门诊胃食管反流病患者的临床特征分析

Clinical features analysis of the outpatients with gastroesophageal reflux disease

目的研究南京地区门诊胃食管反流病(Gerd)患者的临床特点。方法对926例门诊Gerd患者的一般人口学特征、主诉症状与Gerd Q量表调查、胃镜与幽门螺杆菌(H.pylori)感染检查以及药物治疗预后情况进行分析。结果行胃镜检查的Gerd患者中,男女比例为1.19∶1,平均年龄(49.5±13.2)岁,平均体质指数(BMI)为(24.6±3.5)kg/m2,平均腹围为(87.6±10.7)cm,大专以上学历者220例(220/664,33.1%),非体力劳动者254例(254/664,38.3%)。反酸(78.5%,727/926)、烧心(75.2%,696/926)、上腹部不适(62.1%,525/926)、胸骨后不适(48.7%,451/926)、咽部异物感(44.2%,409/926)、胸痛(42.7%,395/926)为常见的主诉症状。病例组Gerd Q量表积分显著高于对照组(P<0.05),取9分为诊断临界值时,Gerd Q量表的诊断价值最大。反流性食管炎(RE)内镜检出率为33.73%(226/670)。RE患者H.pylori阳性率较同期行胃镜检查的全部患者显著降低(P<0.05)。药物联合治疗RE的总有效率为90.27%,非糜烂性反流病(Nerd)为75.57%(331/438)。结论 Gerd门诊常见,BMI和腹围是其两个重要的危险因素。Gerd Q量表评分是诊断Gerd的一个较好的筛选指标。质子泵抑制剂(PPI)+促动力药+黏膜保护剂3药联合是治疗Gerd比较有效的方案之一。

Objective To investigate the clinical features of outpatients with gastroesophageal reflux disease in Nanjing region.Methods The general demographic characteristics,main symptoms,Gerd Q survey,gastroscopy,H.pylori infection inspection,drug treatment and prognosis of 926 outpatients with gastroesophageal reflux disease were evaluated.Results Among the patients accepted gastroscopy,the ratio between male and female was 1.19∶ 1,the mean age was（49.5±13.2） years old,the mean body mass index was（24.6±3.5） kg/m2,the mean abdominal circumference was（87.6±10.7） cm,the proportion of patients with college education and non-manual workers were 33.1%（220/664） and 38.3%（254/664）,respectively.The clinical manifestations were mainly acid reflux（78.5%,727/926）,heartburn（75.2%,696/926）,upper abdominal discomfort（62.1%,575/926）,retrosternal discomfort（48.7%,451/926）,pharyngeal foreign body sensation（44.2%,409/926） and chest pain（42.7%,395/926）.The Gerd Q score in case group was significantly higher than that in the control group（P0.05）.Taking 9 as the Gerd Q threshold score for gastroesophageal reflux disease,we obtained the maximal diagnostic value of the Gerd Q.Endoscopic detectable rate of reflux esophagitis was 33.73%（226/670）.H.pylori infection rate in patients with reflux esophagitis was significantly lower than that in all patients accepted gastroscopy of the same period（P0.05）.The total effective rates of drugs in combination therapy in reflux esophagitis group and non-erosive reflux disease group were 90.27%（204/226） and 75.57%（331/438）,respectively.Conclusion Outpatients with gastroesophageal reflux disease are common.Body mass index and abdominal circumference are 2 important risk factors for gastroesophageal reflux disease.Gerd Q is a good screening index for diagnosis of gastroesophageal reflux disease.Proton pump inhibitors combined with prokinetic agents and mucosal protective agents is a more effective programs in the treatment of gastroesophageal reflux disease.