聚乙二醇电解质散与硫酸盐溶液在肠道准备及肠镜检查质量中的效果对比

Comparison of the effects of polyethylene glycol electrolyte powder and oral sulfate solution on bowel preparation and the quality of colonoscopy

摘要:

目的 评价聚乙二醇（polyethylene glycol，PEG）电解质散和复方口服硫酸盐溶液（oral sulphate solution，OSS）进行肠道准备的效果，并比较二者在肠镜检查质量方面的差异。方法 采用单中心、回顾性、横断面研究设计，收集2024年1月1日至12月31日期间在北京大学第一医院中心院区内镜中心接受结肠镜检查并使用上述两种清肠药物的患者资料。分析结肠清洁度评分、腺瘤检出率（adenoma detection rate，ADR）、无蒂锯齿状病变检出率（sessile serrated lesion detection rate，SSLDR）等质控指标，按年龄分层分析以上指标。二元逻辑回归分析影响肠道清洁度是否“优秀”的因素，并评价两组清肠方案的肠镜检查质量。结果 共纳入15 936例结肠镜检查者，PEG组13 321例，OSS组2 615例。波士顿肠道准备评分总分PEG组较OSS组高［8.00（7.00，8.00）比8.00（6.00，8.00），Z=-5.560，P<0.001］，在横结肠和降结肠差异显著；PEG组降结肠泡沫评分更高（Z=-2.589，P=0.010）。PEG、女性、下午检查、年龄小都是清洁度评分“优秀”的正相关因素。PEG组ADR［44.8%（5 965/13 321）比39.2%（1 024/2 615），P<0.001］、SSLDR［7.8%（1 035/13 321）比6.0%（157/2 615），P=0.002］均优于OSS组。年龄分层显示，>50岁和≤50岁者，清洁效果均以PEG方案更佳，ADR分别为54.0%（4 808/8 910）和31.0%（2 181/7 026），SSLDR分别为8.1%（721/8 910）和6.7%（471/7 026）；>50岁者PEG组隆起型息肉检出数更多。结论 两种清肠药物均能取得较高的结肠清洁度，但PEG方案在肠道清洁质量、ADR、SSLDR方面均优于OSS方案，尤其在>50岁及息肉高风险人群中优势更加明显。

Abstract:

Objective To compare the efficacy of polyethylene glycol (PEG) electrolyte powder versus oral sulfate solution (OSS) for bowel preparation and their impacts on colonoscopy quality. Methods This single-center, retrospective, cross-sectional study included patients who underwent colonoscopy with PEG or OSS at Endoscopy Center, central branch of Peking University First Hospital between January 1st and December 31st 2024. Indicators including bowel cleanliness score, adenoma detection rate (ADR), sessile serrated lesion detection rate (SSLDR) were analyzed, and age-stratified subgroup analysis were performed. Binary logistic regression analysis was performed to identify factors associated with excellent bowel cleanliness. The quality of colonoscopy under two bowel preparation regimens were evaluated. Results A total of 15 936 patients with 13 321 in the PEG group and 2 615 in the OSS group were included. The PEG group had higher overall Boston bowel preparation scale score [8.00 (7.00, 8.00) VS 8.00 (6.00, 8.00), Z=-5.560, P<0.001], especially in the transverse and descending colon, and higher foam scores in the descending colon (Z=-2.589, P=0.010). Use of PEG, female gender, afternoon examination, and younger age positively predicted excellent cleanliness. ADR [44.8% (5 965/13 321) VS 39.2% (1 024/2 615), P<0.001] and SSLDR [7.8% (1 035/13 321) VS 6.0% (157/2 615), P=0.002] were higher in the PEG group than those in the OSS group. Age stratification confirmed PEG''s superiority in both >50 and ≤50 age groups, with ADRs of 54.0% (4 808/8 910) and 31.0% (2 181/7 026), respectively, and SSLDRs of 8.1% (721/8 910) and 6.7% (471/7 026), respectively. For those >50 years old, the PEG group detected more elevated polyps. Conclusion While both regimens provide adequate bowel preparation, PEG regimen demonstrates superior cleansing quality, ADR, SSLDR, over OSS regimen, particularly in patients over 50 years old, and those with higher risk polyps.