摘要
目的
探讨胃食管反流病量表（GerdQ）、胃镜检查和PPI试验对中国人GERD的诊断价值。
方法
本研究为全国多中心研究，研究对象为2012年4月至12月在全国9所医院消化科门诊就诊、存在上消化道症状且年龄≥18岁的患者。所有患者均在指导下完整填写GerdQ问卷。选取GerdQ≥8分的患者进行胃镜检查、24 h多通道腔内阻抗联合pH值监测和PPI试验。统计学方法采用卡方检验。
结果
GerdQ≥8分的患者共5 349例。在1 584例行胃镜检查的患者中，反流性食管炎465例（29.4%），消化性溃疡75例（4.7%），上消化道恶性肿瘤9例（0.6%）。在328例接受24 h多通道腔内阻抗联合pH值监测的患者中，监测结果阳性130例，其中经胃镜诊断为反流性食管炎48例（36.9%）；监测结果阴性198例，其中经胃镜诊断为反流性食管炎35例（17.7%）；前者诊断为反流性食管炎的比例高于后者，差异有统计学意义（χ2＝15.379，P〈0.01）。未行24 h多通道腔内阻抗联合pH值监测组与24 h多通道腔内阻抗联合pH值监测阳性组的PPI试验阳性率分别为85.4%（549/643）和89.6%（120/134），差异无统计学意义（χ2＝1.612，P＝0.204）。PPI试验阳性患者的24 h多通道腔内阻抗联合pH值监测阳性率为61.2%（120/196），高于PPI试验阴性的41.2%（14/34），差异有统计学意义（χ2＝4.789，P＝0.038）。
结论
GerdQ评分对GERD的诊断具有重要参考价值，但我国上消化道肿瘤发病率较高，有上消化道症状的患者在治疗前均应行胃镜检查，此后可直接应用PPI进行治疗。
Objective To investigate the diagnostic value of gastroesophageal reflux disease questionnaire （GerdQ）, esophagogastroduodenoscopy （EGD） and proton pump inhibitor （PPI） test in gastroesophageal reflux disease （GERD） in Chinese population. Methods This was a national wide multicenter study. From April 2012 to December 2012, outpatients in the departments of gastroenterology of nine hospitals, aged over 18 years old and with upper gastrointestinal problems were selected as study objectives. GerdQ were completely filled out with guide by all patients. The patients with GerdQ≥ 8 received gastroscopy, 24 hour impedance-pH monitoring and PP1 test. Chi square test was used for statistical analysis. Results The number of patients with GerdQ≥8 was 5 349. Among the 1 584 patients who received EGD, 465（29.4%） cases had reflux esophagitis （RE）, 75（4.7 %） eases had peptic ulcers, and nine （0.6 % ） cases had upper gastrointestinal malignant tumors. Among the 328 patients received 24 hour impedance-pH monitoring, 130 patients presented with positive results, and 48 （36. 9%） patientswere diagnosed with RE by EGD. Among the 198 patients with negative results in 24-hour impedance pH monitoring, 35（17.7%） patients were diagnosed with RE by EGD. The diagnostic rate of RE in patients with positive results was higher than that in patients with negative results, and the difference was statistically significant （x2=15. 379, P〈0.01）. The positive rates of PPI test of patients received no 24- hour impedance-pH monitoring and received 24-hour impedance-pH monitoring were 85. 4% （549/643） and 89.6 % （120/134）, respectively, and the difference was not statistically significant （x2= 1.612, P = 0. 204）. The positive rate of 24-hour impedance-pH monitoring in patients with positive PPI test was 61.2% （120/196）, which was higher than that of patients with negative PPI test （41.2 %, 14/34）, and the difference was statistically significant （x2= 4. 789,P=0. 038）. Conclusions GerdQ has important reference value in the diagnosis of GERD. However, in consideration of the high incidence of upper gastrointestinal cancer in China, patients with upper gastrointestinal symptoms should receive EGD before treatment. Afterwards PPI treatment could be directly utilized.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2016年第4期241-245,共5页
Chinese Journal of Digestion
关键词
胃食管反流
问卷调查
胃镜
质子泵抑制剂
Gastroesophageal reflux
Questionnaires
Gastroscopes
Proton pump inhibitors
