唾液胃蛋白酶及胆汁酸检测在胃食管反流病中的诊断价值

Pepsin and bile acids detection in saliva for the diagnosis of gastroesophageal reflux disease

目的探讨唾液胃蛋白酶及胆汁酸检测在胃食管反流病(GERD)中的诊断价值。方法选取2018年1月至2019年6月就诊于广东省人民医院的104例GERD患者为GERD组,再将其分为食管表现组、食管外表现组、焦虑抑郁组、非焦虑抑郁组4个亚组,同时设立健康对照组43名,收集两组晨起及午餐后2 h唾液,用ELISA方法检测唾液中总胃蛋白酶(TPP)及总胆汁酸(TBA)浓度,比较其差异,通过受试者工作曲线评估唾液TPP、TBA检测的诊断效能及其敏感性和特异性。结果GERD组晨起唾液TPP,午餐后2 h唾液TPP、TBA浓度分别为27.1(9.7,50.3)μg/L、32.4(14.0,58.7)μg/L、(18.4±2.3)μmol/L,均高于健康对照组[7.0(5.1,9.1)μg/L、7.4(5.2,9.4)μg/L、(12.6±5.0)μmol/L](P<0.01)。两组晨起唾液TBA浓度差异无统计学意义(P>0.05),GERD各亚组间的TPP、TBA浓度间的差异均无统计学意义(均P>0.05)。午餐后唾液TPP检测的诊断效能中等,当午餐后唾液TPP>41.33μg/L时,其诊断GERD的敏感性和特异性分别为82.8%、73.3%,而唾液TBA检测无明显诊断效能。结论唾液胃蛋白酶检测对诊断GERD具有较高的敏感性和特异性,而唾液胆汁酸检测对GERD无明显诊断价值。

Objective To identify the value of the detection of pepsin and bile acids in saliva for the diagnosis of gastroesophageal reflux disease(GERD).Methods From January 2018 to June 2019,104 GERD patients and 43 healthy people in Guangdong Provincial People′s Hospital were recruited.The 104 patients of GERD group were divided into four sub-groups,including esophageal symptoms GERD group,extraesophageal symptoms GERD group,anxiety or depression group,non-anxiety and non-depression group.Saliva was collected on waking in morning and 2 h after finishing lunch.The concentration of the total pepsin(TPP)and total bile acids(TBA)from saliva was detected by ELISA method.Receiver operating characteristics analysis was used to identify the sensitivity and specificity of the saliva pepsin and bile acids detection.Results The concentration of TPP in morning waking samples and postprandial samples in the GERD group was 27.1(9.7,50.3)μg/L and 32.4(14.0,58.7)μg/L,the concentration of TBA in postprandial samples was(18.4±2.3)μmol/L,and these levels were significantly higher than that of the control group[7.0(5.1,9.1)μg/L,7.4(5.2,9.4)μg/L,(12.6±5.0)μmol/L](P<0.01).The concentration of TBA in morning waking samples had no significant difference between these two groups(P>0.05).The concentration of TPP and TBA had no significant difference among the four GERD sub-groups(P>0.05).Pepsin in postprandial saliva samples had moderate diagnostic value for GERD,when the saliva pepsin concentration in postprandial samples was higher than 41.33μg/L,it had a sensitivity of 82.8%and a specificity of 73.3%.The bile acids in saliva had no significant diagnostic value for GERD.Conclusions Pepsin detection in saliva has a high level of sensitivity and specificity for diagnosing GERD.However,bile acids in saliva has no significant diagnostic value for GERD.