胆汁反流对不同性别患者胃黏膜影响的临床研究

Clinical study of influence of bile reflux on gastric mucosa of different sexual patients

目的 研究胆汁反流对不同性别患者胃黏膜的影响.方法 选择2014 年1 月至2015年1 月在石家庄市第一医院进行胃镜检查的患者中检出胃胆汁反流患者664 例作为研究对象,记录其性别、年龄、饮食习惯、烟酒嗜好、既往病史、焦虑和（或）抑郁状态评估结果,观察分析其内镜下表现、病理检测结果和HP 检测结果,比较不同性别之间胆汁反流发生高峰年龄、相关危险因素、胆汁反流对胃黏膜造成的影响的异同.结果 （1）男性胆汁反流检出率为6.75%;女性胆汁反流检出率为7.02%,女性检出率高于男性,差异有统计学意义（P〈0.05）.（2）发生胆汁反流男性最小年龄11 岁,最大年龄85 岁,平均（47.45±17.58）岁;女性最小年龄14 岁,最大年龄85 岁,平均（47.49±17.29）岁,不同性别发生胆汁反流的最小年龄和最大年龄无差异（P〉0.05）.男性和女性胆汁反流检出率在70 岁之前随年龄增高而升高,70 岁以后随年龄增高开始下降,男性反流检出高峰在51～60 岁,女性反流检出高峰在41～50 岁,女性胆汁反流高峰年龄大于男性（P〈0.05）.（3）在女性组中,焦虑和（或）抑郁状态患者发生胆汁反流率最高,其次喝咖啡、非甾体消炎药、烟酒、糖尿病等.在男性组中,吸烟组发生胆汁反流率最高,其次是焦虑和（或）抑郁状态、饮酒、喝咖啡、非甾体消炎药、糖尿病等.（4）内镜特征胃溃疡男性58 例,检出率为17.70%,女性19例,检出率为5.29%,男性多于女性,差异有统计学意义（P〈0.05）.充血水肿、出血点、出血斑、糜烂、糜烂出血、胃息肉、胃癌检出率男性与女性差异无统计学意义（P〉0.05）.（5）病理检查：炎症、炎症＋胃小凹增生女性高于男性,差异有统计学意义（P〈0.05）;炎症＋肠化、炎症＋肠化＋异型增生、胃溃疡发生率男性高于女性,差异有统计学意义（P〈0.05）;炎症＋肠化＋胃小凹增生、炎症＋异型增生、肠化＋异型增生、肠化＋胃小凹增生、胃炎性增生性息肉、胃底腺息肉、胃癌、HP 感染二者之间检出率差异无统计学意义（P〉0.05）.结论 胆汁反流可造成胃黏膜各种损害,男性和女性之间胆汁反流高峰年龄、相关危险因素、内镜和病理表现有一定的差异;HP 感染发生率无性别差异。

Objective To investigate the influence of bile reflux on gastric mucosa of different sexual patients. Methods From January 2014 to January 2015, 664 patients with gastric bile reflux were selected through gastroscopy in the first hospital of Shijiazhuang city and their gender, age, hobby (include diet, alcohol, tobacco), past medical history, anxiety and/or depression state evaluation results were recorded, meanwhile endoscopic manifestation, pathological results and HP test results were observed; the difference of bile reflux peak age, related risk factors, the effects on the gastric mucosa between male patients and female patients were comparatively analyzed. Results (1) Among 664 patients with gastric bile reflux, male patients were 305 cases, which detection rate was 6.75%. meanwhile female patients were 359 cases, which detection rate was 7.02%; the difference between male and female was statistically&nbsp;significant(P<0.05). (2) Minimum age were 11 years and maximum age were 85 years in male with bile reflux, mean age were (47.45±17.58) years; In female, minimum age were 14 years, maximum age were 85 years, mean age were (47.49±17.29) years, difference was not statistically significant (P>0.05); before 70 years, whether the patients were male or female, bile reflux rate increased along with aging; after the 70 years old, bile reflux rate decreased along with aging; male reflux detection peak was at the age of 51 to 60 years, female reflux detection peak was at the age of 41 to 50 years; female bile reflux peak age was earlier than male’s (P<0.05). (3) In the female group, bile reflux rate was the highest in patients with anxiety and depression state, the next was drinking coffee, non-steroidal anti-inflammatory drugs, alcohol and tobacco, diabetes, etc. In male group, bile reflux rate was the highest in smoking group, the second was the state of anxiety or depression, alcohol, coffee, non-steroidal anti-inflammatory drugs, diabetes, etc. (4) Endoscopic manifestation in the male, 58 cases suffered gastric ulcer, which detection rate was 17.70%, while in the female, 19 cases suffered gastric ulcer, which detection rate was 5.29%, the difference was statistically significant (P<0.05); Detection rate of hyperemia edema, petechiae or purpura, erosion, erosion accompany with bleeding, gastric polyps, gastric cancer were not different between male and female (P>0.05). (5) Pathological examination: the incidence of inflammation, inflammation accompany with hyperplasia of gastric pit in female was more than in male; the difference was statistically significant (P<0.05); the incidence of inflammation accompany with intestinal metaplasia, inflammation accompany with intestinal metaplasia and dysplasia, gastric ulcer in male was more than in female (P<0.05); the incidence of inflammation accompany with intestinal metaplasia and hyperplasia of gastric pit, inflammation accompany with dysplasia, intestinal metaplasia accompany with dysplasia, intestinal metaplasia accompany with hyperplasia of gastric pit, hyperplastic polyp, fundic gland polyps, gastric cancer were not different between male and female (P>0.05). Detection rate of HP infection was not different between male and female (P>0.05). Conclusion Bile reflux can cause gastric mucosal damage; Bile reflux peak age, the related risk factors, endoscopic and pathological manifestations have certain difference between male and female; There is no gender difference in HP infection.