典型反流症状对胃食管反流疾病的诊断效果

Value of typical reflux symptom in the diagnosis of gastroesophageal reflux disease

[目的]评价典型反流症状在胃食管反流疾病（GERD）患者中的的诊断价值。[方法]选取2011年1月-2013年12月于本院消化内科就诊,有反流症状疑诊为GERD的122例患者为研究对象,以胃食管反流疾病问卷（GerdQ）评价患者的症状,以胃镜检查发现反流性食管炎（RE）和（或）质子泵抑制剂（PPI）试验阳性作为GERD的诊断标准,并进行RE的洛杉矶（LA）分级,据此将122例患者分为GERD组和非GERD组。比较2组的临床资料及GerdQ评分,通过受试工作者曲线（ROC）计算GerdQ的临界值、灵敏度、特异度以及Youden指数。[结果]122例患者中诊断为GERD者88例,占72.1%。GERD组和非GERD组患者在性别、年龄、阳性症状（烧心、反流）的发生率及其评分、阳性影响（睡眠障碍、服用药物）的发生率及其评分等方面无明显差异（P〉0.05）,GERD组的阴性症状（上腹痛、恶心）的发生率明显低于非GERD组（P0.05）。ROC表明将9分作为其临界值时,灵敏度为81.2%,特异度为57.9%,Youden指数达到0.391,ROC曲线面积为0.65,诊断意义最大。[结论]典型反流症状可以在一定程度上帮助GERD的诊断,采用GerdQ自评问卷来评价反流症状,并以9分为临界值,有较高的诊断价值,可以作为初诊GERD简易有效的方法。

[Objective]To evaluate the value of typical reflux symptom in the diagnosis of patients with gastroesophageal reflux disease（GERD）.[Methods]122patients with reflux symptom from July 2011 to February 2013 were enrolled for study.Gastroesophageal reflux disease questionnaire（GerdQ）was used to evaluate the symptom.Patients with reflux esophagitis（RE）examined by endoscopy and/or positive PPI trial were diagnosed with GERD,and patients with RE were classified by Los Angeles（LA）standard.Then all the cases were divided into GERD group and non-GERD group.Clinical data and the score of GerdQ were compared between the two groups.The cut-off points,sensitivity,specificity and Youden index were calculated by the receiver operating characteristic（ROC）curve.[Results]88cases（72.1%）were diagnosed with GERD.There were no significant differences between the two groups in gender,age,the occurrence rates and scores of positive symptoms including heartburn and reflux,the occurrence rates and scores of positive affect including dyssomnia and medication（P〈0.05）.The occurrence rates of negative symptoms including upper abdominal pain and nausea in GERD group were significantly lower than non-GERD group（P〈0.05）,and the scores of negative symptoms in GERD group were significantly higher than non-GERD group（P〈0.05）.There were no significant differences in the total score among different LA classifications（P〈0.05）.A cut-off point of nine had a sensitivity of 81.2% and specificity of 57.9% with maximum Youden index of 0.391 and the area under the ROC was 0.65.[Conclusion]Typical reflux symptoms couldhelp the diagnosis of GERD to a certain extent.GerdQ was performed to evaluate the reflux symptoms,and a cut-off point of nine has high diagnostic value,which could be used as a simple and effective method for diagnosis of GERD.