反流性食管炎1405例临床和内镜特点分析

Clinical and endoscopic analysis on cases of reflux esophagitis

目的分析反流性食管炎患者的临床和内镜检查特点。方法回顾性分析自2004年9月至2007年1月北京友谊医院诊治的反流性食管炎患者的性别、年龄、是否存在幽门螺旋杆菌感染和食管裂孔疝，并且按照洛杉矶标准进行分级。结果1405例反流性食管炎患者中，男女比例1．75：1，二者差异有统计学意义（P〈0．01）。男、女性患者平均年龄有一定差异（P=0．01）。患者发病高峰年龄在40-60岁。根据洛杉矾标准，A、B级分别与C、D级患者间年龄存在差异（P〈0．01）。Hp阳性患者277例，感染率明显降低（P〈0．01）。合并有食管裂孔疝患者195例，与食管炎严重程度和年龄显著相关（P〈0．01）。结论反流性食管炎男性患者的平均年龄较低，检出量多于女性患者。食管炎患者Hp感染率明显降低。高龄和合并有食管裂孔疝的患者食管炎更严重。患者黏膜破损较易发生在食管右半侧壁。

Objective To analyze the clinical and endoscopic features of Chinese patients with reflux esophagitis （RE）. Methods A total of 1405 RE patients were analyzed retrospectively. Data on gender, age, presence/absence of H pylori （Hp） infection and associated esophageal hiatal hernia were collected. Esophagitis was divided into different grades according to Los Angeles Classification. Results Of 18 823 patients, 1405 were diagnosed with RE. The ratio of male to female patients was 1.75：1 （P 〈 0. 01 ）. The mean age of male and female patients was significantly different（ P = 0. 01 ）. The peak age at onset of the disease was 40 - 60 years. According to Los Angeles Classification, there were significant differences in the age of patients with grades A and B compared to patients with grades C and D（ P 〈 0.01 ）. Two hundred and seventy-seven patients were infected with Hp, the infection rate being low （ P 〈 0. 01 ）. Complication of esophageal hiatal hernia was found to he significantly associated with the severity of esophagitis and age in 195 patients（ P 〈0. 01 ）. Esophageal mucosa damages were mainly located at the fight esophageal wall. Conclusion The peak age of onset of RE is 40 - 60 years and higher in males than in females. The mean age of onset of RE is lower in males than in females. The infection rate of Hp is significantly decreased in patients with esophagitis. Old age and esophageal hiatal hernia are associated with more severe esophagitis. Right esophageal mucosal damage is more likely to occur in RE patients.