摘要
目的评价食管高分辨测压与钡餐造影在系统性硬化症(SSc)患者中的应用价值,并探讨食管运动障碍与患者临床参数的相关性。方法选择2016年1月至2019年12月海南医学院第一附属医院风湿免疫科收治并采用2013 ACR/EULAR分类标准诊断的28例SSc患者为病例组,选择在消化科就诊,有食管相关症状的15例非SSc患者为对照组。所有患者在短时间内先后进行食管钡餐及食管高分辨测压检查。以2013ACR/EULAR分类标准为诊断SSc金标准,利用ROC曲线以及线性加权weighted kappa系数比较食管高分辨测压与钡餐造影诊断SSc的一致性。通过独立样本t检验比较两组患者食管高分辨率测压参数的差异。通过Spearman双变量线性相关检验探讨病例组患者食管运动障碍与临床参数的相关性。结果食管高分辨测压与食管钡餐诊断方法ROC曲线下面积(AUC)分别为0.870、0.686,差异有统计学意义(P<0.05);诊断SSc食管受累,测压法敏感性为75.00%,特异性为93.33%,钡餐法敏感性71.00%,特异性为53.33%;食管高分辨测压诊断方法与金标准诊断结果较一致,weighted kappa系数为0.20(P<0.05),钡餐法诊断与金标准诊断结果不一致,weighted kappa系数为0.18(P>0.05);病例组患者的食管下扩约肌长度、食管收缩前沿速度以及食管远端收缩积分分别为(2.50±0.72)cm、(1.96±0.44)cm/s、(1067.21±43.83)mmHg·s·cm,明显低于对照组的(3.51±0.29)cm、(3.81±0.36)cm/s、(1680.93±45.66)mmHg·s·cm,差异均有统计学意义(P<0.05);病例组患者中,食管运动障碍与抗拓扑异构酶抗体(抗Scl-70)阳性及年龄有线性相关(r=0.577、0.465,P<0.05),与发病年限、性别、抗核抗体(ANA)等临床参数无相关性(P>0.05)。结论食管高分辨率测压与食管钡餐均可用于SSc患者消化道受累的诊断与评估,但测压法优于钡餐法,临床可依据所依托医院的技术特点开展相应检查;食管下扩约肌长度可用于SSc食管受累的诊断与
Objective To evaluate the value of high-resolution esophageal manometry and barium meal examination in patients with systemic sclerosis(SSc),and to analyze the correlation between esophageal motility disorder and clinical data.Methods From January 2016 to December 2019,28 patients with SSc who were diagnosed by 2013 ACR/EULAR classification standard were selected as the case group,and 15 cases of non-SSc patients with esophageal related symptoms were selected as the control group.All patients underwent esophageal barium meal and esophageal high-resolution manometry in a short time.Using the 2013 ACR/EULAR classification standard as the gold standard for the diagnosis of SSc,ROC curve and linear weighted Kappa coefficient were used to compare the consistency of esophageal high-resolution manometry and barium meal radiography in the diagnosis of SSc.The differences of esophageal high-resolution manometry parameters between the two groups were compared by independent sample t-test.Spearman bivariate linear correlation test was used to explore the correlation between esophageal dyskinesia and clinical parameters.Results The area under ROC curve(AUC)of esophageal high-resolution manometry and esophageal barium meal diagnosis were 0.870 and 0.686,respectively,and the difference was statistically significant(P<0.05).The sensitivity and specificity of manometry and barium meal examination were 75.00%and 93.33%,71.00%and 53.33%,respectively.The results of high-resolution manometry were consistent with gold standard.The weighted Kappa coefficient was 0.20(P<0.05).The results of barium meal and gold standard were not consistent.The weighted Kappa coefficient was 0.18(P>0.05).The length of the lower esophageal dilator,the front velocity of esophageal contraction and the distal esophageal contraction integral of the case group were(2.50±0.72)cm,(1.96±0.44)cm/s,(1067.21±43.83)mmHg·s·cm,respectively,which were significantly lower than corresponding(3.51±0.29)cm,(3.81±0.36)cm/s and(1680.93±45.66)mmHg·s·cm of the contro
作者
叶凤
郭峰
许闽广
王华南
王敏
郑颜萍
李国铨
YE Feng;GUO Feng;XU Min-guang;WANG Hua-nan;WANG Min;ZHENG Yan-ping;LI Guo-quan(Department of Rheumatology and Immunology,the First Affiliated Hospital of Hainan Medical University,Haikou 570100,Hainan,CHINA;Department of Physiology,Hainan Medical University,Haikou 570100,Hainan,CHINA)
出处
《海南医学》
CAS
2020年第21期2761-2764,共4页
Hainan Medical Journal
基金
海南省卫生计生行业科研项目(编号:16A200109)。
关键词
系统性硬化症
食管高分辨率测压
食管钡餐
食管下扩约肌长度
食管收缩前沿速度
诊断一致性
Systemic sclerosis(SSc)
High-resolution manometry of esophagus
Barium meal of esophagus
Length of inferior esophageal dilator
Eesophageal contraction front velocity
Diagnostic consistency
