上海市松江社区居民肠易激综合征流行病学调查

An epidemiological investigation of irritable bowel syndrome in Shanghai Songjiang communities

目的探讨上海市松江地区常住成年社区居民符合罗马Ⅲ诊断标准的肠易激综合征（IBS）患者的患病率、亚型、分布特征及危险因素等。方法采用多级、分层、整群随机抽样法，在2010年4月至5月间，对上海市松江区共45个社区居民进行面访式问卷调查。IBS诊断采用罗马Ⅲ标准，分型采用Bristol粪便形状分型量表。同时完成焦虑自评量表、抑郁自评量表及睡眠质量评估量表。结果完成调查并回收问卷合格者7648份（名），有效率为90％。抽样人数占上海市松江区总人口数的1．62％。共检出符合罗马Ⅲ标准的IBS患者970例，其中男性492例，女性478例。标化后IBS患病率为13．1％，其中男性为13．8％，女性为12．7％，男女比例为1：0．92，男女检出率差异无统计学意义（P〉0．05）。患病率在18～29岁年龄段最高（18．2％，P=0．000）。符合罗马Ⅲ分型标准中最多见的是未定型（45．3％），其次在男性以腹泻型（27．0％）多见，女性则以便秘型（19．5％）多见。在肥胖组（x2=4．046，P=0．044）、受高等教育组（x2=31．210，P=0．000）、脑力劳动组（x2=8．409，P=0．015）、未婚组（X2=26．933，P=0．000）、非腹部手术组（X2=5．894，P=0．015）IBS的患病率高于对照组。有胃肠道感染史、腹部手术史、服用抗生素及止痛药物史IBS的患病风险分别提高5．105、3．388、2．949及2．811倍（P=0．000）。多因素分析显示较多地食用辛辣食物，IBS患病危险提高1．69倍（P=0．000），而高蛋白质饮食则是保护性因素（OR=0．900，P=0．000）。焦虑（OR=2．452，P=0．000）及失眠（OR=2．452，P=0．000）同样是IBS患病的危险因素。结论IBS是上海市松江区社区成人的常见病和多发病。胃肠道感染史、腹部手术史、服用抗生素及止痛药物、嗜好辛辣食物、焦虑及失眠可能是IBS患病的危险因素。

Objective To explore the prevalence, subtype, distribution characteristics and risk factors of IBS met ROME III criteria in local adult residents of Shanghai Songjiang area. Methods With multi-stage, stratified cluster random sampling method, from April to May in 2010, residents of 45 shanghai Songjiang communities were interviewed by questionnaire survey. IBS diagnosis was based on Rome III criteria, and the subtypes were according to Bristol stool scale. Self-rating anxiety scale （SAS）, self-rating depression scale （SDS） and Athens insomnia scale （AIS） were also simultaneously finished. Results There were 7648 individuals who completed the survey with qualified questionnaires; the efficient rate was 90%. The sample size accounted about 1. 62% of total population in Shanghai Songjiang area. Total 970 patients were detected, who met the Rome Ill criteria,of those 492 males and 478 females. The adjusted prevalence of IBS was 13. 1%, 13.8% in males and 12. 7% in females. The ratio of mate to female was 1 ： 0. 92. There was no significant difference in detection rate between males and females （P〉0.05）. The prevalence was highest in the 18 to 29 years age group （18.2% ,P=0. 000）. IBS unsubtyped （IBS-U） was the most common type in patients who met the Rome UI criteria （45.3 %）, IBS with diarrhea （IBS-D） type was more common in male （27.0%） and IBS with constipation （IBS-C） was more common in female （19.5%）. The IBS prevalence of obesity group （Z2 = 4. 046, P = 0. 044）, higher education group （ 2 = 31. 210, P = 0. 000）, mental group （x2= 8. 409,P=0. 015）, unmarried group（X2 =26. 933,P=0. 000）and no abdominal surgery history group（x2= 5. 894,P=0. 015） was higher than that of control group. The risk of IBS prevalence in those who had the history of gastrointestinal infection, abdominal surgery, taking antibiotics or analgesics increased by 5. 105, 3. 388, 2. 949 and 2. 811 times respectively（P=0. 000）. Multivariate analysis indicated that the risk of IBS prevalence was increased by 1. 69 times if took more spicy food, however high-protein diet was a protective factor （OR = 0. 900, P = 0. 000）. Anxiety （OR=2. 452, P= 0. 000） and insomnia （OR= 1. 923, P= 0. 000） were also risk factors of IBS. Conclusion IBS is a common and frequently occurring disease in Shanghai Songjiang community. The history of gastrointestinal infection, abdominal surgery, taking antibiotics or analgesics, intake of more spicy food, anxiety and insomnia may be risk factors of IBS.