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不明原因消化道出血胶囊内镜漏诊的原因分析

(2014-10-22 12:22:39)

    【摘要】
        目的 探讨不明原因消化道出血(OGIB)胶囊内镜的漏诊原因。
        方法 对133例OGIB患者进行回顾性研究,包括确诊组104例和漏诊组29例,收集两组患者的人口学特征、疾病特征和胶囊内镜特征等方面进行统计,统计内容具体包括患者年龄、性别、是否具有基础疾病,胶囊运行时间、图像质量,导泻剂类型,发病病程,血红蛋白浓度,病变部位及病变类型共10项,计量资料采用t检验,计数资料采用卡方检验,采用单因素及多因素logistic回归对相关性进行分析。
        结果 两组平均年龄比较差异有统计学意义(t=2.095,P=0.038),血红蛋白浓度比较差异有统计学意义(t=2.143,P=0.034),病变类型构成比较差异有统计学意义(χ2=20.222,P<0.001),病变部位分布比较差异有统计学意义(χ2=33.732,P<0.001),图像质量好差构成比较差异有统计学意义(χ2=9.219,P=0.002),导泻剂类型构成比差异有统计学意义(χ2=6.999,P=0.024)。病变类型和病变部位分别进行卡方分割合并后再次行四格表的卡方检验显示,憩室病在两组间的构成差异具有统计学意义(χ2=22.233,P<0.001),末端回肠及回盲部病变对胶囊内镜诊断结果的影响具有统计学意义(χ2=24.412,P<0.001)。单因素logsitic回归分析显示,年龄增大有利于确诊(OR=1.024,P=0.041),而血红蛋白浓度升高(OR=0.982,P=0.036)、末端回肠及回盲部病变(OR=0.110,P<0.001)、憩室病(OR=0.102,P<0.001)、磷酸钠盐的使用(OR=0.367,P=0.027)、图像质量差(OR=0.258,P=0.004)均增加了漏诊风险。多因素logistic回归分析显示,导泻剂类型(P=0.05)及血红蛋白浓度(P=0.394)无统计学意义,年龄增加(OR=1.031,P=0.032)减少漏诊风险,而末端回肠及回盲部病变(OR=0.145,P=0.001)、憩室病(OR=0.118,P=0.001)、图像质量差(OR=0.245,P=0.016)是胶囊内镜漏诊的相关因素。
        结论 患者年龄、病变类型、病变部位、图像质量对胶囊内镜诊断结果具有较大影响,存在憩室病、末端回肠及回盲部病变、图像质量差的患者漏诊风险较大。
    【关键词】胶囊内窥镜;不明原因消化道出血


    【Abstract】
    Objective   To analyze the risk factors for false negative diagnosis of obscure gastrointestinal bleeding (OGIB) by capsule endoscopy.
    Methods   A total of 133 OGIB inpatients, 104 in true positive group and 29 in false negative group, were reviewed. The features of demography, diseases and capsule endoscopy were collected and then analyzed, which included 10 variables like age, sex, time of bleeding, diseases accompanied, type and location of the disease,hemoglobin concentration, transit time of CE, quality of CE pictures and type of purgative agents. All data were analyzed with t test, and all the enumeration data were analyzed with chi square test. Logistic regression was used to analyze the correlation between the factors and results of diagnosis.
    Results   Age (t=2.095, P=0.038), concentration of hemoglobin (t=2.143, P=0.034), type (χ2=20.222, P<0.001) and location (χ2=33.732, P<0.001) of the diseases, image quality of the CE (χ2=9.219, P=0.002) and the type of purgative agents (χ2=6.999, P=0.024) were found to have statistical differences between the two groups. Chi-square and partition Chi-square test revealed the occurrence of diverticulosis and lesion location, i.e. lower ileum and ileumcecum, were of statistical difference between the two groups (χ2=22.233, P<0.001 and χ2=24.412, P<0.001). Univariate logistic regression showed diverticulosis (OR=0.102, P<0.001), lower bowel diseases (OR=0.110, P<0.001), poor quality of CE pictures (OR=0.258, P=0.004) and the use of sodium phosphate agent (OR=0.367, P=0.027) were risk factors for false negative diagnosis, while older age facilitated diagnosis (OR=1.024, P=0.041). However, multivariate logistic regression showed no statistic significance in type of purgative agent (P=0.05) or the concentration of hemoglobin (P=0.394). Furthermore, elder age facilitated positive diagnosis (OR=1.031, P=0.032), while diverticulosis (OR=0.118, P=0.001), lower bowel diseases (OR=0.145, P=0.001) and poor quality of CE pictures (OR=0.245, P=0.016) were correlated with higher probability of false negative diagnosis.
    Conclusion   Age, disease type, disease location and image quality exert great influence on CE diagnosis. Diverticulosis, lower location of the diseases and poor CE image quality are risk factors for false negative diagnosis.
    【Key words】Capsule endoscopes;Obscure gastrointestinal bleeding                        

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个人资料
    智发朝 单位:南方医科大学附属南方医院
    所属科室:
    出生:1972-03-17
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