascular malformation in 21 cases.The time for CE to pass through the pylorus was 1-517 min, 56.8 min averagely; the small-intestinal transit time was 49-568 min,273.3 min averagely. Univariate analysis showed that the detection rates of patients with and without diarrhea were 30% and 38%（P〈0.05）; the detection rates of patients ≥ 50 years old and 50 years old were 41.1% and 33.6%（P〈0.05）, and the detection rates of patients with and without alarm symptoms were 58.1% and 33.1%（P〈0.01）. Multivariate logistic regression analysis showed that the presence of alarm symptoms was an independent predictor for increased CE positive diagnostic rate（OR = 2.611; 95% CI =1.129-6.039）. Capsule retentions occurred in three cases totally, but were discharged naturally. Conclusion CE has certain diagnostic value for chronic abdominal pain, especially for the patients with alarm symptoms, but the application value still needs further study.