胃超声造影对慢性咳嗽儿童胃食管反流的诊断价值

Value of gastric contrast-enhanced ultrasound to the diagnosis of gastroesophageal reflux in children with chronic cough

目的观察慢性咳嗽患儿胃食管反流的超声造影特征,探讨胃超声造影对慢性咳嗽患儿胃食管反流的诊断价值。方法2022年3月—2023年3月西安交通大学第二附属医院诊治慢性咳嗽患儿82例,均行胃超声造影检查,其中有病理性胃食管反流者49例为观察组,无病理性胃食管反流者33例为对照组,记录2组贲门与腹段食管处5 min内反流次数和总反流时间,测量His角、腹段食管长度、静息时和反流时腹段食管直径,计算食管扩张绝对值。采用Pearson相关法分析5 min内总反流时间、5 min内反流次数与食管扩张绝对值的相关性。绘制ROC曲线,评估His角、腹段食管长度诊断慢性咳嗽患儿胃食管反流的效能。结果82例患儿中有病理性胃食管反流者49例(59.76%),其中5 min内反流1次35例,反流2次12例,反流3次2例;5 min内总反流时间3~5 s 27例,6~8 s 17例,>8 s 5例;食管扩张绝对值为(6.83±2.20)mm。观察组His角[(62.69±7.04)°]大于对照组[(53.45±6.79)°](t=-6.058,P<0.001),腹段食管长度[(1.97±0.28)cm]短于对照组[(2.16±0.39)cm](t=2.381,P=0.022),静息时腹段食管直径[(7.16±1.22)mm]与对照组[(7.14±1.06)mm]比较差异无统计学意义(t=-0.072,P=0.943)。观察组患儿5 min内总反流时间、5 min内反流次数与食管扩张绝对值均呈正相关(r=0.468,P=0.002;r=0.333,P=0.027)。His角、腹段食管长度分别以55°、1.95 cm为最佳截断值,诊断慢性咳嗽患儿胃食管反流的AUC分别为0.828(95%CI:0.741~0.915,P<0.001)、0.633(95%CI:0.513~0.752,P=0.035),灵敏度分别为91.1%、53.3%,特异度分别为63.2%、80.5%。结论有胃食管反流的慢性咳嗽患儿胃超声造影指标His角增大、腹段食管长度缩短,食管扩张绝对值可反映胃食管反流程度,His角对慢性咳嗽患儿胃食管反流有较高诊断价值。

Objective To observe the contrast-enhanced ultrasound(CEUS)features of gastroesophageal reflux(GR)in children with chronic cough,and to explore the value of CEUS to the diagnosis of GR in children with chronic cough.Methods From March 2022to March 2023,82children with chronic cough received gastric CEUS in the Second Affiliated Hospital of Xi’an Jiaotong University,and were divided into 49children with pathological GR(observation group)and 33children without pathological GR(control group).The frequency and total duration of GR within 5min at the lower esophageal sphincter and abdominal esophagus were recorded in both groups.The His angle,length of abdominal esophagus,and diameters of abdominal esophagus at rest and during GR were measured.The absolute value of esophageal dilation was calculated.Pearson correlation analysis was used to assess the correlations of total duration and frequency of GR within 5 min with the absolute value of esophageal dilation.ROC curves were plotted to evaluate the efficacies of His angle and length of abdominal esophagus on diagnosing GR in children with chronic cough.Results In 82children,pathological GR developed in 49cases(59.76%),among whom 35children experienced GR once within 5min,12experienced GR twice,and 2experienced GR three times.The total duration of GR within 5min was 3to 5sin27children,6to 8sin 17,and>8sin 5.The absolute value of esophageal dilation was(6.83±2.20)mm.The His angle was greater in observation group[(62.69±7.04)°]than that in control group[(53.45±6.79)°](t=-6.058,P<0.001),the length of the abdominal esophagus was shorter in observation group[(1.97±0.28)cm]than that in control group[(2.16±0.39)cm](t=2.381,P=0.022),and there was no significant difference in the diameter of abdominal esophagus at rest between observation group[(7.16±1.22)mm]and control group[(7.14±1.06)mm](t=-0.072,P=0.943).In observation group,the total duration and frequency of GR within 5 min were positively correlated with the absolute value of esophageal dilation(r=0.468,P=0.002;r=0.333,P=0.027).When the optimal cut-offvalues of His angle and abdominal esophagus length were 55°and 1.95cm,the AUCs for diagnosing GR in children with chronic cough were 0.828(95%CI:0.741-0.915,P<0.001)and 0.633(95%CI:0.513-0.752,P=0.035),the sensitivities were 91.1%and 53.3%,and the specificities were 63.2%and 80.5%,respectively.Conclusions GR would increase the His angle and reduce the length of abdominal esophagus in children with chronic cough.The absolute value of esophageal dilation can reflect the degree of GR.The His angle has a high diagnostic value.