糜蛋白酶、N-乙酰半胱氨酸和链蛋白酶在上消化道内镜检查中对图像清晰度影响的回顾性研究

Impact of chymotrypsin, N-acetylcysteine and chain protease on image visibility in upper gastrointestinal endoscopy

目的比较上消化道内镜检查前分别应用N-乙酰半胱氨酸、链蛋白酶和糜蛋白酶对内镜图像清晰度的影响。方法将2016年1月-2016年7月行无痛胃镜检查的患者,在胃镜检查前分为4组,其中A组为对照组(西甲硅油600 mg+NaHCO_3 2 g),B组为糜蛋白酶组(西甲硅油600 mg+糜蛋白酶200 u+NaHCO_3 2 g),C组N-乙酰半胱氨酸组(西甲硅油600 mg+N-乙酰半胱氨酸600 mg+NaHCO_3 2 g),D组为链蛋白酶组(西甲硅油600 mg+链蛋白酶20 000 u+NaHCO_3 2 g)。各组将相应药物稀释在100 ml生理盐水中,均嘱患者在行胃镜检查前30 min口服该稀释溶液。所有入组患者的胃镜检查都由同一位高年资内镜医师完成,每位患者的内镜图片清晰度分别由另两位高年资内镜医师进行评估,这3名医师均对患者分组不知情。每组分别选取诊断为慢性胃炎的54名患者(共216名)进行回顾性研究,统计分析图像清晰度评分总分、内镜操作时胃腔冲洗时间及并发症发生率的组间差异。结果 A、B、C和D 4组图像清晰度评分的总分分别为(32.19±3.06)、(36.64±3.18)、(39.03±3.69)和(39.89±3.35)分,A组评分最低(P<0.05),B组其次(P<0.05),C、D组总分较高且组间差异无统计学意义(P>0.05);胃镜检查中需要再冲洗的时间分别为(42.00±21.67)、(17.78±13.39)、(12.32±11.08)和(11.98±10.04)s。A组胃镜再冲洗时间最长(P<0.05),而B、C、D组耗时相近(P>0.05)。各组胃镜检查结束后(患者清醒后)的不适反应总发生率之间差异均无统计学意义(P>0.05)。结论在进行上消化道内镜检查前,西甲硅油分别联合糜蛋白酶、N-乙酰半胱氨酸和链蛋白酶均能安全有效地提高内镜图像的清晰度,缩短再冲洗的时间,无明显不良反应。其中N-乙酰半胱氨酸组和链蛋白酶组的效果最佳,且两者效果相似,说明西甲硅油联合N-乙酰半胱氨酸或链蛋白酶使用时均能更有效地提高胃镜图像的清晰度,缩短再冲洗时间,从而可以提高早期病变的检出率。当临床上使用N-乙酰半胱氨酸和链蛋白酶受限时,也可考虑使用糜蛋白酶提高内镜图像的清晰度。

Objective To compare the effect of chymotrypsin, N-acetylcysteine and chain protease on theimage visibility before upper gastrointestinal endoscopy. Methods The patients who underwent painless gastroscopyfrom January 2016 to July 2016 were divided into four groups before gastroscopy. Group A is the control group（simethicone 600 mg ＋ NaHCO3 2 g）. Group B is the chymotrypsin group （simethicone 600 mg ＋ chymotrypsin 200 u ＋ NaHCO3 2 g）. Group C is the N-acetylcysteine group （simethicone 600 mg ＋ N-acetylcysteine 600 mg＋ NaHCO3 2 g）. Group D is the chain protease group （simethicone 600 mg ＋ chain protease 20 000 u ＋ NaHCO32 g）. The corresponding drug is diluted in 100 ml of normal saline. Each group of patients was required to oral thediluted solution 30 minutes before gastroscopy. All patients＇ gastroscopies were completed by one endoscopist, andeach patient＇s endoscopic image visibility were evaluated by the other two endoscopists. The three endoscopistswere unaware of grouping. Each group chose 54 patients diagnosed with chronic gastritis to conduct a retrospectivestudy. The total patients were 216. The total scores of image visibility, the washing time and the incidence ofcomplications were compared and analyzed. Results The total image scores of group A, B, C and D were（32.19 ± 3.06）, （36.64 ± 3.18）, （39.03 ± 3.69） and （39.89 ± 3.35）, respectively. Group A was the lowest （P 〈 0.05）,followed by group B （P 〈 0.05）. The total scores of group C and D were higher, and there was no difference betweengroups （P 〉 0.05）. The washing time of each group were （42.00 ± 21.67） s, （17.78 ± 13.39） s, （12.32 ± 11.08） s and（11.98 ± 10.04） s. Group A was the longest （P 〈 0.05）, while there were no significant differences among group B, Cand D （P 〉 0.05）. There were no significant differences in adverse effects among groups after upper gastrointestinalendoscopy. Conclusion Before conducting upper gastrointestinal endoscopy, simethicone in combination withchymotrypsin, N-acetylcysteine and chain protease can safely and effectively improve the visibility of endoscopicimages and shorten the washing time. There is no obvious adverse reactions. N-acetylcysteine group and thechain protease group have the best effect, and the two effects are similar. So simethicone in combination withN-acetylcysteine or chain protease can be more effective in enhancing gastroscopic image visibility, shorter washingtime, which can improve the detection rate of early lesions. When the clinical use of N-acetylcysteine and chainprotease is limited, the use of chymotrypsin can also be considered to improve the visibility of endoscopic images.