糜蛋白酶在胃镜检查中的应用价值

目的探讨胃镜术前使用糜蛋白酶对提高胃镜视野清晰度及早期消化道病变的检出情况。方法选取2018年1月—12月常熟市第一人民医院消化科(苏州大学附属常熟医院)内镜中心收治的1942例行常规胃镜检查患者,男997例,女945例,年龄(51.3±11.5)岁,年龄范围为26~75岁,按照随机数表法将其随机分为二甲硅油散组(n=637)、二甲硅油散联合糜蛋白酶组(n=656)和二甲硅油散联合链霉蛋白酶组(n=649)。每组患者口服不同剂量的药物,比较三组患者胃镜视野清晰度和早期病变检出情况。结果二甲硅油散联合链霉蛋白酶组的胃镜视野清晰度88.6%(575/649)]优于二甲硅油散联合糜蛋白酶组81.9%(537/656)],两组均优于二甲硅油组58.9%(375/637)],差异有统计学意义(P<0.05)。与单用二甲硅油散组相比,二甲硅油散联合糜蛋白酶组和二甲硅油散联合链霉蛋白酶组在食管异型增生和早期食管癌的检出率比较,差异无统计学意义(P>0.05),二甲硅油散联合链霉蛋白酶组在上皮内瘤变7.6%(49/649)]和早期胃癌检出率2.3%(15/649)]方面高于二甲硅油散联合糜蛋白酶组6.4%(42/656)、1.5%(10/656)],差异有统计学意义(P<0.05);其余组间比较,差异无统计学意义(P>0.05)。三组患者均顺利完成胃镜检查,检查过程中无严重不良反应。结论在使用二甲硅油散基础上,胃镜术前口服糜蛋白酶不仅可以提高视野清晰度,还能提高早期胃癌和胃上皮内瘤变的检出率。

The value of chymotrypsin in gastroscopy

Objective To investigate the value of chymotrypsin in improving the visibility of gastroscope and the early detection of digestive tract lesions.Methods A retrospective study was performed on 1942 cases of patients who underwent routine gastroscopy from January to December 2018.There were 997 male and 945 female,aged(51.3±11.5)years old,ranging from 26 to 75 years old.Patients were randomly divided into the dimethicone powder group(n=637),dimethicone powder combined with chymotrypsin group(n=656)and dimethicone powder combined with streptomycin protease group(n=649).Patients in each group were given oral administration of different doses of drugs,and the visibility of gastroscope and the detection of early lesions in the three groups were compared.Results The gastroscopic clarity of dimethicone powder combined with streptomyces proteinase group88.6%(575/649)]was better than that of dimethicone powder combined with chymotrypsin group81.9%(537/656)],and the difference was statistically significant(P<0.05).Compared with use scattered groups of dimethicone powder,dimethicone powder joint chymotrypsin group joint pronase and dimethicone powder in the esophagus hyperplasia and early esophageal cancer detection rates,there was no statistically significant difference(P>0.05).The dimethicone powder combined pronase group in intraepithelial neoplasia7.6%(49/649)]and early gastric cancer detection rate2.3(15/649)]was higher than dimethicone powder loose joint chymotrypsin group6.4%(42/656)],1.5%(10/656)],(P<0.05).There was no significant difference between the other groups(P>0.05).All the patients in the three groups completed the gastroscopy without serious adverse reactions.Conclusion On the basis of dimethicone powder,oral chymotrypsin before gastroscopy can not only improve visual clarity,but also improve the detection rate of early gastric cancer and gastric intraepithelial neoplasia.