罗马Ⅳ诊断标准对肠易激综合征患者的影响程度

Influence of Rome Ⅳ diagnostic criteria on patients with irritable bowel syndrome

目的探讨罗马Ⅳ与非罗马ⅣIBS患者治疗后症状改善情况及不同诊断标准IBS对患者的影响程度。方法选取2016年6月2日至8日在武汉华中科技大学同济医学院协和医院消化内科门诊就诊的1500例年龄>18岁有肠道症状的患者进行问卷访谈,治疗6个月后通过电话对IBS患者、非IBS患者、罗马ⅣIBS患者和非罗马ⅣIBS患者进行随访,以肠易激综合征症状严重程度量表(IBS-SSS)评估患者治疗后的症状改善情况,以患者日常生活工作、是否选择结肠镜检查、是否选择药物治疗、药物治疗疗效情况评估符合不同诊断标准的IBS对患者的影响程度。采用Studentt检验、Mann-WhitneyU检验和卡方检验进行统计学分析。结果共随访352例有肠道症状患者,其中IBS患者175例(罗马ⅣIBS84例,非罗马ⅣIBS91例),非IBS患者177例,有142例患者响应。非IBS患者与IBS患者[37.3%(66/177)比43.4%(76/175)],以及罗马ⅣIBS患者与非罗马ⅣIBS患者[40.5%(34/84)比46.2%(42/91)]的响应率差异均无统计学意义(χ^2=1.379、0.573,P=0.240、0.449)。与非IBS患者相比,IBS患者对药物治疗的满意度更低[71.4%(30/42)比47.5%(19/40)];与非罗马Ⅳ标准的IBS患者相比,罗马ⅣIBS患者更可能进行结肠镜检查[35.7%(15/42)比58.8%(20/34)],差异均有统计学意义(χ^2=4.878、4.039,P=0.027、0.044)。治疗6个月后,罗马ⅣIBS患者和非罗马ⅣIBS患者所有症状都有改善(P均<0.05),罗马ⅣIBS患者症状改善情况更显著,IBS-SSS总分低于非罗马ⅣIBS患者[-130分(-185分,60分)比-70分(-100分,28分)],差异有统计学意义(Z=-3.065,P=0.002),主要表现在腹痛症状方面,罗马ⅣIBS患者IBS-SSS腹痛评分低于非罗马ⅣIBS患者[-80分(-100分,-40分)比0分(-40分,0分)],差异有统计学意义(Z=-4.631,P<0.01)。结论IBS症状对门诊患者的治疗满意度有较大影响,即使有相似的良好治疗效果,符合罗马Ⅳ诊断标准的IBS症状对患者造成的影响仍较非罗马ⅣIBS更严重。

Objective To investigate the improvement of symptoms of the patients after treatment in patients with Rome Ⅳ or non-Rome Ⅳ irritable bowel syndrome (IBS), and to explore the influence of IBS diagnosed by different criteria on the patients. Methods From June 2nd to 8th in 2016, at Outpatients Department of Gastroenterology, Union Hospital Affiliated to Tongji Medical College, Huazhong Uiversity of Science and Technology in Wuhan, 1 500 outpatients aged over 18 years old and with intestinal symptom were selected for questionnaire. After treatment for six months, IBS patients, non-IBS patients, patients with Rome Ⅳ IBS and patients with non-Rome Ⅳ IBS were followed up by phone calls. After treatment, the improvement of symptoms of the patients was evaluated by irritable bowel syndrome symptom severity scale (IBS-SSS). The degree of influence of IBS diagnosed with different criteria on patients was evaluated by the patient′s daily work whether to choose colonoscopy examination, whether to choose medication, and the efficacy of medicine. Student′s t test, Mann-Whitney U test and chi-square test were performed for statistical analysis. Results A total of 352 patients with intestinal symptoms were followed-up, including 175 patients with IBS (84 patients with Rome Ⅳ IBS and 91 patients with non-Rome Ⅳ IBS) and 177 non-IBS patients, and 142 patients responded. There were no statistically significant differences in response rate between non-IBS patients and IBS patients (37.3%, 66/177 vs. 43.4%, 76/175), and between patients with Rome Ⅳ IBS and patients with non-Rome Ⅳ IBS (40.5%, 34/84 vs. 46.2%, 42/91)(χ^2=1.379 and 0.573, P=0.240 and 0.449). Compared with the non-IBS patients, the degree of satisfaction of medicine was lower in IBS patients (71.4%, 30/42 vs. 47.5%, 19/40). Compared with non-Rome Ⅳ IBS patients, Rome type Ⅳ IBS patients were more likely to receive colonoscopy (35.7%, 15/42 vs. 58.8%, 20/34), and the differences were statistically significant (χ^2=4.878 and 4.039, P=0.027 and 0.044). After six months of treatment, symptoms improved in both Rome Ⅳ IBS patients and non-Rome Ⅳ IBS patients (both P<0.05), however, the symptoms improved more significantly in Rome Ⅳ IBS patients and the total score of IBS-SSS was lower than that of non-Rome Ⅳ IBS patients (-130,-185 to 60 vs.-70,-100 to 28), and the difference was statistically significant (Z=-3.065, P=0.002). The difference was mainly showed the symptom of abdominal pain, and the IBS-SSS abdominal pain score of Rome Ⅳ IBS patients was lower than that of non-Rome Ⅳ IBS patients (-80,-100 to -40 vs. 0,-40 to 0), and the difference was statistically significant (Z=-4.631, P<0.01). Conclusions IBS symptoms influence a lot on the satisfaction degree of treatment in outpatients. Even with similar good therapeutic effects, the Rome Ⅳ IBS symptoms have a more severe impact on patients than non-Rome Ⅳ IBS symptoms.