The value of gastric juice and peripheral blood total bile acids in the diagnosis of bile reflux gastritis in children
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摘要:
目的 探讨胃液及外周血总胆汁酸(TBA)在儿童胆汁反流性胃炎(BRG)中的表达及对诊断BRG的价值。 方法 回顾性分析2021年5月—2023年6月金华市妇幼保健院诊治的120例BRG患儿的临床资料，将BRG患儿设为BRG组，同期选取59例健康体检儿童作为健康对照组，对比胃液及外周血TBA。采用Kendall ' s tau-b法分析胃液及外周血TBA与BRG患儿临床特征的相关性。绘制受试者工作特征(ROC)曲线分析TBA诊断BRG的AUC值、灵敏度及特异度。 结果 BRG组胃液及外周血TBA分别为[(13.55±4.74)μmol/L、(11.24±3.04)μmol/L]，均高于健康对照组[(8.08±1.83)μmol/L、(7.71±2.05)μmol/L，P＜0.05]。不同幽门螺杆菌感染、肠化生、淋巴滤泡增生、胃小凹增生、黏膜浅层血管扩张的BRG患儿胃液、外周血TBA比较，差异均有统计学意义(P＜0.05)。Kendall ' s tau-b相关性分析显示，胃液及外周血TBA与幽门螺杆菌感染、肠化生、淋巴滤泡增生、胃小凹增生、黏膜浅层血管扩张、总胆汁反流内镜下分级呈正相关关系(P＜0.05)。ROC曲线分析显示，胃液及外周血TBA诊断BRG的AUC值分别为0.872、0.780；灵敏度分别为90.80%、50.00%；特异度分别为69.50%、96.60%。 结论 胃液及外周血TBA在BRG患儿中呈异常表达趋势，观察其表达有利于为临床诊断提供指导。 Abstract:Objective To investigate the expression of total bile acid (TBA) in gastric juice and peripheral blood in children with bile reflux gastritis (BRG) and its diagnostic value. Methods The clinical data of 120 children with BRG diagnosed and treated in Jinhua Maternal and Child Health Care Hospital from May 2021 to June 2023 were retrospectively analyzed. The BRG children were set as the observation group, and 59 healthy children were selected as the control group during the same period. The gastric fluid and peripheral blood TBA were compared. Kendall ' s tau-b method was used to analyze the correlation between gastric fluid and peripheral blood TBA and the clinical characteristics of BRG children. Receiver operating characteristic (ROC) curve was drawn to analyze the AUC value, sensitivity and specificity of TBA diagnosis of BRG. Results The TBA of gastric juice and peripheral blood in the observation group were [(13.55±4.74) μmol/L and (11.24±3.04) μmol/L], respectively, which were higher than those in the control group [(8.08±1.83) μmol/L and (7.71±2.05) μmol/L, P < 0.05]. There were statistically significant differences in TBA in gastric juice and peripheral blood among different Helicobacter pylori infection, intestinal metaplasia, lymphoid follicular hyperplasia, gastric fovea hyperplasia and mucosal superficial vasodilation (P < 0.05). Kendall ' s tau-b correlation analysis showed that gastric fluid and peripheral blood TBA were positively correlated with Helicobacter pylori infection, intestinal metaplasia, lymphofollicular hyperplasia, gastric fovea hyperplasia, mucosal superficial vasodilation, and total bile reflux (P < 0.05). ROC curve analysis showed that the AUC values of TBA in gastric juice and peripheral blood were 0.872 and 0.780, respectively. The sensitivity were 90.80% and 50.00%. The specificity were 69.50% and 96.60%. Conclusion The expression of TBA in gastric juice and peripheral blood is abnormal in BRG children, and the observation of its expression is helpful to provide guidance for clinical diagnosis. -
Key words:
- Bile reflux gastritis /
- Gastric juice /
- Peripheral blood /
- Total bile acid /
- Children
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图 1 胃液及外周血TBA诊断BRG的ROC曲线
Figure 1. ROC curve of gastric fluid and peripheral blood TBA in diagnosis of BRG
表 1 BRG组与健康对照组胃液及外周血TBA比较(x±s，μmol/L)
Table 1. Comparison of TBA in gastric juice and peripheral blood between the two groups(x±s, μmol/L)
组别 例数 胃液TBA 外周血TBA BRG组 120 13.55±4.74 11.24±3.04 健康对照组 59 8.08±1.83 7.71±2.05 t值 11.073 8.058 P值 < 0.001 < 0.001 
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表 2 不同临床特征BRG患儿胃液TBA比较(x±s，μmol/L)
Table 2. Comparison of gastric fluid TBA in BRG children with different clinical characteristics(x±s, μmol/L)
临床特征 例数 胃液TBA 统计量 P值 性别 0.022a 0.985 男 65 13.56±4.90 女 55 13.54±4.59 年龄 0.635a 0.526 ＞6岁 48 13.89±4.75 ≤6岁 72 13.32±4.74 幽门螺杆菌感染 8.194a ＜0.001 有 57 16.54±4.43 无 63 10.85±3.13 肠化生 5.538a ＜0.001 有 52 16.00±4.01 无 68 11.67±4.41 淋巴滤泡增生 4.195a ＜0.001 有 59 15.28±5.35 无 61 11.88±3.34 间质水肿 1.639a 0.104 有 52 14.36±5.24 无 68 12.93±4.26 胃小凹增生 4.057a ＜0.001 有 51 15.59±5.55 无 69 12.04±3.35 黏膜浅层血管扩张 4.220a ＜0.001 有 56 15.38±5.40 无 64 11.95±3.38 固有膜内平滑肌纤维增生 0.522a 0.602 有 48 13.27±5.41 无 72 13.74±4.27 总胆汁反流内镜下分级 73.143b 0.003 Ⅲ级 49 17.66±3.76 Ⅱ级 27 12.14±2.41 Ⅰ级 44 9.84±2.87 注：a为t值，b为F值。
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表 3 不同临床特征BRG患儿外周血TBA比较(x±s，μmol/L)
Table 3. Comparison of TBA in peripheral blood of BRG children with different clinical characteristics(x±s, μmol/L)
临床特征 例数 外周血TBA 统计量 P值 性别 0.428a 0.670 男 65 11.13±3.12 女 55 11.37±2.96 年龄 0.234a 0.816 ＞6岁 48 11.16±3.06 ≤6岁 72 11.29±3.05 幽门螺杆菌感染 7.364a ＜0.001 有 57 13.03±2.67 无 63 9.62±2.39 肠化生 5.791a ＜0.001 有 52 12.87±2.67 无 68 9.99±2.71 淋巴滤泡增生 2.622a 0.010 有 59 11.96±3.05 无 61 10.54±2.88 间质水肿 0.529a 0.598 有 52 11.40±3.07 无 68 11.11±3.04 胃小凹增生 3.383a 0.001 有 51 12.29±2.94 无 69 10.47±2.89 黏膜浅层血管扩张 3.184a 0.002 有 56 12.15±2.91 无 64 10.44±2.95 固有膜内平滑肌纤维增生 1.375a 0.172 有 48 11.71±2.95 无 72 10.93±3.08 总胆汁反流内镜下分级 14.822b ＜0.001 Ⅰ级 44 9.51±2.44 Ⅱ级 27 11.65±2.78 Ⅲ级 49 12.57±2.96 注：a为t值，b为F值。
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表 4 胃液及外周血TBA与BRG患儿临床特征的相关性分析
Table 4. Correlation analysis of clinical features of TBA in gastric juice and peripheral blood and BRG children
变量 胃液TBA 外周血TBA 幽门螺杆菌感染 肠化生 淋巴滤泡增生 胃小凹增生 黏膜浅层血管扩张 总胆汁反流内镜下分级 胃液TBA r值 0.033 0.545 0.446 0.240 0.247 0.245 0.690 P值 ＜0.001 ＜0.001 ＜0.001 0.001 0.001 0.001 ＜0.001 外周血TBA r值 0.333 0.478 0.403 0.191 0.217 0.212 0.360 P值 ＜0.001 ＜0.001 ＜0.001 0.011 0.004 0.005 ＜0.001 幽门螺杆菌感染 r值 0.545 0.478 0.886 0.233 0.229 0.214 0.766 P值 ＜0.001 ＜0.001 ＜0.001 0.011 0.013 0.020 ＜0.001 肠化生 r值 0.446 0.403 0.886 0.149 0.167 0.160 0.684 P值 ＜0.001 ＜0.001 ＜0.001 0.104 0.069 0.082 ＜0.001 淋巴滤泡增生 r值 0.240 0.191 0.233 0.149 0.706 0.751 0.280 P值 0.001 0.011 0.011 0.104 ＜0.001 ＜0.001 0.001 胃小凹增生 r值 0.247 0.217 0.299 0.167 0.706 0.784 0.273 P值 0.001 0.004 0.013 0.069 ＜0.001 ＜0.001 0.002 黏膜浅层血管扩张 r值 0.245 0.212 0.214 0.160 0.751 0.784 0.319 P值 0.001 0.005 0.020 0.082 ＜0.001 ＜0.001 ＜0.001 总胆汁反流内镜下分级 r值 0.690 0.360 0.766 0.684 0.280 0.273 0.319 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 0.001 0.002 ＜0.001
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表 5 胃液及外周血TBA诊断BRG的效能分析
Table 5. Efficacy analysis of TBA in diagnosing BRG in gastric juice and peripheral blood
检验结果变量 AUC SE P值 渐近95% CI cut-off值 约登指数 灵敏度 特异度 胃液TBA 0.872 0.028 ＜0.001 0.818~0.926 9.180 0.603 90.80 69.50 外周血TBA 0.780 0.036 ＜0.001 0.709~0.850 10.785 0.466 50.00 96.60
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