摘要
目的观察内痔患者结肠镜下肛齿线距离、痔核直径变化,探讨其对重度内痔的诊断价值。方法2021年11月—2023年11月上海健康医学院附属崇明医院诊治非急性发作期内痔患者3002例,其中Goligher分级Ⅳ度742例为重度组,Ⅰ~Ⅲ度2260例为非重度组。比较2组年龄、性别比例、体质量指数及便秘、便血、排便疼痛、肛门瘙痒比率。2组均行结肠镜检查,记录肛齿线距离、痔核直径。绘制ROC曲线,评估肛齿线距离、痔核直径对重度内痔的诊断效能。以肛齿线距离、痔核直径诊断重度内痔的最佳截断值为标准判定3002例患者重度内痔患病情况,以Goligher分级诊断结果为金标准,评估二者诊断重度内痔的效能。采用Kappa检验评估肛齿线距离、痔核直径及二者联合与Goligher分级诊断结果的一致性。结果(1)重度组肛齿线距离[(10.37±2.16)mm]、痔核直径[(18.75±2.05)mm]均大于非重度组[(6.81±2.13)、(12.72±2.97)mm](t=39.365,P<0.001;t=51.426,P<0.001),年龄、性别比例、体质量指数及便秘、便血、排便疼痛、肛门瘙痒比率与非重度组比较差异均无统计学意义(P>0.05)。(2)肛齿线距离、痔核直径分别以1.56、15.22 mm为最佳截断值,诊断重度内痔的AUC分别为0.705(95%CI:0.715~0.812,P<0.001)、0.826(95%CI:0.805~0.907,P<0.001);二者联合诊断重度内痔的AUC为0.922(95%CI:0.928~0.985,P<0.001),大于肛齿线距离、痔核直径单独检测(Z=11.457,P=0.002;Z=8.425,P=0.014)。(3)肛齿线距离(≥1.56 mm)诊断重度内痔1340例,痔核直径(≥15.22 mm)诊断重度内痔1266例,二者联合(肛齿线距离≥1.56 mm且痔核直径≥15.22 mm)诊断重度内痔861例。以Goligher分级诊断结果为金标准,肛齿线距离、痔核直径及二者联合诊断重度内痔的灵敏度分别为64.82%、67.11%、94.88%,特异度分别为62.00%、66.02%、93.05%,准确率分别为62.69%、66.02%、93.50%,阳性预测值分别为35.90%、39.34%、81.77%,阴性预测值分别为84.30%、85.94%、98.23%,与Goligher分级诊断一致性的Kappa值分别为0.422、0.468、0.834。二者联合诊断重度内痔的灵敏度、特异度、准确率、阳性预测值、阴性预测值及Kappa值均高于肛齿线距离(χ^(2)=11.966~43.737,P均<0.05)、痔核直径(χ^(2)=9.783~38.686,P均<0.05)单独诊断。结论重度内痔患者肛齿线距离、痔核直径增大,二者联合对重度内痔诊断具有较好价值,与临床诊断结果的一致性较好。
Objective To study the changes of anorectal-dentate line distance and hemorrhoidal core diameter in patients with internal hemorrhoids,and to investigate its value to the diagnosis of severe internal hemorrhoids.Methods Totally3002 patients with internal hemorrhoids in non-acute exacerbation stage were treated in Chongming Hospital Affiliated to Shanghai University of Medicine and of Health Sciences from November 2021 to November 2023,and were divided into742 patients with Goligher gradeⅣ(severe group),and 2260 patients with Goligher gradeⅠtoⅢ(non-severe group).The age,gender ratio,body mass index,and rates of constipation,blood in stool,painful defecation and anal itching were compared between two groups.Colonoscopy was performed in two groups,and the anorectal-dentate line distance and hemorrhoidal core diameters were recorded.ROC curves were plotted to assess the efficiencies of anorectal-dentate line distance and hemorrhoidal core diameter on the diagnosis of severe internal hemorrhoids.The optimal cut-off values of anorectal-dentate line distance and hemorrhoidal core diameter for severe internal hemorrhoids were used to diagnose the severe internal hemorrhoids in 3002 patients and the Goligher grade was used as the gold standard to evaluate the efficiency of anorectal-dentate line distance combined with hemorrhoidal core diameter for severe internal hemorrhoids.Kappa test was used to evaluate the consistencies of Goligher grade with anorectal-dentate line distance and hemorrhoidal core diameter single and in combination.Results(1)The anorectal-dentate line distance and hemorrhoidal core diameter were greater in severe group[(10.37±2.16),(18.75±2.05)mm]than those in non-severe group[(6.81±2.13),(12.72±2.97)mm](t=39.365,P<0.001;t=51.426,P<0.001),and there were no significant differences in the age,gender ratio,body mass index and the rates of constipation,blood in stool,defecation pain and anal itching between two groups(P>0.05).(2)With 1.56 and 15.22 mm as the optimal cut-off values of anorectal-dentate line distance and hemorrhoidal core diameter,the AUCs of them two single and in combination for diagnosing severe internal hemorrhoids were 0.705(95%CI:0.715-0.812,P<0.001),0.826(95%CI:0.805-0.907,P<0.001),and 0.922(95%CI:0.928-0.985,P<0.001),the AUC of combination was greater than that of single one(Z=11.457,P=0.002;Z=8.425,P=0.014).(3)Among 3002 patients,1340 patients with anorectal-dentate line distance≥1.56 mm and1266 with hemorrhoidal core diameter≥15.22 mm were diagnosed with severe internal hemorrhoids,and 861 patients with anorectal-dentate line distance≥1.56 mm and hemorrhoidal core diameter≥15.22 mm were diagnosed with severe internal hemorrhoids.Taking Goligher grade as the gold standard,the sensitivities of anorectal-dentate line distance,hemorrhoidal core diameter and their combination for diagnosing severe internal hemorrhoids were 64.82%,67.11%and94.88%,the specificities were 62.00%,66.02%and 93.05%,the accuracies were 62.69%,66.02%and 93.50%,the positive predictive values were 35.90%,39.34%and 81.77%,the negative predictive values were 84.30%,85.94%and98.23%,and the Kappa values with Goligher grade were 0.422,0.468 and 0.834,respectively.All the above values of combination were higher than those of anorectal-dentate line distance(χ^(2)=11.966-43.737,all P values<0.05)and hemorrhoidal core diameter(χ^(2)=9.783-38.686,all P values<0.05).Conclusion In patients with severe internal hemorrhoids,the anorectal-dentate line distance and hemorrhoidal core diameter increase,and the combination of them two has a high value to the diagnosis of severe internal hemorrhoids,with a good consistency with the clinical diagnosis.
作者
王萍
许俊
WANG Ping;XU Jun(Department of Gastroenterology,Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences,Shanghai202150,China)
出处
《中华实用诊断与治疗杂志》
2024年第11期1149-1153,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
上海市崇明区科学技术委员会课题项目(CKY2021-12)。
关键词
内痔
Goligher分级
肛齿线距离
痔核直径
严重程度
internal hemorrhoids
Goligher grade
anorectal-dentate line distance
hemorrhoidal core diameter
severity
