内镜下射频消融术治疗胃食管反流病疗效的影响因素分析

Analysis on the factors that affect the therapeutic effects of endoscopic radiofrequency ablation on gastroesophageal reflux disease

目的分析内镜下射频消融术(Stretta)治疗胃食管反流病(GERD)疗效的影响因素。方法选择2016年1月至2019年1月金华市中医医院收治的内镜下Stretta治疗的GERD患者70例作为研究对象,根据预后效果分为预后良好组(57例)和预后不良组(13例)。收集所有患者的临床资料,包括患者性别、年龄、体质量指数(BMI)、病程、合并症(高血压、冠心病、糖尿病)、吸烟、酗酒情况及汉密尔顿抑郁量表(HAMD)评分和汉密尔顿焦虑量表(HAMA)评分。采取非条件logistic逐步回归分析内镜下Stretta治疗GERD后疗效的影响因素。结果经单因素分析,与预后良好组相比,预后不良组女性、年龄≥60岁、BMI≥25 kg/m^(2)、病程≥5年、酗酒、HAMD评分≥8分、HAMA评分≥7分的患者比例更高,差异均有统计学意义(χ^(2)=9.574、10.821、22.575、8.653、10.586、4.070、8.653,均P<0.05)。经logistic回归性分析证实女性、年龄≥60岁、BMI≥25 kg/m^(2)、病程≥5年、酗酒、HAMD评分≥8分、HAMA评分≥7分是内镜下Stretta治疗GERD预后不良的危险因素,差异均有统计学意义(χ^(2)=11.174、6.023、8.698、5.972、5.821、7.485、5.443,均P<0.05)。经一致性分析显示,性别、年龄、BMI、病程、有无酗酒习惯、HAMD评分和HAMA评分可用于内镜下Stretta治疗GERD疗效的预测,并且联合预测具有较高的一致性,0.827>0.577、0.533、0.795、0.547、0.606、0.434、0.547。结论内镜下Stretta治疗GERD疗效的影响因素比较多,如性别、年龄、BMI、病程、是否酗酒、HAMD评分和HAMA评分,这对于临床治疗GERD患者具有一定参考价值,且联合预测具有较高的准确率。

Objective To investigate the factors that affect the therapeutic effects of endoscopic radiofrequency ablation(Stretta procedure)on gastroesophageal reflux disease(GERD).Methods Seventy patients with gastroesophageal reflux disease who received endoscopic radiofrequency ablation(Stretta procedure)treatment in Jinhua Hospital of Traditional Chinese Medicine from January 2016 to January 2019 were included in this study.They were divided into good prognosis group(n=57)and poor prognosis group(n=13)according to prognostic effects.The clinical data of all patients were collected,including gender,age,body mass index(BMI),course of disease,complications(hypertension,coronary heart disease,diabetes),smoking,drinking,Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)scores.Unconditional stepwise logistic regression was performed to analyze the factors that affect the therapeutic effects of Stretta procedure on GERD.Results Univariate analysis results revealed that the proportion of patients aged≥60 years with BMI≥25 kg/m^(2),alcohol abuse,HAMD score≥8,HAMD score≥7 was significantly higher in the poor prognosis group than in the good prognosis group(χ^(2)=9.574,10.821,22.575,8.653,10.586,4.070,8.653,all P<0.05).Logistic regression analysis confirmed that female gender,age≥60 years,BMI≥25 kg/m^(2),course of disease≥5 years,alcohol abuse,HAMD score≥8 and HAMA score≥7 were the risk factors for poor prognosis of gastroesophageal reflux disease(χ^(2)=11.174,6.023,8.698,5.972,5.821,7.485,5.443,all P<0.05).Consistency analysis revealed that gender,age,BMI,course of disease,alcohol abuse,HAMD score and HAMA score could be used to predict the therapeutic effects of endoscopic radiofrequency ablation(Stretta procedure)on GERD.Combined application of gender,age,BMI,course of disease,alcohol abuse,HAMD score and HAMA score exhibited higher consistency than a single application,0.827>0.577,0.533,0.795,0.547,0.606,0.434 and 0.547.Conclusion There are many factors that affect the therapeutic effects of endoscopic radiofrequency ablation(Stretta procedure)on GERD,including gender,age,BMI,course of disease,alcohol abuse,HAMD score and HAMA score.This is of certain reference value for clinical treatment of GERD,and combined application of these influential factors has a high accuracy in the prediction of the therapeutic effects of Stretta procedure on GERD.