陕西省农村成人胃食管反流病、功能性消化不良和肠易激综合征的重叠患病调查

Survey on the overlapping prevalence of gastroesophageal reflux disease,functional dyspepsia and irritable bowel syndrome among rural adults in Shaanxi Province

目的探讨陕西省农村成人胃食管反流病(GERD)、功能性消化不良(FD)和肠易激综合征(IBS)的重叠患病率及其危险因素。方法于2019年2月1日至10月31日通过多阶段、分层整群抽样对随机选取的陕西省12个村进行入户问卷调查,共纳入2423名受调查者,其中男1037名,女1386名,年龄为(45.3±16.9)岁。依据蒙特利尔标准诊断GERD,依据罗马Ⅳ标准诊断FD和IBS,计算3种疾病的重叠患病率,分析GERD、FD和IBS重叠的危险因素。统计学方法采用多因素logistic回归分析。结果2423名受调查者中,624例患有GERD(302例)、FD(377例)或IBS(167例),其中30.77%(192/624)的患者存在≥2种疾病的重叠;GERD与FD重叠、GERD与IBS重叠、FD与IBS重叠、GERD与FD和IBS重叠的患病率分别为2.56%(62/2423)、1.61%(39/2423)、2.52%(61/2423)、1.24%(30/2423)。多因素分析显示女性、无先兆偏头痛与GERD和FD重叠、FD和IBS重叠、GERD和IBS重叠均呈正相关[比值比(OR)=3.08、2.68、3.66、7.37、5.91、4.46,95%可信区间(CI)1.35~7.01、1.35~5.30、1.52~8.83、3.97~13.69、1.78~19.60、2.01~9.92,P均<0.05];大量饮酒[酒精摄入量≥50 g/d(男)或≥30 g/d(女)]与FD和IBS重叠、GERD和IBS重叠,以及GERD、FD和IBS重叠均呈正相关(OR=3.69、4.20、4.91,95%CI 1.19~11.48、1.01~17.50、1.23~19.52,P均<0.05);重度吸烟(吸烟≥20支/d)与GERD和FD重叠、FD和IBS重叠、GERD和IBS重叠,以及GERD、FD和IBS重叠均呈正相关(OR=3.44、6.25、8.27、7.04,95%CI 1.07~11.01、1.60~24.44、1.80~38.07、1.76~28.12,P均<0.05);初中或高中教育水平、年龄≥60岁与GERD和FD重叠、FD和IBS重叠、GERD和IBS重叠,以及GERD、FD和IBS重叠均呈负相关(OR=0.47、0.29、0.20、0.05、0.23、0.10、0.37、0.16,95%CI 0.23~0.93、0.09~0.95、0.09~0.42、0.01~0.19、0.09~0.60、0.02~0.65、0.15~0.87、0.03~0.81,P均<0.05)。结论GERD、FD和IBS的重叠很常见,并受多种因素影响。女性、年龄≥60岁、重度吸烟、大量饮酒、教育程度低和无先兆偏头痛病史与GERD、FD和IBS间多种重叠的发生相关。

Objective To investigate the overlapping prevalence and risk factors of gastroesophageal reflux disease(GERD),functional dyspepsia(FD)and irritable bowel syndrome(IBS)among rural adults in Shaanxi Province.Methods From February 1 to October 31 in 2019,12 villages in Shaanxi Province were randomly selected for household questionnaire survey through multistage stratified cluster sampling.A total of 2423 subjects were enrolled,including 1037 males and 1386 females,with age of(45.3±16.9)years old.GERD was diagnosed according to the Montreal criteria,FD and IBS were diagnosed according to the RomeⅣcriteria.The overlapping prevalence of the three diseases were calculated.The risk factors for the overlapping of GERD,FD and IBS were analyzed.Multivariate logistic regression was used for statistical analysis.Results Among the 2423 subjects,624 cases had GERD(302 cases),FD(377 cases)or IBS(167 cases),of which 30.77%(192/624)patients had overlap of≥two diseases.The overlap rates of GERD and FD,GERD and IBS,FD and IBS,GERD,FD and IBS were 2.56%(62/2423),1.61%(39/2423),2.52%(61/2423)and 1.24%(30/2423),respectively.The results of Multivariate analysis showed that female and migraine without aura were positively correlated with the overlap of GERD and FD,FD and IBS,and GERD and IBS(odds ratio(OR)=3.08,2.68,3.66,7.37,5.91 and 4.46,95%confidence interval(CI)1.35 to 7.01,1.35 to 5.30,1.52 to 8.83,3.97 to 13.69,1.78 to 19.60 and 2.01 to 9.92;all P<0.05).Heavy drinking(alcohol intake≥50 g/d(male)or≥30 g/d(female))was positively correlated with the overlap of FD and IBS,GERD and IBS,and GERD,FD and IBS(OR=3.69,4.20 and 4.91,95%CI 1.19 to 11.48,1.01 to 17.50 and 1.23 to 19.52;all P<0.05).Heavy smoking(smoking≥20 cigarettes per day)was positively correlated with the overlap of GERD and FD,FD and IBS,GERD and IBS,and GERD,FD and IBS(OR=3.44,6.25,8.27 and 7.04,95%CI 1.07 to 11.01,1.60 to 24.44,1.80 to 38.07 and 1.76 to 28.12;all P<0.05).The educational level of junior or senior high school and age≥60 years old were negatively correlated with the overlap of GERD and FD,FD and IBS,GERD and IBS,and GERD,FD and IBS(OR=0.47,0.29,0.20,0.05,0.23,0.10,0.37 and 0.16,95%CI 0.23 to 0.93,0.09 to 0.95,0.09 to 0.42,0.01 to 0.19,0.09 to 0.60,0.02 to 0.65,0.15 to 0.87 and 0.03 to 0.81;all P<0.05).Conclusions The overlap of GERD,FD and IBS is common and affected by many factors.Female,age≥60 years old,heavy smoking,heavy drinking,low education level and history of migraine without aura are associated with multiple overlaps of GERD,FD and IBS.