肠易激综合征不同诊断标准对汶川地震灾区中学生患病率的影响

Influence of Different Diagnostic Standards on the Prevalence of Irritable Bowel Syndrome among Middle School Students in Areas Affected by Wenchuan Earthquake

目的调查汶川地震灾区中学生肠易激综合征(IBS)的患病情况,分析罗马Ⅱ和罗马Ⅲ诊断标准对该人群IBS患病率的影响。方法在汶川地震后2年半和3年,分别用罗马Ⅱ和罗马Ⅲ标准制定IBS中学生问卷调查表对地震灾区和非地震灾区5所中学的中学生进行2次调查,分析比较IBS患病率的变化。结果用罗马Ⅱ标准调查发现地震灾区中学生IBS患病率为23.6%;非地震灾区患病率为21.6%,二者比较无统计学意义(P=0.267);用罗马Ⅲ标准调查发现地震灾区中学生IBS患病率为6.2%,非地震灾区患病率为4.6%,二者比较无统计学意义(P=0.139)。符合两种诊断标准的地震灾区IBS学生有10.3%,非地震灾区IBS学生有9.2%,两者差异无统计学意义(P>0.05)。②支持两种诊断标准的症状方面,地震灾区IBS学生每天排便>3次或每周排便<3次等症状相比较有统计学意义(P<0.001)。③按罗马Ⅲ标准,各亚型构成比IBS-C为30.4%,IBS-D为28.4%,IBS-M为8.8%,IBS-U为32.4%;按罗马Ⅱ标准,各亚型构成比为IBS-C为28.5%,IBS-D为47.7%,腹泻和便秘交替型为18.6%,罗马Ⅲ标准中的IBS-M和IBS-U合为一组与罗马Ⅱ标准中的腹泻和便秘交替型的构成比进行比较,二者有统计学意义(P<0.001)。结论罗马Ⅱ和罗马Ⅲ两种标准调查地震灾区中学生IBS患病率和分型存在着差异,但两种标准对地震灾区IBS患病率的影响是对等的,患病率和分型的不同是由两种标准的本身的差异造成,可能更接近罗马Ⅲ诊断标准。

Objective To investigate the prevalence of irritable bowel syndromes（IBS） among middle school students in areas affected by WenChuan Earthquake,and analyze the infl uence of Rome Ⅱ and Rome Ⅲ diagnostic criteria on the morbidity of IBS.Methods Two and a half years,and three years after the earthquake,IBS questionnaires based on Rome Ⅱ and Rome Ⅲ criteria respectively were made to survey students in five middle schools from both the affected and non-affected areas.The difference of prevalence was compared between Rome Ⅱ and Rome Ⅲ criteria.Results Based on Rome Ⅱ,the prevalence of middle school students from earthquake stricken areas was 23.6% and 21.6% in students from other areas,with no statistically significant difference between the two groups（P=0.267）.According to Rome Ⅲ,the above two number were respectively 6.2% and 4.6%,and there was also no statistically significant difference（P=0.139）.Based on both Rome Ⅱ and Rome Ⅲ criteria,those two numbers were 10.3% and 9.2% without significant difference between the two groups,either（P 0.05）.As for symptoms that supported both diagnosis standards,there was a significant difference among the symptoms in IBS students from the earthquake stricken areas such as a defecation frequency of 3 times per day or less than 3 per week（P 0.001）.According to Rome Ⅲ,each subtype constituent ratio was： IBS-C subtype（30.4%）,IBS-D subtype（28.4%）,IBS-M subtype（8.8%） and IBS-U subtype（32.4%）.According to Rome Ⅱ,each subtype constituent ratio was： IBS-C subtype（28.5%）,IBS-D subtype（47.7%）,Diarrhea and constipation alternate type（18.6%）. Combined IBS-M subtype and IBS-U subtype based on Rome Ⅲ and diarrhea and constipation alternate type based on Rome Ⅱ had a statistically significant difference in constituent radio（P 0.001）.Conclusions The morbidity and types of IBS in middle school students in the earthquake stricken areas are different between Rome Ⅱ and Rome Ⅲ criteria,but their infl uences on morbidity of IBS are mostly the same.So the difference of morbidity and types of IBS comes from the differences between the two criteria themselves.Diagnosis based on Rome Ⅲ criteria is closer to the actual reality.