中老年人缺铁性贫血的内镜观察与临床分析

Analysis of the clinicle and endoscopic examination between middle and aged patients of iron deficiency anemia(IDA)

目的 :探讨中老年人缺铁性贫血 (IDA)的病史特征 ,评价内镜检查在IDA诊断中的作用。方法 :通过对比观察研究 2 81例中年和老年患者发生缺铁性贫血的发病因素 ,并根据内镜观察随访结果进行总结。年龄大于或等于 6 0岁为老年组 (1 4 3例 ) ,年龄 4 0～ 5 9岁为中年组 (1 38例 )。结果 :2 81例患者 ,中年组的IDA主要表现为轻中度贫血 ,内镜检出其主要来源于上消化道疾病 (82 1 38) :溃疡病和胃炎等 ;老年组的IDA主要表现为重度贫血 ,内镜检出其主要来源于下消化道疾病 (86 1 4 3) :痔疮 ,结肠炎等 ;两者比较有显著性差异 (X2 =1 4 .0 1 ,P <0 .0 1 )。结论 :老年人 6 0 .1 4 %IDA的病因来源于下消化道 ,临床表现重度贫血较突出 ;中年人 5 9.4 2 %来源于上消化道 ,临床主要表现为轻中度贫血。(对疑诊为IDA的患者应反复做大便OB试验 ,并常规做胃肠镜双向检查。)结合大便OB试验及内镜双向检查 ,对提高IDA病因的检出率和诊断的准确性具有重要意义。

Objective: To investigate the feature of pathogenesis in middle and aged patients with iron deficiency anemia( IDA),and assess the role of diagnosis through endoscopic examination. Method: Data from 281 cases of IDA admitted into our hospital from May 1995 to October 1999 were analyzed retrospectively and summarized the experience by endoscopic examing.patients over 60 belonged to the aged group(143 cases) and the ones between 40～59 belonged to middle group(138 cases). Result: Among 281 cases, the major symptoms of IDA in 138 cases of the middle patients were mild and moderate anemia, endoscopic examinations revealed upper gastrointestinal diseases ( 82/138):ulcer and gastritis ; 143 cases of the aged patients were serious anemia and focused lower gastrointestinal diseases (86/143):homrrhoids and colitis. Both were significantly different (X 2=14.37,P<0.01).Conclusion: Occurrence of IDA was positively related with lower gastrointestinal diseases in the aged patients and upper gastrointestinal diseases in the middle patients. Combination with occult blood test and the indoscopic examination is very important for increasing the detectable rate and the diagnostic accuracy of IDA.