上海嘉定地区1279例胃癌症状-就诊-确诊时间研究

Study on the time from symptom-visiting doctor-diagnosis of 1279 cases of gastric cancer in Jiading district of Shanghai

目的调查上海嘉定地区胃癌患者从出现症状,到就诊及确诊时间。了解其影响因素,分析其与国际差距的原因。方法收集2012年12月至2020年4月上海交通大学附属瑞金医院北院病理诊断为胃癌患者共1279例的临床资料。调查患者首次就诊的症状(按照常见“胃癌报警症状”:腹痛、腹胀、反酸、嗳气、恶心呕吐、呕血黑便、乏力纳差等进行分类),就诊时间及确诊时间(胃镜活检或者外科手术病理确诊),采用多因素Logistic回归模型等方法进行统计学分析影响患者就诊及确诊因素。结果1279例患者就诊的主要症状为腹痛556例(43.47%)、饱胀、反酸、嗳气389例(30.42%);黑便、呕血、乏力205例(16.03%),进食梗阻感、恶心呕吐87例(6.80%),体检发现肿瘤指标升高42例(3.28%)。就诊时间平均为(1.25±0.55)个月,就诊时间与患者症状、就医距离、医疗费用支付途径等相关。确诊时间平均为(4.76±1.85)个月,确诊时间与患者就诊时间、首次就诊是否采用胃镜检查等相关。Logistic回归分析显示,就诊症状(OR=1.545,95%CI:1.341~1.781)、医疗费用支付途径(OR=1.939,95%CI:1.021~3.681)是胃癌确诊及时性的危险因素。就医距离(OR=1.695,95%CI:1.509~1.989)、首次就医选择胃镜检查(OR=1.008,95%CI:1.049~1.124)是胃癌确诊及时性的保护因素。结论上海嘉定地区胃癌患者出现症状以腹痛、饱胀反酸嗳气、呕血黑便乏力为主,就诊和确诊时间较国外时间长,与患者对胃癌认识及胃镜检查意识、就医距离、医疗费用支付途径等因素相关。

Objective To investigate the time from symptom onset to visit doctor and diagnosis of gastric cancer in Jiading district of Shanghai.To understand the influencing factors and analyze the reasons for its gap with the international community.Methods The clinical data of 1279 patients with gastric cancer diagnosed by pathology in the Ruijin Hospital North Affiliated to Shanghai Jiao Tong University School of Medicine from December 2012 to April 2020 were collected.The symptoms of patients first visit(according to common"gastric cancer alarm symptoms":abdominal pain,abdominal distension,acid regurgitation,belching,nausea and vomiting,hematemesis and melena,weakness and poor appetite,etc.),visiting time and diagnosis time(endoscopic biopsy or surgical pathological diagnosis)were investigated.Multivariate Logistic regression model and other methods were used for statistical analysis of the factors influencing the visiting and diagnosis of patients.Results The main symptoms of 1279 patients were abdominal pain in 556(43.47%),bloating,acid regurgitation and belching in 389(30.42%),black stools,hematemesis and fatigue in 205(16.03%),food obstruction,nausea and vomiting in 87(6.80%),and elevated tumor indexes found by physical examination in 42(3.28%).The average medical visit time was(1.25±0.55)months,which was related to the patients′symptoms,the distance and the way of payment of medical expenses.The average diagnosis time was(4.76±1.85)months,which was related to the time of the patients′visit and whether the first visit was performed by gastroscopy.Logistic regression analysis showed that symptoms(OR=1.545,95%CI:1.341-1.781)and medical expenses payment method(OR=1.939,95%CI:1.021-3.681)were risk factors for timely diagnosis of gastric cancer.Medical treatment distance(OR=1.695,95%CI:1.509-1.989)and the choice of gastroscopy for first visit(OR=1.008,95%CI:1.049-1.124)were protective factors for timely diagnosis of gastric cancer.Conclusion The symptoms of gastric cancer patients in Jiading area of Shanghai are mainly abdominal pain,distension,regurgitation of acid,belching,hematemesis,black stools,and fatigue.The time of visit and diagnosis was longer than that in foreign countries,which was related to the patients′awareness of gastric cancer and gastroscopy,medical treatment distance,medical expense payment route and other factors.