探究超声结合血清胃泌素17（G-17）、胃蛋白酶对胃食管反流病（GERD）的诊断价值。

回顾性分析延安大学附属医院2022年3月至2024年3月收治的402例GERD患者的临床资料，纳入观察组，另选取130例同期健康体检者作为对照组。根据观察组患者24 h食管pH监测检查结果分为非糜烂性反流病组（n=228）和反流性食管炎组（n=174），所有受试者均行超声检查，收集所有受试者超声检查参数[胃贲门角（His）角、腹段食管长度]和血清G-17、胃蛋白酶等指标水平；比较不同组别受试者间各指标差异；绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC）评估超声多参数结合G-17、胃蛋白酶对GERD的诊断价值。

反流性食管炎组His角大于非糜烂性反流病组、对照组，非糜烂性反流病组His角大于对照组，腹段食管长度短于非糜烂性反流病组、对照组，非糜烂性反流病组腹段食管长度短于对照组，差异均有统计学意义（P<0.05）。反流性食管炎组G-17、胃蛋白酶高于非糜烂性反流病组、对照组，非糜烂性反流病组高于对照组，差异均有统计学意义（P<0.05）。His角、腹段食管长度、G-17、胃蛋白酶诊断GERD的AUC分别为0.602、0.590、0.581、0.567，对GERD均有诊断价值（P<0.05）。根据Youden指数计算cutoff，His角、腹段食管长度、G-17、胃蛋白酶分别为95.32°、2.50 cm、5.56 pmol/L、25.50 ng/mL，其中联合诊断价值最优，灵敏度及特异度分别为76.3%和84.6%。单因素和多因素Logistic回归分析显示，His角<95.32°、腹段食管长度≥2.50 cm、G-17<5.56 pmol/L、胃蛋白酶<25.50 ng/mL是GERD的保护因素（P<0.05）。

超声检测His角和腹段食管长度结合血清G-17、胃蛋白酶在一定程度上可以提高对GERD的检出率，多指标联合为临床患者诊断及预后评估提供更可靠的参考依据。

To explore the diagnostic value of ultrasound combined with serum gastrin 17 (G-17) and pepsin for gastroesophageal reflux diseases (GERD).

A retrospective analysis was conducted on the clinical data of 402 patients with GERD admitted to Yan'an University Affiliated Hospital from March 2022 to March 2024, they were included in the observation group, and another 130 healthy individuals who underwent physical examinations during the same period were selected as the control group. According to the 24-hour esophageal pH monitoring examination results of the patients in the observation group, they were divided into the non-erosive reflux disease group (n=228) and the reflux esophagitis group (n=174), all subjects underwent ultrasound examination, and the ultrasound examination parameters [gastric cardia (His) angle, abdominal esophageal length] and the levels of indicators such as serum G-17 and pepsin of all subjects were collected; the differences of each index among subjects in different groups were compared; the receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was calculated to evaluate the diagnostic value of multiple ultrasound parameters combined with G-17 and pepsin for gastroesophageal reflux diseases.

The His angle in the reflux esophagitis group was larger than that in the non-erosive reflux disease group and the control group, the His angle in the non-erosive reflux disease group was larger than that in the control group, the length of the abdominal esophagus in the reflux esophagitis group was shorter than that in the non-erosive reflux disease group and the control group, the length of the abdominal esophagus in the non-erosive reflux disease group was shorter than that in the control group, with statistically significant differences (P<0.05). The levels of G-17 and pepsin in the reflux esophagitis group were higher than those in the non-erosive reflux disease group and the control group, the non-erosive reflux disease group was higher than the control group, with statistically significant differences (P<0.05). The AUC of His angle, abdominal esophageal length, G-17 and pepsin in the diagnosis of gastroesophageal reflux disease was 0.602, 0.590, 0.581 and 0.567 respectively, all of which had diagnostic value for gastroesophageal reflux disease (P<0.05). The cutoff was calculated based on the Youden index principle, the His angle, abdominal esophageal length, G-17, and pepsin were 95.32°, 2.50 cm, 5.56 pmol/L, and 25.50 ng/ml, respectively, among them, the combined diagnostic value was the best, and the corresponding sensitivity and specificity were 76.3% and 84.6%, respectively. The results of univariate and multivariate Logistic regression analyses showed that His angle<95.32°, abdominal esophageal length≥2.50 cm, G-17<5.56 pmol/L, and pepsin<25.50 ng/ml were protective factors for gastroesophageal reflux disease (P<0.05).

Ultrasound detection of the His angle and the length of the abdominal esophagus combined with serum G-17 and pepsin can improve the detection rate of gastroesophageal reflux disease to a certain extent, the combination of multiple indicators provides a more reliable reference basis for the diagnosis and prognosis evaluation of clinical patients.