反流性食管炎质子泵抑制剂治疗失败51例分析

Failure of proton pump inhibitor therapy in 51 patients with reflux esophagitis

目的探讨反流性食管炎病人质子泵抑制剂治疗后失败的危险因素。方法回顾性分析重庆市大足区人民医院2018年4月至2020年4月205例接受质子泵抑制剂治疗反流性食管炎病人临床资料,并依据治疗结果分为治疗成功组(胃镜检查食管黏膜完全愈合,154例)、治疗失败组(胃镜检查食管黏膜愈合不完全或复发,51例)。所有病人入院后给予奥美拉唑(质子泵抑制剂)或奥美拉唑联合莫沙必利(胃动力)治疗。统计并对比两组性别、年龄、民族、体质量指数(BMI)、是否吸烟、是否饮酒、家族史、是否焦虑、是否抑郁、治疗时间、是否幽门螺旋杆菌(Hp)感染、用药方式、疾病严重程度差异。再将两组有差异的信息纳入多因素logistic回归分析模型,行量化赋值,以治疗结果为因变量(Y,失败=1,成功=0),明确反流性食管炎病人经质子泵抑制剂治疗后失败的危险因素。结果两组性别、年龄、民族、家族史、治疗时间、Hp感染对比差异无统计学意义(P>0.05);治疗失败组BMI>24 kg/m^(2)、吸烟、饮酒、焦虑、抑郁、单独应用质子泵抑制剂、疾病严重程度C~D级病人占比分别为70.59%(36/51)、64.71%(33/51)、78.43%(40/51)、70.59%(36/51)、68.63%(35/51)、64.71%(33/51)、62.75%(32/51),显著多于治疗成功组的25.97%(40/154)、35.71%(55/154)、25.32%(39/154)、19.48%(30/154)、18.83%(29/154)、44.81%(69/154)、9.74%(15/154),差异有统计学意义(P<0.05)。经多因素logistic回归分析证实BMI>24 kg/m^(2)、吸烟、饮酒、焦虑、抑郁、单独应用质子泵抑制剂、疾病严重程度C~D级为反流性食管炎病人经质子泵抑制剂治疗后失败的危险因素,均有P<0.05。结论反流性食管炎病人质子泵抑制剂治疗失败的危险因素较多,如BMI、吸烟、饮酒、焦虑、抑郁、用药方式、疾病严重程度,临床治疗工作中应当给予关注。

Objective To investigate the risk factors for failure after proton pump inhibitor therapy in patients with reflux esophagitis.Methods The clinical data of 205 patients with reflux esophagitis treated with proton pump inhibitors in Chongqing Dazu District People's Hospital from April 2018 to April 2020 were retrospectively analyzed..According to the results of treatment,the patients were divided into successful group(complete healing of esophageal mucosa by gastroscopy,154 cases)and failed group(incomplete healing of esophageal mucosa by gastroscopy or recurrence,51 cases).All patients were treated with omeprazole(proton pump inhibitor)or omeprazole plus mosapride(gastric motility)after admission.Gender,age,ethnicity,body mass index(BMI),smoking,drinking,family history,anxiety,depression,treatment time,Helicobacter pylori(Hp)infection,medication methods and disease severity were compared between the two groups.Then,the information with differences between the two groups was included in the multivariate logistic regression analysis model,and the quantitative value was assigned.The treatment outcome was taken as the dependent variable(Y,failure=1,success=0)to identify the risk factors of failure in patients with reflux esophagitis after proton pump inhibitor treatment.Results There were no significant differences in gender,age,ethnicity,family history,treatment time and Hp infection between the two groups(P>0.05).In the failed group,the proportions of patients with BMI>24 kg/m^(2),smoking,drinking,anxiety,depression,proton pump inhibitor alone,and disease severity C-D were 70.59%(36/51)and 64.71%(33/51),78.43%(40/51),70.59%(36/51),68.63%(35/51),64.71%(33/51),62.75%(32/51),significantly increased than those in the successful treatment group 25.97%(40/154),35.71%(55/154),25.32%(39/154),19.48%(30/154),18.83%(29/154),44.81%(69/154),9.74%(15/154),and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis confirmed that BMI>24 kg/m^(2),smoking,alcohol consumption,anxiety,depression,proton pump alone and disease severity grade C-D were risk factors for failure after proton pump treatment for reflux esophagitis(P<0.05).Conclusion Patients with reflux esophagitis have many risk factors for treatment failure,such as BMI,smoking,alcohol consumption,anxiety,depression,medication style,and disease severity,which should be paid attention to in clinical treatment.