超声观察小儿胃贲门角对胃食管反流的诊断价值

Diagnostic value of infantile His angle by ultrasonography in gastroesophageal reflux

目的应用超声观察小儿胃贲门(His)角的大小、生长变化规律及其在胃食管反流(GER)诊断中的价值。方法选取GER小儿156例(GER组)和健康小儿573例(健康组),按年龄将各组分为新生儿、婴儿、幼儿及儿童4个年龄段,超声观察胃食管连接部并测量His角的大小,结果进行对比分析。绘制ROC曲线判断His角诊断GER的价值及最佳截断值。结果健康组小儿His角均值为87.2°±7.2°,其中新生儿为93.3°±8.7°,婴儿为90.4°±6.6°,幼儿为86.2°±4.3°,儿童为84.5°±8.8°。GER组小儿His角均值为108.3°±6.7°,明显大于健康组,差异有统计学意义(P<0.01);其中新生儿为107.5°±7.2°,婴儿为108.9°±7.2°,幼儿为106.8°±3.5°,儿童为106.2°±5.3°,均大于同年龄段健康组,差异有统计学意义(均P<0.01)。His角诊断GER的ROC曲线下面积为0.969,最佳截断值为102.2°,其诊断敏感性为94.1%,特异性为97.9%。结论正常小儿的His角随年龄的增大逐渐变小;GER小儿的His角明显大于正常小儿,且不同年龄段小儿His角大小无明显差异;His角增大可作为诊断小儿GER的指标之一。

Objective To observe the size,growth and development rules of His angle in children and its value in diagnosis of gastroesophageal reflux.Methods All children were divided into GER group（156 cases）and healthy group（573 cases）.Each group was divided into 4 age brackets including newborn,infant,young children and children.Gastroesophageal junction was observed and His angle was measured by abdominal ultrasound.The data were statistically analyzed,and the ROC curve was drawn to judge the value of His angle in diagnosis of GER and to find the best cut-off value.Results The His angle of healthy group was87.2°±7.2°,in which newborn group was 93.3°±8.7°,infant group was 90.4°±6.6°,young children group was 86.2°±4.3°,children group was 84.5°±8.8°.The His angle of GER group was 108.3°±6.7°,in which newborn group was 107.5°±7.2°,infant group was108.9°±7.2°,young children group was 106.8°±3.5°,children group was 106.2°±5.3°.The His angle of GER group was significantly greater than that of healthy group in the same age（P0.01）.The area under ROC curve was 0.969,and the optimal cut-off value was 102.2°.The sensitivity and specificity of His angle in diagnosis of GER were 94.1% and 97.9%.Conclusion The His angle is diminishing with age,and it is significantly higher in gastroesophageal reflux children than that in normal children.But there is no significant difference between different age groups.The His angle can be used as one of the indexes for diagnosing GER in children.