基于临床大数据对反流性食管炎相关影响因素的分析

Analysis of risk factors for reflux esophagitis based on clinical big data platform

背景近年来随着人们生活及饮食习惯的改变,反流性食管炎(reflux esophagitis,RE)的发病率逐年上升,影响了人们的生活质量.同时RE发病的相关危险因素及幽门螺杆菌(Helicobacter pylori,H.pylori)的感染与根除同RE的关系是当下的热点问题.目的通过临床大数据分析探究RE发病的相关危险因素及与H.pylori感染的关系.方法采用回顾性分析,对2010-03/2018-12在朝阳医院行消化内镜检查的住院患者进行筛选及分组研究.病例组为消化内镜确诊为RE,并且有明确洛杉矶(LosAngeles,LA)分级结果及H.pylori检查结果的住院患者,并进一步将病例组分为轻度RE组(LA-A)和重度RE组(LA-B、LA-C和LA-D);对照组是通过消化内镜检查确认为非RE、有H.pylori检查结果,并且排除了胃食管反流症状的患者.通过大数据平台,分析性别、年龄、体质指数(body mass index,BMI)、血脂、血糖、吸烟饮酒史、基础病、食管裂孔疝和H.pylori感染等多种因素同RE的关系.结果单因素Logistic回归分析发现对于RE,男性、BMI、吸烟史、食管裂孔疝是其危险因素,高密度脂蛋白胆固醇为其保护因素,而高血压和高脂血症病史是重度RE的危险因素,甘油三脂升高是轻度RE的危险因素.多因素Logistic回归校正后显示,无论病情程度如何,男性、BMI和食管裂孔疝均是RE的独立危险因素,H.pylori感染是RE的保护因素.结论RE的发病和发展与生活习惯、基础疾病和H.pylori感染等密切相关.

BACKGROUND In recent years,with the changes in people’s lives and dietary habits,the incidence of reflux esophagitis(RE)has increased year by year,seriously affecting people’s quality of life.The risk factors related to the incidence of RE and the relationship of Helicobacter pylori(H.pylori)infection and eradication with RE are now hot research topics.AIM To explore the risk factors for RE and the relationship between H.pylori infection and RE through a big data platform.METHODS A retrospective analysis was conducted to screen and group inpatients who underwent digestive endoscopy at Chaoyang Hospital from March 2010 to December 2018 in the study.The patients were divided into either an RE group or a control group.The RE group consisted of patients diagnosed with RE by digestive endoscopy with clear Los Angeles(LA)grading results and H.pylori results,and they were further divided into two subgroups:Mild RE(LA-A)and severe RE(LA-B,LA-C,and LA-D).The control group was confirmed as having no RE(endoscopic diagnosis of chronic superficial gastritis)by digestive endoscopy with H.pylori test results,and patients with gastroesophageal reflux symptoms were excluded.Both groups were analyzed through a big data platform,including gender,age,body mass index(BMI),blood lipids,blood glucose,smoking,drinking,hypertension,fatty liver,diabetes,hyperlipidemia,hiatal hernia,H.pylori infection and so on.RESULTS Univariate logistic regression analysis demonstrated that male gender,high BMI,smoking,and esophageal hiatal hernia were risk factors for RE.High-density lipoprotein cholesterol was found to be a protective factor.In addition,previous hypertension and hyperlipidemia are risk factors for severe RE,and elevated triglycerides are a risk factor for mild RE.Multivariate logistic regression analysis showed that male gender,high BMI,and esophageal hiatus hernia were independent risk factors for RE regardless of the severity of RE,and H.pylori infection was found to an independent protective factor for RE.CONCLUSION The occurrence and development of RE are closely related to some lifestyles,basic diseases,and H.pylori infection.