摘要目的 评价磁共振小肠造影(MRE)及放射性核素异位胃黏膜显像(EGMI)检查在儿童下消化道出血中的诊断价值.方法 收集2014年2月至2016年4月安徽省儿童医院普外科收治的因下消化道出血行手术探查的54例患儿临床资料,包括性别、年龄、出血量、术前最低血红蛋白(Hb)水平.根据手术探查结果分为病变组和非病变组.病变组为手术和术后病理结果证实为梅克尔憩室(MD)或小肠重复畸形患儿,共36例,其中男25例,女11例;年龄(2.86±1.59)岁.非病变组为手术探查结果为阴性或虽存在病变但非MD或小肠重复畸形,共18例,其中男14例,女4例;年龄(3.87±1.62)岁.待患儿出血基本停止后行MRE和EGMI检查,检查前禁食、禁水4～6 h.采用SPSS 13.0软件进行统计学处理.EGMI、MRE及二者联合检查对MD或小肠重复畸形的诊断意义通过受试者工作特征曲线(ROC)进行评价,依据Youden指数最大原则获得最佳诊断界值,并计算此时的灵敏度与特异度,P<0.05为差异有统计学意义.结果 2组患儿性别差异无统计学意义(x2=0.415,P>0.05),而年龄、出血量和术前最低Hb水平差异均有统计学意义(t=2.179、2.027、2.222,均P<0.05).2组患儿EGMI和MRE结果判定分级比较差异均有统计学意义(x2=15.226、29.121,均P<0.01).EGMI和MRE对肠道发育畸形诊断的最佳界值均>3级,即将可能阳性和肯定阳性归为阳性结果.依据上述界值,EGMI单独、MRE单独、二者串联、二者并联诊断的曲线下面积(AUC)值依次为0.809、0.917、0.750、0.847,敏感度依次为61.1%、75.0%、55.6%、80.6%,特异度依次为90.4%、94.4%、94.4%、88.9%,Youden指数依次为0.515、0.694、0.500、0.695.年龄和术前最低Hb值诊断的最佳界值分别为2.92岁和80 g/L,二者诊断的AUC值分别为0.761和0.672,Youden指数分别为0.515和0.333.EGMI、MRE与年龄的AUC值进行两两比较,差异均有统计学意义(均P<0.05).结论 MRE联合EGMI在儿童下消化道出血中具有较高的诊断价值,且MRE作为单独诊断手段同样值得临床应用.

abstractsObjective To evaluate the diagnostic value of magnetic resonance enterography(MRE)and ectopic gastric mucosa imaging(EGMI)in children with lower gastrointestinal hemorrhage.Methods The clinical data including gender,age,amount of bleeding and preoperative minimum hemoglobin(Hb)levels of 54 children with lower gastrointestinal hemorrhage were collected,who received surgical exploration in Department of Pediatric Surgery,Anhui Provincial Children's Hospital between February 2014 and April 2016.Children were divided into lesion group and non-lesion group according to the findings of surgical exploration.Lesion group were defined as children with Meckel's diverticulum(MD)or duplication of the small intestine by surgery and postoperative pathological findings.A total of 36 cases,25 cases of boys,11 cases of girls,aged(2.86±1.59)years old.Non-lesion group were defined as children,who underwent operation with negative result or with lesions but not MD or duplication of the small intestine.A total of 18 cases,14 cases of boys,4 cases of girls,aged(3.87±1.62)years old.MRE and EGMI were performed when the children stopped bleeding,before the inspection,should fasting for 4-6 h.SPSS 13.0 software was used for statistical processing.The evaluation of EGMI,MRE and the both in diagnosing MD or duplication of the small intestine were conducted by receiver operating characteristic curve(ROC).According to the principles of biggest gain best diagnostic value by Youden index,and the degree of sensitivity and specificity was calculated at this time,P<0.05 for the difference was statistically significant.Results There was no significant differences statistically in gender between 2 groups(x2=0.415,P>0.05).There were statistically significant differences in age,amount of bleeding and preoperative minimum hemoglobin levels(t=2.179,2.027,2.222,all P<0.05).There were statistically significant differences in classification comparison by EGMI and MRE between 2 groups(x2=15.226,29.121,all P<0.01).The optimal cut-off value of EGMI and MRE in the diagnosis of enteric malformation was more than level 3,and the suspected positive and being positive value was assigned as positive results.According to the cut-off value above,EGMI,MRE and EGMI plus MRE in series and in parallel in the diagnosis of enteric malformation,the areas under curves(AUC)were 0.809,0.917,0.750 and 0.847,respectively.The sensitivity was 61.1％,75.0％,55.6％and 80.6％,respectively.The specificity was 90.4％,94.4％,94.4％and 88.9％,respectively.The Youden's indexes were 0.515,0.694,0.500 and 0.695,respectively.The optimal cut-off value of age and preoperative minimum hemoglobin levels in the diagnosis of enteric malformation were 2.92 years and 80 g/L,respectively.The AUC was 0.761 and 0.672.The Youden's indexes were 0.515 and 0.333.There was no significant differences statistically in AUC compared with age,MRE and EGMI(all P<0.05).Conclusions The high diagnostic value in children with lower gastrointestinal hemorrhage is found by using MRE and EGMI.Then,MRE as a separate diagnosis method is also worthy of clinical application.