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中华临床医师杂志(电子版) ›› 2020, Vol. 14 ›› Issue (09) : 685 -689. doi: 10.3877/cma.j.issn.1674-0785.2020.09.004

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临床研究

质子泵抑制剂对老年人磁控胶囊胃镜图像质量的影响
李嘉欣1, 李丽1, 王艳君1, 刘梅林1, 焦红梅1,()   
  1. 1. 100034 北京大学第一医院老年病内科
  • 收稿日期:2020-03-27 出版日期:2020-09-15
  • 通信作者: 焦红梅
  • 基金资助:
    中国医院整合联盟爱胃科研基金(AHLW201803)

Effect of proton pump inhibitors on image quality of magnetically controlled capsule endoscopy in elderly patients

Jiaxin Li1, Li Li1, Yanjun Wang1, Meilin Liu1, Hongmei Jiao1,()   

  1. 1. Department of Geriatrics, Peking University First Hospital, Beijing 100034, China
  • Received:2020-03-27 Published:2020-09-15
  • Corresponding author: Hongmei Jiao
  • About author:
    Corresponding author: Jiao Hongmei, Email:
引用本文:

李嘉欣, 李丽, 王艳君, 刘梅林, 焦红梅. 质子泵抑制剂对老年人磁控胶囊胃镜图像质量的影响[J/OL]. 中华临床医师杂志(电子版), 2020, 14(09): 685-689.

Jiaxin Li, Li Li, Yanjun Wang, Meilin Liu, Hongmei Jiao. Effect of proton pump inhibitors on image quality of magnetically controlled capsule endoscopy in elderly patients[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2020, 14(09): 685-689.

目的

探讨应用质子泵抑制剂对老年人磁控胶囊胃镜(MCE)图像质量的影响。

方法

回顾性分析2018年1月至2019年4月北京大学第一医院接受MCE检查的老年患者(≥60岁)临床资料,根据是否应用质子泵抑制剂分为2组,比较2组的胃视野清洁度、黏膜可视度、疾病检出率及不良反应事件情况。采用Mann-Whitney U检验比较MCE胃视野清洁度和黏膜可视度积分的组间差异,采用χ2检验或Fisher精确检验比较2组患者疾病检出率的差异。

结果

共纳入93例患者[男性70例,中位年龄75.0(60~93)岁],未应用质子泵抑制剂组(N组)54例;应用质子泵抑制剂组(P组)39例。N组胃总体视野清洁度评分高于P组[22.0(6.0,23.0)分vs 19.5(11.0,23.0)分],差异具有统计学意义(Z=-3.186,P<0.001)。N组胃总体黏膜可视度评分高于P组[18.0(6.0,18.0)分vs 17.0(11.0,18.0)分],差异具有统计学意义(Z=-2.158,P=0.031)。N组患者的整体胃视野好于P组,尤其是胃底、胃体部视野更清晰。N组和P组胃部病变总检出率比较(57.4% vs 51.3%),差异无统计学意义(χ2=0.343,P=0.558)。2组均未发生不良反应及胶囊滞留。

结论

对于老年人群,应用质子泵抑制剂虽会影响MCE视野,但不影响病变检出率,MCE对老年人群是安全的检查选择。

Objective

To evaluate the effect of proton pump inhibitors (PPI) on cleanliness and visibility during magnetically controlled capsule endoscopy (MCE) in elderly patients.

Methods

Patients (≥60 years) who underwent MCE from January 2018 to April 2019 at Peking University First Hospital were included. They were divided into two groups based on PPI use or not before MCE. The quality of gastric preparation was assessed by cleanliness and visualization scores in six regions (cardia, fundus, body, angularis, antrum, and pylorus). Information on cleanliness and visualization scores, adverse events, and examination outcomes of MCE was collected and compared between the two groups. Cleanliness and visualization scores were compared using Mann-Whitney U test. Chi-square test or Fisher exact test was used for comparison of examination outcomes.

Results

Ninety-three patients (70 males; median age, 75.0 years; age range, 60-93 years) were included and divided into either group N (without PPI, n=54) or group P (with PPI, n=39). The total cleanliness score in group N was higher than that of group P [22.0 (6.0, 23.0) vs 19.5 (11.0, 23.0), Z=-3.186, P<0.001]. The total visualization score in group N was also higher than that of group P [18.0 (6.0, 18.0) vs 17.0 (11.0, 18.0), Z=-2.158, P=0.031]. Gastric preparation of group N was better than that of group P, especially at the fundus and body of the stomach. The rates of positive findings were 57.4% (31/54) and 51.3% (20/39) in groups N and P, respectively (χ2=0.343, P=0.558). No patients experienced capsule lodgment in the gastrointestinal tract. No adverse event was observed during the examination.

Conclusion

In elderly patients, PPI use appears to decrease the image quality of MCE. However, it does not affect examination outcomes. Current study suggests that MCE is overall a safe examination in the elderly.

表1 行磁控胶囊胃镜检查的老年患者一般情况
表2 2组行磁控胶囊胃镜检查的老年患者胃视野清洁度评分比较[分,中位数(最小值,最大值)]
图1 P组及N组胃底清晰度比较 图a为P组胃底"雾霾状"表现;图b为N组胃底清晰表现;N组为未应用质子泵抑制剂组,P组为应用质子泵抑制剂组
图2 胃远端(胃窦)与胃近端(胃底)清洁度及黏膜可视度评分比较
表3 2组行磁控胶囊胃镜检查的老年患者胃黏膜可视度评分比较[分,中位数(最小值,最大值)]
表4 2组行磁控胶囊胃镜检查的老年患者病变检出率比较[例(%)]
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