肠易激综合征症状学诊断标准的特异性研究

A study on the specificity of the symptom-based diagnostic criteria of irritable bowel syndrome

目的 探讨社区人群中肠易激综合征 (IBS)的症状学诊断标准的特异性情况。方法 在广东省社区人群关于IBS调查中 ,共收集到 2 3 9例符合RomeⅡ标准及 479例符合Manning诊断标准的IBS症状人群。按一定比例选取其中 3 8例IBS症状人群到医院进行包括肠镜在内的相关检查。结果 (1) 3 8例接受检查的IBS症状人群中 ,男性 13例 ,女性 2 5例 ;城市 2 1例 ,农村 17例 ;年龄范围 18～ 73岁 ,平均年龄 41.5 5岁 ;已就诊过者 9例 ,未就诊过者 2 9例 ;3 8例均符合Manning诊断标准 ,其中 3 0例符合RomeⅡ诊断标准 ;(2 ) 2例符合糖尿病 2型的诊断标准 ,2例符合溃疡性结肠炎的诊断 ,1例诊断为肠蛔虫病。该 5例均符合IBS的Manning诊断标准 ,IBS诊断的符合率为 86.84% ;其中 4例符合IBS的RomeⅡ诊断标准 ,IBS诊断的符合率为 86.67% ;(3 )另有 1例肠镜检查发现直肠有一单发息肉 ;1例血常规检查示血红蛋白为 91g/L ;1例血沉为 2 6mm/h ,其余均小于 2 0mm/h ;腹部超声检查发现上述 2例糖尿病有轻度脂肪肝 ,另外 1例为肝区小囊肿。结论 RomeⅡ及Manning标准对社区人群中IBS的诊断均有较高的特异性 ;

Objective To explore the Specificity of the symptom-based diagnostic criteria of irritable bowel syndrome in the community based population.Methods A total of 239 subjects fulfilling Rome Ⅱcriteria and 479 subjects fulfilling Manning criteria were collected during the population based screening survey of IBS in Guangdong Province. Thirty eight subjects who were conformed with the symptom based criteria for IBS in the screening survey were arranged to undergo a detailed clinical examination including colonscope in hospital to exclude the organic disease of colon and other systematic diseases which could explain the symptoms of IBS.Results (1) Of the 38 subjects, 13 were male and 25 were female. Mean age of the subjects was 41.55yr with a range of 18～73yr. Twenty three point seven(9/38) had sought medical health. All the 38 subjects fulfilled Manning criteria and 30 subjects fulfilled Rome Ⅱ criteria.(2) Five subjects were detected having organic colon diseases or other systematic diseases which included diabetes mellitus ( n =2),ulcerative colitis ( n =2),and bowel ascaridiasis ( n =1).Consequently,the prevalence was corrected according to the correct diagnostic rate(86.84% for Manning , 86.67% for RomeⅡ). (3) Of these 38 subjects, one was found to have benign polyps, one was anemic with hemoglobin 91g/l, all the erythrocyte sedimentation rates (ESR) were normal except one with 26mm/h. On abdominal ultrasound examination, the 2 patients found to have diabetes mellitus were also identified to have mild fatty liver, the other one was found to have hepatic cyst.Conclusion The symptom-based criteria (including Rome Ⅱ and Manning criteria) was found to be highly specific for IBS. Routine performance of colonscope and blood sugar may be useful while making a diagnosis of IBS.