重庆市一社区0～4岁儿童便秘患病率和排便情况横断面调查

A cross-sectional study on the prevalence of constipation and defecation of community children aged 0 to 4 years in Chongqing

目的 基于社区调查0～4岁儿童便秘患病率和排便情况.方法 采取整群抽样方法,以在重庆市渝中区大溪沟社区卫生服务中心（调查现场）出生后建立儿童健康体检卡的全部0～4岁儿童家长为问卷调查对象,2013年10 ～ 12月对来调查现场的儿童家长指导填写儿童生长发育和营养状况调查问卷;对未来调查现场的儿童家长通过电话指导完成问卷调查,家长按Bristol图确定儿童大便形状.以罗马Ⅲ便秘诊断标准作为本文诊断便秘标准,获得社区儿童便秘患病率;以Bristol大便形状1～3型分别与本文便秘诊断标准主要倚重项目组合,计算敏感度、特异度、阳性似然比和阴性似然比.结果 所在社区建立儿童健康体检卡的0～4岁儿童共1 206名,进入分析972份有效问卷中男535名,女437名;符合本文便秘诊断标准55例,所在社区0～4岁儿童便秘患病率为5.6％.符合本文便秘诊断标准的55例均为Bristol大便形状的1～3型;0～4和～6月龄组以6型便为主,8月龄以上组以4型便为主.Bristol大便形状1～3型分别与本文便秘诊断标准倚重项目“每周排便2次及以下”和“排便疼痛或排便困难史”组合后诊断便秘的敏感度均为100％,特异度96.8％以上,前者阳性似然比高于后者（142.9 vs 31.3）.结论 0～4岁儿童便秘患病率为5.6％,Bristol大便形状1～3型是儿童发生便秘的警示指标.

Objective To investigate the prevalence of constipation and defecation of community children aged 0 to 4 years. Children aged 0 to 4 years lived in Daxigou community health service centers （ survey site ） in Yuzhong District of Chongqing were enrolled into the survey. A questionnaire and telephone inquiries were investigated to get the growth and nutritional status of children from October to December 2013. The prevalence of constipation was obtained according to modified Rome Ⅲ criteria. Sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were calculated combined Bristol Stool Form Scale type 1 to 3 with major items of the diagnostic criteria. Results There were 1 206 children in total under 4 years old in the conmmnity, 1 050 of which received questionnaires, 1 000 questionnaires were retrieved, 972 questionnaires were valid including 535 males and 437 females. The prevalence of constipation for children was 5.6% （55/972）. Stool types of 55 children diagnosed as constipation were all Bristol stool type 1 to 3. Bristol stool type 6 was the major stool type in 0 -4 months and -6 months groups and stool type 4 was the major stool type in groups over 8 months. Sensitivity and specificity of the criteria of defecation less than twice per week and history- of defecation pain or difficult combined with Bristol stool type 1 to 3 was 100% and over 96.8%, respectively and positive likelihood ratio of the former was higher than that of the latter （ 142.9 vs 31.3）.Conclusion The prevalence of constipation was 5.6% in children aged 0 to 4 years. Bristol stool chart shape provides a quantitative diagnostic indicator for constipation children.