不同性别患者下消化道功能性疾病临床症状特点

Gender differences of clinical symptom characters in lower functional digestive disorders

目的了解不同性别患者下消化道功能性疾病(Lower functional digestire disorders,LFDs)临床症状特点的差异。方法对2005年8月至2006年5月在我科门诊进行电子结肠镜检查的所有患者进行连续问卷调查,按照罗马Ⅱ标准诊断LFDs,分析比较男女患者LFDs的临床特点。结果(1)在被调查的1986例中,实际应答人数1820例,应答率为91.64%。共统计出LFDs952例,其中女性493例,男性459例,女性所占比例高于男性。LFDs中女性患者平均年龄较男性大(P<0.05),二者平均病程的差异无统计学意义(P>0.05)。男女LFDs患者均以35～40岁年龄段内人数最多。40岁以下的LFDs患者以男性所占比例为大,而40岁以上的LFDs患者以女性所占比例为大。(2)男女LFDs中,均以肠易激综合征(irritable bowel syndrome,IBS)最多见,男性IBS以D-IBS最多见,其次为C-IBS(64例),A-IBS(13例);而女性IBS以C-IBS(186例)最多见,其次为D-IBS(116例),A-IBS(25例);男性功能性腹泻(45例,9.80%)发生率高于功能性便秘(26例,5.66%)。而女性患者中后者(37例,7.51%)高于前者(18例,3.65%)。(3)所调查的肠道症状中,女性LFDs患者腹痛、便秘、肛门坠胀感、手辅助排便及便后腹部症状缓解的发生率高于男性(P值均<0.05),而男性腹泻和大便窘迫感的发生率高于女性(P值均<0.05);腹胀、腹部不适、腹泻便秘交替、大便不尽感的发生率在二者间的差异无统计学意义(P值均>0.05)。(4)女性LFDs患者中重叠有上消化道症状者(248例,50.30%)多于男性(201例,43.79%)(P<0.05),其中恶心、食欲下降、反酸、反流、烧心等症状的发生率女性高于男性(P值均<0.05),上腹痛、上腹胀、上腹不适、呕吐、早饱等症状的发生率在二者间的差异无统计学意义(P值均>0.05)。结论不同性别LFDs患者的发病年龄及各种消化道症状的发生存在着差异,对其认识有助于更进一步地了解LFDs的临床特点,有助于临床上对疾病的诊断与鉴别。

Objective To analyze the gender differences of clinical symptom characters of the lower functional digestive disorders （LFDs）. Methods Consecutively investigated the patients received the electronic colonoscopies in Wuban Union Hospital endoscope center from August 2005 to May 2006. Diagnosis the functional digestive disorders in it according to the Rome Ⅱ criteria based on the endoscope results, and analyze the gender-related differences of clinical symptom characters of LFDs. Results （ 1 ） Of the 1 986 consecutive patients, 1 820 actually responsed to the questionnaire and the response i＇ate was 91.64%. There were 952 LFDs in our trial （493 female and 459 male）. The average age of female patients was older than male （P 〈 0.05 ） , and the time of course had no difference between them （P 〉 0.05）. In all the LFDs patients, prevalanee age was in 35 ～ 40 yars old. Below 40 yrs, male patients were predominant while above 40 yrs female were predominant. （2） IBS was the most common disease in LFDs in both women and men. D-IBS was predominant in male, while C-IBS was predominant female patients. There were more functional diarrhea patients than functional constipation patients in men, while in women the later was more than the former. （3） The incidence rates of abdominal pain, constipation, anus tenesmus, assistant defecation and improvement of abdominal discomfort after defecation were higher in women than men （P 〈 0.05 ） , however, the incidence rates of diarrhea and defecation urgency were higher in men than women （P 〈 0.05 ）. The incidence rates of abdominal bloating, abdominal discomfort, alternation bowel movements and incomplete evacuation had no statistic differences between men and women （P 〉 0. 05）. （4） Upper digestive symptoms incidence rates in women （50.30%） were higher than men （43.79%） （P 〈 0. 05）. The incidence rates of nausea, appetite lost, acid reflux, regurgitation and heartburn were higher in women than men （P 〈 0. 05）, the incidence rates of upper abdominal pain, upper abdominal bloating, upper abdominal discomfort, vomiting and early satiety had no statistic differences in women and men （ P 〉 0.05 ）. Conclusion There are differences about age and digestive symptom characters between men and women, which is helpful to the diagnosis and differentiation of the lower functional digestive disorders.