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Article(id=1322934562967401078, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322934544927687233, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202407055, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1720886400000, receivedDateStr=2024-07-14, revisedDate=1722787200000, revisedDateStr=2024-08-05, acceptedDate=null, acceptedDateStr=null, onlineDate=1793341778747, onlineDateStr=2026-10-30, pubDate=1739548800000, pubDateStr=2025-02-15, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793341778747, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793341778747, creator=13701087609, updateTime=1793341778747, updator=13701087609, issue=Issue{id=1322934544927687233, tenantId=1146029695717560320, journalId=1319373162502258839, year='2025', volume='47', issue='3', pageStart='193', pageEnd='284', issueExtLink='null', onlineDate='null', pubDate='1739548800000', pubDateStr='2025-02-15', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793341774446, creator='13701087609', updateTime=1793341774446, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=255, endPage=261, ext={EN=ArticleExt(id=1322934563198087800, articleId=1322934562967401078, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Efficacy of 2 L versus 3 L polyethylene glycol in bowel preparation: a real-world study, columnId=1320435174995772212, journalTitle=Journal of Army Medical University, columnName=Clinical Medicine, runingTitle=null, highlight=null, articleAbstract=
Objective‍

‍To compare the efficacy of 2 L and 3 L polyethylene glycol (PEG) electrolyte solution for bowel preparation in a real-world setting.

Methods

A real-world, single-center cohort study was conducted on the individuals undergoing colonoscopy in Department of Gastroenterology of Chengdu Third People's Hospital between May and October 2023. Based on our inclusion and exclusion criteria, they were given 2 L (n=4 684) and 3 L (n=3 700) PEG electrolyte solution for bowel preparation. The primary outcome indicator was the adequacy of bowel preparation by Boston bowel preparation score (BBPS). Secondary outcome indicators included the BBPS score, polyp detection rate (PDR), tolerability, compliance, and incidence of adverse events.

Results

‍The adequacy rate of bowel preparation was 94.35% in the 3 L group, significantly higher than that of the 2 L group (91.29%, P<0.001). The 3 L group obtained a higher BBPS score then the 2 L group (6.92±1.06 vs 6.81±1.14, P<0.001). But there was no statistical difference in the PDR between the 2 groups (P=0.073). And the rate of PEG completion (P=0.810), administration of low residue diet as required (P=0.094) or use of dimethicone (P=0.072) were comparable between the 2 groups. However, the incidences of vomiting (4.5% vs 3.2%, P=0.002), abdominal discomfort (5.0% vs 3.9%, P=0.011) and sleep disturbance (18.0% vs 14.6%, P<0.001) were obviously higher in the 3 L group than the 2 L group.

Conclusion

In a real-world setting, 2 L PEG is a considerably safe and effective regimen for bowel preparation.

, authors=Jiaojun LI1, 2, Xianhao TAN2, 3, Chen ZHANG2, Yifeng LIU2, Lin JIANG2, Xiaobin SUN2, Jing SHAN2, authorsList=Jiaojun LI, Xianhao TAN, Chen ZHANG, Yifeng LIU, Lin JIANG, Xiaobin SUN, Jing SHAN, authorCompany=null, correspAuthors=Jing SHAN, authorNote=null, correspAuthorsNote=null, copyrightStatement=© 2025 Journal of Army Medical University, copyrightOwner=Editorial Office of Journal of Army Medical University, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322934563906925181, articleId=1322934562967401078, tenantId=1146029695717560320, journalId=1319373162502258839, language=CN, title=在真实世界中使用2 L和3 L聚乙二醇电解质溶液进行肠道准备的效果比较, columnId=1322185541475488183, journalTitle=陆军军医大学学报, columnName=临床医学, runingTitle=null, highlight=null, articleAbstract=
目的

比较在真实世界中2 L及3 L聚乙二醇电解质溶液（polyethylene glycol，PEG）的肠道准备效果。

方法

本研究为真实世界环境中单中心的队列研究，研究对象为2023年5-10月在成都市第三人民医院消化内科接受结肠镜检查并使用2 L或3 L PEG进行肠道准备的患者。根据纳排标准，3 L 组共纳入3 700 例，2 L 组共纳入4 684 例。主要结果指标是根据波士顿肠道准备评分（Boston bowel preparation score，BBPS）计算的肠道准备充分率；次要结果包括BBPS分数、息肉检出率（polyp detection rate，PDR）、耐受性、依从性和不良反应。

结果

3 L组的肠道准备充分率为94.35%，高于2 L 组的91.29%（P<0.001）；BBPS总分为（6.92±1.06）分，高于2 L 组的（6.81±1.14）分（P<0.001）。2组的PDR无统计学差异（P=0.073）。2组患者PEG完成率（P=0.810）、按要求进行低渣饮食（P=0.094）及服用二甲硅油（P=0.072）差异均无统计学意义。3 L组的呕吐率（4.5% vs 3.2%，P=0.002）、腹部不适率（5.0% vs 3.9%，P=0.011）和睡眠障碍率（18.0% vs 14.6%，P<0.001）高于2 L组。

结论

在真实世界，2 L PEG是一种安全有效的肠道准备方案。

, authors=李蕉君1, 2, 谭贤豪2, 3, 张宸2, 刘一锋2, 姜琳2, 孙晓滨2, 单晶2, authorsList=李蕉君, 谭贤豪, 张宸, 刘一锋, 姜琳, 孙晓滨, 单晶, authorCompany=null, correspAuthors=单晶, authorNote=null, correspAuthorsNote=
‍单晶，E-mail：
SHAN Jing，E-mail：
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Endoscopy，2017，49（4）：378-397., articleTitle=Performance measures for lower gastrointestinal endoscopy：a European Society of Gastrointestinal Endoscopy （ESGE） quality improvement initiative, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322934564150194814, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, xref=1, ext=[AuthorCompanyExt(id=1322934564158583423, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, companyId=1322934564150194814, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1School of Clinical Medicine，North Sichuan Medical College，Nanchong，Sichuan), AuthorCompanyExt(id=1322934564166972032, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, companyId=1322934564150194814, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1川北医学院临床医学院，四川 南充)]), AuthorCompany(id=1322934565806944898, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, xref=2, ext=[AuthorCompanyExt(id=1322934565832110723, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, companyId=1322934565806944898, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Gastroenterology，Chengdu Third People’s Hospital，Chengdu，Sichuan), AuthorCompanyExt(id=1322934565840499332, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, companyId=1322934565806944898, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2成都市第三人民医院消化内科，四川 成都)]), AuthorCompany(id=1322934565907608197, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, xref=3, ext=[AuthorCompanyExt(id=1322934565915996806, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, companyId=1322934565907608197, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3College of Clinical Medicine，Southwest Medical University，Luzhou，Sichuan，China), AuthorCompanyExt(id=1322934565941162631, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, companyId=1322934565907608197, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3西南医科大学临床医学院，四川 泸州)])], figs=[ArticleFig(id=1322934572081623740, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, language=EN, label=null, caption=null, figureFileSmall=kLqC8Yj4TqjKlSXBHCMd6A==, figureFileBig=MVgWxQN60i2fdjit0wOlag==, tableContent=null), ArticleFig(id=1322934572249395901, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, language=CN, label=图1, caption=2 L 组年龄的ROC曲线, figureFileSmall=kLqC8Yj4TqjKlSXBHCMd6A==, figureFileBig=MVgWxQN60i2fdjit0wOlag==, tableContent=null), ArticleFig(id=1322934572475888319, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
指标2 L PEG组（n=4 684）3 L PEG组（n=3 700）t/χ2P
年龄/岁53.02±14.2754.41±14.16-4.458<0.001
BMI/（kg/m2）23.18±3.3623.14±3.400.4820.630
男性2 241（47.84）1 703（46.03）2.7390.098
低渣饮食4 221（90.12）3 374（91.19）2.7960.094
服用二甲硅油4 226（90.22）3 291（88.95）3.2390.072
方案完成率/%0.4220.810
0~<503（0.06）2（0.05）
50~<7522（0.47）21（0.57）
75~1004 659（99.47）3 677（99.38）
一级亲属患有结直肠癌311（6.64）209（5.65）3.4890.062
第一次肠镜检查2 909（62.11）2 107（56.95）22.892<0.001
BMI>25 kg/m21 242（26.52）967（26.14）0.1540.694
腹部手术史968（20.67）673（18.19）8.0560.005
糖尿病216（4.61）159（4.30）0.4770.490
肝硬化6（0.13）14（0.38）5.4410.020
帕金森1（0.02）5（0.14）0.094a
便秘18（0.38）26（0.70）4.0150.045
肢体活动障碍3（0.06）4（0.11）0.707 a
服用三环类抗抑郁药史3（0.06）4（0.11）0.707 a
肠道准备不充分低风险人群2 108（45.00）1 710（46.22）1.2020.273
), ArticleFig(id=1322934572622688960, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, language=CN, label=表1, caption=

不同剂量 PEG 研究人群人口特征的比较［例（%），x¯±s］

, figureFileSmall=null, figureFileBig=null, tableContent=
指标2 L PEG组（n=4 684）3 L PEG组（n=3 700）t/χ2P
年龄/岁53.02±14.2754.41±14.16-4.458<0.001
BMI/（kg/m2）23.18±3.3623.14±3.400.4820.630
男性2 241（47.84）1 703（46.03）2.7390.098
低渣饮食4 221（90.12）3 374（91.19）2.7960.094
服用二甲硅油4 226（90.22）3 291（88.95）3.2390.072
方案完成率/%0.4220.810
0~<503（0.06）2（0.05）
50~<7522（0.47）21（0.57）
75~1004 659（99.47）3 677（99.38）
一级亲属患有结直肠癌311（6.64）209（5.65）3.4890.062
第一次肠镜检查2 909（62.11）2 107（56.95）22.892<0.001
BMI>25 kg/m21 242（26.52）967（26.14）0.1540.694
腹部手术史968（20.67）673（18.19）8.0560.005
糖尿病216（4.61）159（4.30）0.4770.490
肝硬化6（0.13）14（0.38）5.4410.020
帕金森1（0.02）5（0.14）0.094a
便秘18（0.38）26（0.70）4.0150.045
肢体活动障碍3（0.06）4（0.11）0.707 a
服用三环类抗抑郁药史3（0.06）4（0.11）0.707 a
肠道准备不充分低风险人群2 108（45.00）1 710（46.22）1.2020.273
), ArticleFig(id=1322934572714963649, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
指标2 L PEG组（n=4 684）3 L PEG组（n=3 700）t/χ2P
肠道准备充分率/%91.2994.3528.425<0.001
息肉检出率/%45.4947.463.2070.073
BBPS分数/分
总分
右侧结肠
横结肠
左侧结肠		6.81±1.146.92±1.06-4.785<0.001
2.11±0.512.13±0.47-2.4660.014
2.52±0.552.56±0.52-3.514<0.001
2.19±0.482.23±0.47-4.201<0.001
进入时间/ min6.03±7.595.99±7.510.2390.811
退出时间/ min8.14±9.728.50±8.38-1.7770.076
), ArticleFig(id=1322934572870152898, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, language=CN, label=表2, caption=

不同剂量 PEG 肠道准备效果的比较（x¯±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
指标2 L PEG组（n=4 684）3 L PEG组（n=3 700）t/χ2P
肠道准备充分率/%91.2994.3528.425<0.001
息肉检出率/%45.4947.463.2070.073
BBPS分数/分
总分
右侧结肠
横结肠
左侧结肠		6.81±1.146.92±1.06-4.785<0.001
2.11±0.512.13±0.47-2.4660.014
2.52±0.552.56±0.52-3.514<0.001
2.19±0.482.23±0.47-4.201<0.001
进入时间/ min6.03±7.595.99±7.510.2390.811
退出时间/ min8.14±9.728.50±8.38-1.7770.076
), ArticleFig(id=1322934572995982020, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别恶心呕吐腹部不适睡眠障碍其他不适
2 L PEG （n=4 684）549（11.7）148（3.2）181（3.9）685（14.6）140（3.0）
3 L PEG （n=3 700）457（12.4）165（4.5）185（5.0）667（18.0）124（3.4）
χ20.7789.7176.38717.1590.890
P0.3780.0020.011<0.0010.345
), ArticleFig(id=1322934574724035270, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, language=CN, label=表3, caption=

不同剂量 PEG 不良反应及耐受性的比较［例（%）］

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组别恶心呕吐腹部不适睡眠障碍其他不适
2 L PEG （n=4 684）549（11.7）148（3.2）181（3.9）685（14.6）140（3.0）
3 L PEG （n=3 700）457（12.4）165（4.5）185（5.0）667（18.0）124（3.4）
χ20.7789.7176.38717.1590.890
P0.3780.0020.011<0.0010.345
), ArticleFig(id=1322934574820504264, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
变量单因素分析多因素分析
OR （95%CI）POR （95%CI）P
性别（0=女性，1=男性）1.520（1.238~1.867）<0.0010.683（0.555~0.683）<0.001
糖尿病0.508（0.346~0.747）0.0010.594（0.402~0.879）0.009
BMI>25 kg/m20.949（0.756~1.192）0.654
年龄（>60岁）1.733（1.408~2.134）<0.0010.622（0.502~0.769）<0.001
腹部手术史0.644（0.512~0.809）<0.0010.700（0.554~0.884）0.003
服用三环类抗抑郁药史0.047（0.004~0.525）0.0130.043（0.004~0.476）0.010
低渣饮食0.765（0.560~1.047）0.094
服用二甲硅油0.795（0.579~1.093）0.158
一级亲属患有结直肠癌0.627（0.385~1.021）0.061
第一次肠镜检查0.841（0.684~1.034）0.101
肝硬化0.476（0.056~4.088）0.499
肢体活动障碍0.190（0.017~2.105）0.176
帕金森-1.000
), ArticleFig(id=1322934574908584649, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, language=CN, label=表4, caption=

2 L PEG 肠道准备不合格风险因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量单因素分析多因素分析
OR （95%CI）POR （95%CI）P
性别（0=女性，1=男性）1.520（1.238~1.867）<0.0010.683（0.555~0.683）<0.001
糖尿病0.508（0.346~0.747）0.0010.594（0.402~0.879）0.009
BMI>25 kg/m20.949（0.756~1.192）0.654
年龄（>60岁）1.733（1.408~2.134）<0.0010.622（0.502~0.769）<0.001
腹部手术史0.644（0.512~0.809）<0.0010.700（0.554~0.884）0.003
服用三环类抗抑郁药史0.047（0.004~0.525）0.0130.043（0.004~0.476）0.010
低渣饮食0.765（0.560~1.047）0.094
服用二甲硅油0.795（0.579~1.093）0.158
一级亲属患有结直肠癌0.627（0.385~1.021）0.061
第一次肠镜检查0.841（0.684~1.034）0.101
肝硬化0.476（0.056~4.088）0.499
肢体活动障碍0.190（0.017~2.105）0.176
帕金森-1.000
), ArticleFig(id=1322934574975693514, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
变量单因素分析多因素分析
OR （95%CI）POR （95%CI）P
性别（0=女性，1=男性）1.766（1.330~2.346）<0.0010.606（0.453~0.810）0.001
糖尿病0.392（0.240~0.640）<0.0010.430（0.262~0.705）0.001
BMI>25 kg/m20.719（0.533~0.970）0.0310.815（0.600~1.107）0.190
年龄（>60 岁）1.282（0.962~1.708）0.090
腹部手术史1.197（0.817~1.753）0.355
服用三环类抗抑郁药史-0.999
低渣饮食1.167（0.732~1.859）0.516
服用二甲硅油1.114（0.724~1.715）0.622
一级亲属患有结直肠癌1.350（0.682~2.674）0.389
第一次肠镜检查0.920（0.693~1.222）0.567
肝硬化0.357（0.079~1.606）0.179
肢体活动障碍-0.999
帕金森0.239（0.027~2.144）0.201
), ArticleFig(id=1322934575063773899, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934562967401078, language=CN, label=表5, caption=

3 L PEG 肠道准备不合格风险因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量单因素分析多因素分析
OR （95%CI）POR （95%CI）P
性别（0=女性，1=男性）1.766（1.330~2.346）<0.0010.606（0.453~0.810）0.001
糖尿病0.392（0.240~0.640）<0.0010.430（0.262~0.705）0.001
BMI>25 kg/m20.719（0.533~0.970）0.0310.815（0.600~1.107）0.190
年龄（>60 岁）1.282（0.962~1.708）0.090
腹部手术史1.197（0.817~1.753）0.355
服用三环类抗抑郁药史-0.999
低渣饮食1.167（0.732~1.859）0.516
服用二甲硅油1.114（0.724~1.715）0.622
一级亲属患有结直肠癌1.350（0.682~2.674）0.389
第一次肠镜检查0.920（0.693~1.222）0.567
肝硬化0.357（0.079~1.606）0.179
肢体活动障碍-0.999
帕金森0.239（0.027~2.144）0.201
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在真实世界中使用2 L和3 L聚乙二醇电解质溶液进行肠道准备的效果比较
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李蕉君 1, 2 , 谭贤豪 2, 3 , 张宸 2 , 刘一锋 2 , 姜琳 2 , 孙晓滨 2 , 单晶 2
陆军军医大学学报 | 临床医学 2025,47(3): 255-261
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陆军军医大学学报 |临床医学 2025 , 47 (3) : 255 -261
在真实世界中使用2 L和3 L聚乙二醇电解质溶液进行肠道准备的效果比较
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李蕉君1, 2, 谭贤豪2, 3, 张宸2, 刘一锋2, 姜琳2, 孙晓滨2, 单晶2
作者信息
  • 1川北医学院临床医学院，四川 南充
  • 2成都市第三人民医院消化内科，四川 成都
  • 3西南医科大学临床医学院，四川 泸州
通讯作者:
‍单晶，E-mail：
SHAN Jing，E-mail：
Efficacy of 2 L versus 3 L polyethylene glycol in bowel preparation: a real-world study
Jiaojun LI1, 2, Xianhao TAN2, 3, Chen ZHANG2, Yifeng LIU2, Lin JIANG2, Xiaobin SUN2, Jing SHAN2
Affiliations
  • 1School of Clinical Medicine，North Sichuan Medical College，Nanchong，Sichuan
  • 2Department of Gastroenterology，Chengdu Third People’s Hospital，Chengdu，Sichuan
  • 3College of Clinical Medicine，Southwest Medical University，Luzhou，Sichuan，China
出版时间: 2025-02-15 doi: 10.16016/j.2097-0927.202407055
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摘要
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目的

比较在真实世界中2 L及3 L聚乙二醇电解质溶液（polyethylene glycol，PEG）的肠道准备效果。

方法

本研究为真实世界环境中单中心的队列研究，研究对象为2023年5-10月在成都市第三人民医院消化内科接受结肠镜检查并使用2 L或3 L PEG进行肠道准备的患者。根据纳排标准，3 L 组共纳入3 700 例，2 L 组共纳入4 684 例。主要结果指标是根据波士顿肠道准备评分（Boston bowel preparation score，BBPS）计算的肠道准备充分率；次要结果包括BBPS分数、息肉检出率（polyp detection rate，PDR）、耐受性、依从性和不良反应。

结果

3 L组的肠道准备充分率为94.35%，高于2 L 组的91.29%（P<0.001）；BBPS总分为（6.92±1.06）分，高于2 L 组的（6.81±1.14）分（P<0.001）。2组的PDR无统计学差异（P=0.073）。2组患者PEG完成率（P=0.810）、按要求进行低渣饮食（P=0.094）及服用二甲硅油（P=0.072）差异均无统计学意义。3 L组的呕吐率（4.5% vs 3.2%，P=0.002）、腹部不适率（5.0% vs 3.9%，P=0.011）和睡眠障碍率（18.0% vs 14.6%，P<0.001）高于2 L组。

结论

在真实世界，2 L PEG是一种安全有效的肠道准备方案。

聚乙二醇电解质溶液  /  肠道准备  /  比较效益研究  /  真实世界
Objective‍

‍To compare the efficacy of 2 L and 3 L polyethylene glycol (PEG) electrolyte solution for bowel preparation in a real-world setting.

Methods

A real-world, single-center cohort study was conducted on the individuals undergoing colonoscopy in Department of Gastroenterology of Chengdu Third People's Hospital between May and October 2023. Based on our inclusion and exclusion criteria, they were given 2 L (n=4 684) and 3 L (n=3 700) PEG electrolyte solution for bowel preparation. The primary outcome indicator was the adequacy of bowel preparation by Boston bowel preparation score (BBPS). Secondary outcome indicators included the BBPS score, polyp detection rate (PDR), tolerability, compliance, and incidence of adverse events.

Results

‍The adequacy rate of bowel preparation was 94.35% in the 3 L group, significantly higher than that of the 2 L group (91.29%, P<0.001). The 3 L group obtained a higher BBPS score then the 2 L group (6.92±1.06 vs 6.81±1.14, P<0.001). But there was no statistical difference in the PDR between the 2 groups (P=0.073). And the rate of PEG completion (P=0.810), administration of low residue diet as required (P=0.094) or use of dimethicone (P=0.072) were comparable between the 2 groups. However, the incidences of vomiting (4.5% vs 3.2%, P=0.002), abdominal discomfort (5.0% vs 3.9%, P=0.011) and sleep disturbance (18.0% vs 14.6%, P<0.001) were obviously higher in the 3 L group than the 2 L group.

Conclusion

In a real-world setting, 2 L PEG is a considerably safe and effective regimen for bowel preparation.

‍polyethylene glycol  /  bowel preparation  /  comparative effectiveness research  /  real world
李蕉君, 谭贤豪, 张宸, 刘一锋, 姜琳, 孙晓滨, 单晶. 在真实世界中使用2 L和3 L聚乙二醇电解质溶液进行肠道准备的效果比较. 陆军军医大学学报, 2025 , 47 (3) : 255 -261 . DOI: 10.16016/j.2097-0927.202407055
Jiaojun LI, Xianhao TAN, Chen ZHANG, Yifeng LIU, Lin JIANG, Xiaobin SUN, Jing SHAN. Efficacy of 2 L versus 3 L polyethylene glycol in bowel preparation: a real-world study[J]. Journal of Army Medical University, 2025 , 47 (3) : 255 -261 . DOI: 10.16016/j.2097-0927.202407055
正文
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结直肠癌（colorectal cancer，CRC）在我国的发病率和死亡率呈上升趋势，2020年新诊断的CRC病例占全球新发病例总数的28.8%（555 477/1 931 590），CRC相关死亡占全球CRC相关死亡总数的30.6%（286 162/935 173）［1］，疾病负担较前显著加重［2］。
结肠镜检查是筛查、诊断和治疗结直肠病变的主要方法，可降低 CRC 的发病率和死亡率。肠道准备的质量对结肠镜检查的成功起着关键作用。充分的肠道准备可在肠镜检查过程中提供清晰的视野，进而有助于缩短检查时间、提高息肉检出率（polyp detection rate，PDR）并确保治疗的安全性和有效性［3］。
聚乙二醇电解质溶液（polyethylene glycol，PEG）是世界公认的主要肠道准备清洁剂［2-5］，因其安全、有效的特性而被推荐为一线肠道准备药物。在欧洲和美国，4 L PEG 的高剂量方案因疗效显著而被推荐使用。针对我国人群的指南推荐使用2~3 L PEG的低剂量方案［5］。目前，共识建议对没有肠道准备不良风险因素的低风险人群使用2 L方案［6］ 。
既往比较2 L及3 L PEG方案的研究受到样本量小、患者选择偏倚和同一研究中肠道准备方案异质性的限制［7-8］。然而，在真实世界未经选择的人群中，2 L和3 L PEG方案孰优孰劣，目前还缺乏相关的比较研究。本研究比较了在真实世界中2 L和3 L PEG方案对非选择患者肠道准备的效果和耐受性，并提供了大量样本，为临床决策提供了重要的真实世界数据。
1　对象与方法
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1.1　研究人群
本研究是在四川省成都市第三人民医院消化内科进行的真实世界环境中的队列研究。肠道准备方案由医生和患者共同决定，所有患者行肠道准备及肠镜检查前由本人签署肠镜检查知情同意书。本研究纳入了2023年5-10月接受结肠镜检查并使用2 L或3 L PEG进行肠道准备的患者，根据患者选择的肠道准备方案，将患者分为2 L组及3 L组。纳入标准：①年龄≥18岁；②肠镜到达盲肠且波士顿肠道准备评分（Boston bowel preparation score，BBPS）完整的结肠镜检查；③使用2 L或3 L PEG进行肠道准备；④因常规体检及长期腹泻等其他原因行肠镜检查者。排除标准：①患者身高、体质量等信息不完整；②有肠道手术史的病例；③有严重心、肺疾病等情况不能或不愿行肠道准备及肠镜检查者。本研究共纳入患者8 384 例，其中2 L组4 684例，3 L组3 700例。本研究经成都市第三人民医院医学伦理审查委员会审查批准［成都三院伦（2024）S-52号］。
1.2　研究方法
所有计划接受结肠镜检查的患者建议低渣饮食，并在手术前24 h内避免食用肉、蔬菜和水果。本研究为每位患者提供了详细的书面和口头肠道准备教育，包括有关PEG服用方案信息说明以及其他细节（例如服用肠道清洁剂的过程中若有不适应该如何处理等）。2组患者均在肠镜检查前1 d晚上8点开始服用1 L PEG溶液［聚乙二醇电解质粉（Ⅰ），每袋含有3种成分：A组份包括0.74 g氯化钾和1.68 g碳酸氢钠，B组份包括1.46 g氯化钠和5.68 g硫酸钠，C组份包括 60.00 g聚乙二醇4000（商品名：恒康正清）］，首次服用600 mL，之后每10~15分钟服用200 mL，直至服完。服药后患者可来回走动，顺时针轻揉小腹，帮助肠道蠕动，直至开始排便。2 L组上午（8-12点）行结肠镜检查者在当天上午5点服用剩余的1 L PEG溶液，下午（中午12点以后）行结肠镜检查者在当天上午9点服用剩余的1 L PEG溶液，服用方法同前。3 L 组上午行结肠镜检查者在当天上午4-6点间服用剩余的2 L PEG 溶液，下午行结肠镜检查者在当天上午9-11点之间服用剩余的2 L PEG 溶液，首次服用800 mL，之后每10~15分钟服用200 mL，直至服完。患者在服用完规定的全部PEG溶液后，在结肠镜检查前，要求服用100 mL水稀释的二甲硅油散1瓶（2.50 g∶0.15 g，江西恒康药业有限公司）。结肠镜检查在患者服用完最后一剂 PEG 溶液后3~4 h内进行。
结肠镜检查前后，由1名专业护士进行问卷调查，以收集患者的身高、体质量、年龄、病史及不良反应等信息。结肠镜检查由经验丰富的内镜医师进行，每位内镜医师每年均要进行500例以上的结肠镜检查。本研究采用了单盲法设计（内镜医师不清楚患者的分组情况），内镜医师在检查过程中实时对患者的肠道准备情况进行评价，并记录有无发现肠道息肉等信息。
1.3　相关指标的测定及疗效判定
1.3.1　主要结果
主要结果是根据BBPS评分计算所得肠道准备充分率。BBPS评分通过评价患者肠道黏膜表面的清洁程度，将肠道分为盲肠和升结肠、横结肠、直肠和乙状结肠3个部分，每个部分分别进行评分，评分为0~3分。如果肠道内有无法清除的固体大便，黏膜无法看清，则评分为0分；如果肠道内有一部分可以显示清楚，但另一部分因为粪便和不透明的液体残留而显示不清楚，则评分为1分；如果肠道内有少量的小块粪便和不透明的液体残留，但黏膜显示清楚，则评分为2分；而如果所有黏膜显示非常清楚，结肠内没有任何的粪便和不透明的液体残留，则评分为3分。BBPS总分为上述3部分评分总和，总分为9分，评分越高，说明肠道的准备越好。BBPS评分由结肠镜医师在结肠镜检查过程中实时评估。肠道准备充分被定义为BBPS总分≥6分，且每部分得分≥2分。每组患者BBPS评分≥6分占该组患者总人数的比例即为该组的肠道准备充分率。
1.3.2　次要结果
①BBPS 分数，包括总分、左侧结肠、横结肠和右侧结肠的评分；②PDR，指一组中息肉检出的患者数与该组总患者数的比例；息肉定义为肠黏膜表面突出的异常生长的组织，无论大小及数量；③患者的耐受性和依从性，指PEG的服用完成率、是否按说明进行服用PEG、是否遵守低渣饮食的要求以及是否服用二甲硅油；④服用PEG后的不良反应，如恶心、呕吐、腹部不适、睡眠障碍及其他不适（头痛、发热）。护士在结肠镜检查前后使用调查问卷记录患者的耐受性、依从性和不良反应等信息。⑤进入时间，指肠镜前端从进入肛门到达盲肠的时间。⑥退出时间，指肠镜前端开始从盲肠向外退出，到完全退出肛门的时间。
1.4　统计学分析
用SPSS 22.0软件进行统计学处理。性别、不良反应等计数资料采用例（%）表示。计数资料采用χ2或Fisher精确检验进行评估。计量资料采用x¯±s表示，组间比较采用独立样本t检验分析。采用单变量Logistics回归分析研究肠道准备不充分的风险因素后，再进行多变量Logistics回归分析以进一步分析。采用受试者操作特征曲线（receiver operating characteristic curve，ROC）来确定阈值。P<0.05表示差异具有统计学意义。
2　结果
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2.1　人口统计资料和基线特征
表1列出了研究人群的基线特征。2组方案的患者的BMI（P =0.630）及性别（P =0.098）差异无统计学差异；3 L组患者年龄较2 L组大（P<0.001）。在比较2组肠道准备不充分高风险因素中，2 L组中有腹部手术史的患者比例高于3 L组（P=0.005）；3 L组中有肝硬化（P=0.020）、便秘（P=0.045）的患者的比例高于2 L组。2 L及3 L组肠道准备不充分低风险人群比例分别为45.00%及46.22%（P=0.273）。
2.2　肠道准备效果
与2 L组相比，3 L组的肠道准备充分率更高（P<0.001），BBPS分数总分（P<0.001）、右侧结肠评分（P=0.014）、横结肠评分（P<0.001）和左侧结肠评分（P<0.001）均显著升高。然而，2 L组（45.49%）和3 L组（47.46%）的PDR（P=0.073）、肠镜到达盲肠的时间（P=0.811）和退出肛门时间（P=0.076）差异均无统计学意义，见表2。
2.3　不良反应、患者耐受性及依从性
3 L组的呕吐发生率（4.5% vs 3.2%，P=0.002）、腹部不适率（5.0% vs 3.9%，P=0.011）和睡眠障碍率（18.0% vs 14.6%，P<0.001）明显高于2 L组；2组间恶心（P=0.378）和其他不适（P=0.345）的发生率无明显差异。在患者依从性方面，2组患者间低渣饮食（P=0.094）及服用二甲基硅油（P=0.072）的差异无统计学意义。在患者耐受性方面，2组患者间PEG完成率无明显差异（P=0.810），见表1、3。
2.4　肠道准备不足的风险因素
本研究进行了单变量和多变量Logistics回归分析，以评估2组的肠道准备不足的风险因素。在2 L组中，肠道准备不充分的风险因素包括年龄>60岁（OR：0.662，95%CI：0.502~0.769）、男性（OR：0.683，95%CI：0.555~0.683）、糖尿病（OR：0.594，95%CI：0.402~0.879）、服用三环类抗抑郁药史（OR：0.043，95%CI：0.004~0.476）和腹部手术史（OR：0.700，95%CI：0.554~0.884），见表 4。而在 3 L组中，肠道准备不足与男性（OR：0.606，95%CI：0.453~0.810）和糖尿病（OR：0.430，95%CI：0.262~0.705）有关（表 5）。根据最大约登指数，2 L组年龄的ROC曲线分析截断值为56.5岁（图 1）。
3　讨论
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3.1　研究主要结果
本研究显示，3 L PEG的肠道准备充分率显著高于2 L PEG；此外，3 L PEG的BBPS总分也显著高于2 L PEG，表明在提高肠道准备充分率方面，3 L PEG方案更为有效。尽管3 L PEG组的肠道准备充分率更高，但2组的PDR差异并无统计学意义，这表明两种方案在肠道病变检出方面效果相当。同时，3 L PEG在呕吐、腹部不适和睡眠障碍的发生率上均高于2 L PEG，这可能影响患者的耐受性和依从性。通过单变量和多变量Logistics回归分析，本研究发现，2 L和3 L PEG方案在肠道准备不充分的风险因素上存在差异。对于2 L PEG，风险因素包括年龄>60岁、男性、糖尿病等；而对于3 L PEG，主要风险因素为男性和糖尿病。
3.2　肠道准备充分率分析
本研究通过大量样本，在真实世界环境中比较使用2 L和3 L PEG在我国人群中进行肠道准备的效果。由于个体体型的原因，西方国家很少进行2 L和3 L PEG的比较研究，相关研究主要在亚洲进行。来自我国南方和台湾地区的2项研究表明，3 L PEG在肠道准备方面优于2 L PEG，与本研究结果相同［7-8］。然而，在研究方法上，这些研究均使用了随机对照试验（randomized controlled trial，RCT）的研究方法［9］。由于严格的纳入和排除标准，RCT通常被认为是评估干预效果的“金标准”。然而，正是由于其严格的纳入及排除标准，导致其可能无法完全反映真实世界临床环境的复杂性。相比之下，本研究是基于真实世界的研究方法［10］，具有更广泛的纳入标准，通过纳入更多的样本和真实世界的设计为临床实践中的非选择性患者提供了更具普遍性和可靠性的研究结果。本研究中的2组患者在人口特征上存在差异，如3 L PEG组患者的年龄更高，2 L PEG组中第一次结肠镜检查的患者比例更高。不过，由于现实世界中患者的多样性，这种差异在所难免，较大的样本量可减少对主要结果的影响。
最近的一项研究表明，分剂量方案的使用和充分的患者指导可使肠道准备合格率高达98%［11］。此外，另一项研究表明，高依从性可能会提高肠道准备的充分率［12］。本研究能获得较高的肠道准备充分率，考虑与充分的患者教育及高依从性相关。
3.3　肠道准备不充分的风险因素分析
2023年我国《结肠镜检查肠道准备专家共识意见》指出了导致肠道准备不合格的风险因素，包括患有糖尿病、BMI>25 kg/m2、年龄>70岁等［6］。然而，这些结论并非绝对，考虑到各种不同的肠道准备方案，其情况则更为复杂。本研究表明，当使用2 L PEG时，肠道准备不充分的风险因素是男性、年龄>60岁、糖尿病、服用三环类抗抑郁药史和腹部手术史；而当使用3 L PEG时，肠道准备不充分的风险因素仅为男性和糖尿病。提示3 L PEG对于大部分风险因素，如年龄、腹部手术史等仍能获得较高的肠道准备充分率。但糖尿病导致的胃肠道运动功能受损、男性可能较低的依从性都是3 L PEG也未能克服的问题。因此，加强对男性患者的宣教提高其依从性，使用辅药来改善糖尿病患者排便可能进一步提高肠道准备充分率［13-14］。
此外，本研究还对2 L PEG组肠道准备不充分的年龄因素进行了ROC曲线分析，以探索其截断值，并确定为56.5岁。与《结肠镜检查肠道准备专家共识意见》中年龄的截断值为70岁存在差异［6］。当选择3 L PEG时，年龄不再是一个重要的风险因素，这与最近的一项研究结果一致，>60岁的老年患者更适合采用3 L PEG［14］。老年患者由于胃肠道蠕动减弱以及结肠壁松弛，可能会导致结肠扩张，而较高容量的肠道准备方案可大幅增加肠液含量和肠腔内粪便物质，对肠壁产生更大的刺激，增强肠道蠕动。
本研究存在以下3点局限性。①本研究是在四川省成都市第三人民医院进行的单中心研究。我国不同地区的饮食习惯有很大差异，例如西南地区喜食辣椒，而南方沿海地区则以海鲜为常见食材。不同的饮食习惯会影响当地人的肠胃蠕动等健康状况，以往的研究也表明，患者的身体状况会影响肠道准备的结果［15］。因此，本研究的结果能否推广到我国其他地区的人群尚不确定。②未能采用腺瘤检出率（adenoma detection rate，ADR）来评估肠道准备的质量，因为有些患者没有进行息肉切除，因此无法获得病理结果。但欧洲消化内镜学会（European Society of Gastrointestinal Endoscopy，ESGE）质量改进计划指出，PDR也可以一定程度反映肠道黏膜的清洁程度［16］。③本研究中因肠道准备失败而进行额外肠道准备的这部分患者未进行区分，可能导致对结果的影响。但后期通过修改问诊表，确认在2 L和3 L方案中该部分患者的比例均为0.4%~0.5%，因而对本研究的结果影响不大。
在真实世界中，虽然3 L PEG相比于2 L PEG可以获得更高的肠道准备充分率，但2 L PEG肠道准备充分率亦达到90%以上，达到了ESGE推荐的至少90%肠道准备充分率的标准［16］。同时，2组间PDR相当，与研究一致，提示3 L PEG更高的肠道准备充分率对于肠道息肉的检出没有额外的益处［8］。2 L PEG导致的肠道准备相关的不良反应低于3 L PEG，说明2 L PEG的安全性更高。从风险获益比的角度分析，2组获益相当，3 L PEG风险更高，因而可以得出结论：2 L PEG可以视为一种安全有效的肠道准备方案。考虑到肠道准备不充分的风险因素，建议>60岁患者、有三环类抗抑郁药服用史或有腹部手术史的患者，可以采用3 L PEG进行肠道准备以提高肠道准备充分率；而对于男性患者和患有糖尿病者，建议在2 L PEG的基础上加强宣教、使用辅药以提高肠道准备充分率。

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2025年第47卷第3期
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doi: 10.16016/j.2097-0927.202407055
  • 接收时间：2024-07-14
  • 首发时间：2026-10-30
  • 出版时间：2025-02-15
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  • 收稿日期：2024-07-14
  • 修回日期：2024-08-05
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    1川北医学院临床医学院，四川 南充
    2成都市第三人民医院消化内科，四川 成都
    3西南医科大学临床医学院，四川 泸州

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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