胶囊内镜对小肠出血的病因诊断分析

Analyze the etiology of small intestinal bleeding diagnosed by capsule endoscopy

目的分析拟诊小肠出血并行胶囊内镜(capsule endoscopy,CE)检查患者的临床内镜特点及其小肠出血的病因。方法纳入2010年1月至2018年9月于首都医科大学附属北京世纪坛医院拟诊小肠出血并首次行CE检查的全部患者。收集患者的一般资料、CE发现、临床诊断和病因等。结果本研究共纳入93例患者,1例(1.1%)患者发生CE滞留情况。患者年龄14~94岁,平均年龄(59.7±19.4)岁,男性58例(62.4%),应用非甾体抗炎药(non-steroid anti-inflammatory drugs,NSAIDs)者37例(39.8%),住院患者87例(93.5%)。显性出血者较隐匿性出血者住院比例更高、血红蛋白浓度更低(P<0.05)。CE检出小肠炎性反应最多(53/93),小肠血管疾病次之(18/93)。74.2%(69/93)患者明确小肠出血原因,包括:NSAIDs相关性小肠病26例、小肠毛细血管扩张14例、克罗恩病5例、不明原因小肠溃疡5例、小肠淋巴管扩张症5例、门脉高压性小肠病4例、肠道寄生虫病4例、Meckel's憩室3例、嗜酸性粒细胞性胃肠炎1例、隐源性多灶性溃疡性狭窄性小肠炎1例和小肠恶性血管球瘤1例。显性和隐匿性出血者分别有75.0%(51/68)和72.0%(18/25)患者明确了出血原因(P=0.769)。结论CE对小肠出血的病因诊断具有重要意义。小肠炎性反应特别是NSAIDs相关性小肠病是本中心引起小肠出血最为常见的原因。

Objective To analyze the clinical and endoscopic characteristics of the patients with suspected small intestinal bleeding and received a capsule endoscopy(CE)and further to explore the etiology.Methods The consecutive patients with suspected of small intestinal bleeding and receiving a CE for the first time at Beijing Shijitan Hospital,Capital Medical University from January 2010 to September 2018 were enrolled.The basic participant characteristics,CE features,clinical diagnosis and etiology were collected for further analysis.Results A total of 93 patients were enrolled,and CE retention was found in one patient(1.1%).The mean age was(59.7±19.4)years,from 14 to 94 years,and 58 patients(62.4%)were the male.The rate of using non-steroid anti-inflammatory drugs(NSAIDs)and hospitalized patients were 39.8%(37/93)and 93.5%(87/93),respectively.The overt gastrointestinal bleeding group patients had higher rate of hospitalized patients,and lower level of hemoglobin(P<0.05).Small intestinal inflammation(53/93)was the most common lesion,followed by intestinal vascular disease(18/93).The etiology of small intestinal bleeding was indentified in 74.2%(69/93)of patients,including 26 cases of NSAIDs enteropathy,14 of intestinal telangiectasis,5 of Crohn's disease,5 of unidentified ulcers,5 of intestinal lymphangiectasia,4 of portal hypertension enteropathy,4 of parasitic disease,3 of Meckel's diverticulum,1 of eosinophilic gastroenteritis,1 of cryptogenic multifocal ulcerous stenosing enteritis,and 1 of intestinal malignant glomus tumor.The etiology was identified in 75.0%(51/68)and 72.0%(18/25)of patients with overt and obscure gastrointestinal bleeding,respectively(P=0.769).Conclusion CE plays an important role in the diagnosis of small intestinal bleeding.Small intestinal inflammation,especially NSAIDs enteropathy,was the most common etiology of small intestinal bleeding in our hospital.