| 黄美华,陈千生,吴景强,等.老年潜在小肠出血患者血清尿素氮与肌酐校正比值对小肠镜检查进镜路径的影响[J].中国临床保健杂志,2026,29(2):211-215. |
| 老年潜在小肠出血患者血清尿素氮与肌酐校正比值对小肠镜检查进镜路径的影响 |
| Influence of corrected ratio of blood urea nitrogen to creatinine on the enteroscopy path of elderly patients with potential small intestinal bleeding |
| 投稿时间：2025-12-08 |
| DOI：10.3969/J.issn.1672-6790.2026.02.013 |
| 中文关键词: 胃肠出血 内窥镜检查,胃肠道 血尿素氮 肌酐 老年人 |
| 英文关键词: Gastrointestinal hemorrhage Endoscopy,gastrointestinal Blood urea nitrogen Creatinine Aged Fund program:Science and Technology Plan Project of Longyan City,Fujian Province |
| 基金项目:福建省龙岩市科技计划项目 |
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| 中文摘要: |
| 目的 探究老年潜在小肠出血患者血清尿素氮(BUN)与肌酐(Cr)校正比值对小肠镜检查进镜路径的影响。方法 采用前瞻性研究。纳入2021年5月至2023年5月福建医科大学附属龙岩第一医院收治的188例老年潜在小肠出血患者,均进行小肠镜经口或(和)经肛进镜检查；另选取同期收治的中青年(＜60岁)潜在小肠出血患者180例作为对照组。对比老年组与中青年组患者的临床资料差异,包括年龄、性别、症状、血红蛋白、BUN、Cr及BUN/Cr比值等指标；同时统计小肠镜检查的进镜路径类型(单侧经口进镜、单侧经肛进镜、双侧进镜)及病变检出率。将明确出血部位患者根据小肠出血部位分为近端组与远端组,对比两组BUN/Cr比值,采用受试者操作特征(ROC)曲线分析BUN/Cr比值对小肠出血部位诊断的最佳截断值,以截断值(BUN/Cr＞85.46)为分界值,将188例患者分为比值偏大组(96例)与比值正常组(92例),比较两组患者小肠镜不同进镜路径病变检出率。结果 188例老年潜在小肠出血患者中经小肠镜检查明确病因142例,病变检出率75.53%(142/188)。单侧经口进镜97例,明确病因83例,病变检出率85.57%(83/97)；单侧经肛进镜57例,明确病因41例,病变检出率71.93%(41/57)；双侧进镜34例,明确病因18例,通过经口检查明确病因11例,经肛检查明确病因7例,病变检出率52.94%(18/34),单侧经口进镜检出率显著高于双侧进镜(P<0.05)；中青年组血红蛋白、Cr显著高于老年组(P<0.05),而BUN、BUN/Cr均显著低于老年组(均P<0.05)；近端组BUN、BUN/Cr显著高于远端组(P<0.05)；BUN、BUN/Cr临界值分别为5.59 mmol/L、85.46时,其预测远端出血的AUC分别为0.869、0.891,灵敏度分别为82.35%、86.76%,特异度分别为79.73%、83.78%,以BUN/Cr临界值85.46作为分界点时,约登指数最大为0.705,将BUN/Cr＞85.46定义为比值偏大组,BUN/Cr≤85.46定义为比值正常组；比值偏大组BUN、BUN/Cr显著高于比值正常组(P<0.05),憩室发生率显著低于比值正常组(P<0.05)；以明确病因的142例患者为分析对象,比值偏大组经口进镜病变检出率及总病变检出率显著高于比值正常组(P＜0.05),而两组经肛进镜检出率差异无统计学意义(P＞0.05)。结论 血清BUN/Cr比值在老年潜在小肠出血患者中显著高于中青年患者。血清BUN/Cr比值增高提示,经口进镜路径病变检出率更高,可作为老年患者小肠镜检查进镜路径的参考指标。 |
| 英文摘要: |
| Objective To explore the influence of corrected ratio of blood urea nitrogen (BUN) to creatinine (Cr) on the enteroscopy path of elderly patients with potential small intestinal bleeding.Methods Adopting a prospective study,188 elderly patients with potential small intestinal bleeding from Longyan First Hospital Affiliated to Fujian Medical University were enrolled from May 2021 to May 2023.All patients underwent enteroscopy through mouth or(and) anus.An additional 180 young and middle-aged patients with potential small intestinal bleeding (age<60 years old) admitted during the same period were selected as control group.The differences in clinical data between the elderly group and the young group were compared,including age,gender,symptoms,hemoglobin,BUN,Cr and BUN/Cr ratio.The types of enteroscopy paths (unilateral oral enteroscopy,unilateral anal enteroscopy,bilateral enteroscopy) and lesion detection rate of enteroscopy in the two groups were statistically analyzed.142 patients with definite bleeding sites were divided into proximal group and distal group according to the site of small intestinal bleeding.The BUN/Cr ratio of the two groups was compared.Receiver operating characteristic (ROC) curve was used to analyze the optimal cut-off value of BUN/Cr ratio for the diagnosis of small intestinal bleeding site.Taking the cut-off value(BUN/Cr＞85.46) as dividing line,188 patients were divided into high ratio group (n=96) and normal ratio group (n=92).The clinical data of the two groups and the detection rate of lesions in different enteroscopy paths were compared.Results Among 188 elderly patients with potential small intestinal bleeding,142 cases were confirmed by enteroscopy,and the detection rate of lesions was 75.53% (142/188).There were 97 cases of unilateral oral endoscopy,including 83 cases of clear etiology,and the detection rate of lesions was 85.57% (83/97).There were 57 cases of unilateral transanal endoscopy,including 41 cases of clear etiology,and the detection rate of lesions was 71.93% (41/57).There were 34 cases of bilateral endoscope,18 cases of clear etiology,11 cases of clear etiology through oral examination,7 cases of clear etiology through anal examination,and the detection rate of lesions was 52.94% (18/34).The detection rate of unilateral oral endoscopy was significantly higher than that of bilateral endoscopy (P<0.05).The young group showed significantly higher hemoglobin and Cr levels than the elderly group (P<0.05),and also showed significantly lower BUN and BUN/Cr levels (P<0.05).BUN and BUN/Cr in proximal group were significantly higher than those in distal group (P<0.05).When the cut-off values of BUN and BUN/Cr were 5.59 mmol/L and 85.46,the AUCs for predicting distal bleeding were 0.869 and 0.891,and the sensitivities were 82.35% and 86.76%,and the specificities were 79.73% and 83.78% respectively.When the cut-off value of BUN/Cr (85.46) was taken as the dividing line,the maximum Youden index was 0.705.BUN/Cr>85.46 was defined as high ratio group,and BUN/Cr≤85.46 was defined as normal ratio group.The BUN and BUN/Cr in high ratio group were significantly higher than those in normal ratio group (P<0.05) while the diverticulum rate was significantly lower than that in normal ratio group (P<0.05).In an analysis of 142 patients with clear etiology,the detection rate of transoral lesions and detection rate of total lesions in high ratio group were significantly higher than those in normal ratio group (P<0.05),but there was no statistical difference in the detection rate of transanal lesions between the two groups (P>0.05).Conclusions Serum BUN/Cr ratio is significantly higher in elderly patients with potential small intestinal bleeding than that in young patients.An elevated ratio suggests a higher detection rate via the oral enteroscopy route and may serve as a reference indicator for selecting the enteroscopy path in elderly patients. |
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