北京地区有胃食管反流症状人群的服药特征分析

Analysis of the characteristics of medicine taking in patients with gastroesophageai reflux disease in Beijing

目的 调查具有胃食管反流（GER）症状人群用药特点,长期用药的种类及比例,以及治疗满意度等；分析胃食管反流病（GERD）合并功能性肠病（FBD）时对治疗满意度的影响；并比较近年来GER人群服药种类及治疗满意度的变化.方法 于2011年4月至6月对北京大学人民医院消化科门诊就诊人群进行问卷调查,使用反流性疾病问卷（RDQ）调查GER症状发生率,将RDQ评分1～5分定义为可能存在反流症状,≥12分诊断为GERD.按罗马Ⅲ标准判断是否具有FBD.记录RDQ评分＞0分者在调查前一年内和长期（≥1年）服用药物情况及治疗满意度等信息,并与2004年采用同样方法收集的GER人群服用药物种类及治疗满意度等数据进行比较.采用SPSS17.0软件的卡方检验对数据进行统计学分析.结果 2011年完成问卷的1074例受访者中有351例（32.7％）存在GER症状,诊断为GERD者107例（10.0％）.GERD患者中合并FBD者占25.2％（27/107）.存在GER症状者中有304例（86.6％）有服用药物信息,其中78.0％ （237/304）在调查前一年中服用过GER相关药物,且任意GER相关药物、PPI和抗酸剂的服用比例随RDQ评分的递增（1～5、6～11、12～40分）而增高（x2=24.2、13.1,P＜0.05）.诊断为GERD者中有104例有服药信息,其中92例（88.5％）在调查前一年内因GER症状服用过相关药物,55例（52.9％）服用过PPI类药物；32例（30.8％）长期服药,21例（20.2％）长期服用PPI治疗.不同RDQ评分段的受访者对治疗的满意度评价差异无统计学意义（x2 =3.3,P＞0.05）；在对治疗满意度作出评价的70例GERD患者中分别有26例（37.1％）、34例（48.6％）和10例（14.3％）对治疗评价满意、一般和不满意.GERD患者合并FBD与未合并FBD者的治疗满意度差异无统计学意义（x2=3.1,P＞0.05）.2011年GERD患者GER相关药物服用率（88.5％,92/104）及PPI服用率（52.9％,55/104）相比2004年[57.3％（98/171）,7.6％ （13/171）]明显增高（x2=29.4,71.2,P均＜0.01）,且治疗满意度较2004年增高[25.7％（18/70）,x2=12.8,P＜0.01].结论 部分有GER症状的患者需要长期服药,特别是PPI治疗.近些年临床门诊GERD患者的服药比例增加,选择使用PPI的比例增加更为明显,治疗满意度亦有所提高.GER合并FBD似不影响患者的治疗满意度.

Objective To investigate the characteristics of medicine taking,the type and ratio of long-term medication and treatment satisfaction in patients with gastroesophageal reflux disease （GERD）,to analyze the effects of GERD combined with functional bowel disease （FBD） on the treatment satisfaction,and to compare the changes of type of medication and treatment satisfaction in patients with GERD in recent years.Methods From April to June in 2011,the questionnaire survey was conducted in gastroenterology clinic of People＇s Hospital of Peking University.The incidence of typical GERD symptoms was investigated by a validated reflux disease questionnaire （RDQ）,the score between one and five was considered there might be reflux symptoms and the score over 12 was diagnosed as GERD.FBD was diagnosed according to Rome Ⅲ criteria.The information of GERD related medication taking within one year before the survey,long-term medication taking （≥ 1 year）and the treatment satisfaction of patients whose RDQ score over zero was recorded and compared with the data collected in the same method in 2004.The chi-square test was performed for data statistical analyses with SPSS 17.0 software.Results Among 1074 patients who completed questionnaire survey in 2011,the percentage of patients with reflux symptoms was 32.7% （351/1074）,the percentage of diagnosed GERD was 10.0% （107/1074）,and GERD combined with FBD was 25.2% （27/107） of GERD.A total of 304 cases （86.6%） of patients with reflux symptoms had information of medication taking; 78.0% （237/304） of whom had taken GERD related medication within one year before the survey.The rate of GERD related medication taking especially proton pump inhibitor （PPI） and antiacid medication taking increased along with RDQ score （x2 =24.2,13.1 and 18.2,all P〈0.05）.A total of 104 cases of GERD patients had information of medication taking; 88.5 % （92/104） GERD patients had taken GERD related medication within one year before the survey,52.9% （55/104） GERD patients had taken PPI medication,30.8% （32/104） needed long-term medication and 20.2% （21/104） needed longterm PPI treatment.There was no significant difference in treatment satisfaction between different RDQ score ranges （x2 =3.3,P〉0.05）.Among GERD patients who appraised the effects of treatment,the percentage of satisfied,acceptable and not satified with the treatment was 37.1%（26/70）,48.6% （34/70）and 14.3%（10/70）,respectively.There was no significant difference in treatment satisfation between GERD with and without FBD （x2 =3.1,P〉0.05）.In 2011,the rates of medication taking （88.5%,92/104） and PPI taking （52.9%,55/104） in GERD patients significantly increased compared with those in 2004 （57.3%,98/171; 7.6%,13/171,x2 =29.4,71.4,both P〈0.05）.The percentage of treatment satisfaction in 2011（37.1%,26/70） increased compared with that in 2004（25.7%,18/70,x2 =12.8,P〈0.01）.Conclusions Some of patients with GERD symptoms need long-term medication,especially PPI treatment.In recent years,the rate of medication taking in GERD patients increased in outpatients department,PPI taking significantly increased and the treatment satisfaction also increased.Maybe the treatment satisfaction is not affected by GERD combined with FBD.