基于生命质量和临床症状探讨痔病Goligher分级

Goligher classification of hemorrhoids based on quality of life and clinical symptoms

目的Giligher分级是目前应用最广泛的痔病严重度评分系统,但其缺乏对脱垂以外临床症状和生命质量的评估,本研究拟从生命质量评价和临床症状的角度探讨Goligher分级评价痔病严重程度的性能。方法对2017年5月至2018年9月在北京中医药大学东直门医院肛肠科住院的痔病病人进行人口学和疾病情况调查,予以Goligher分级,同时应用SF-36量表评估病人生命质量,统计分析痔病Goligher各分级之间生命质量和脱垂以外其他症状的差异。结果共209例痔病病人完成本次调查,GoligherⅠ级74例、Ⅱ级27例、Ⅲ级42例、Ⅳ级66例。Goligher各分级比较,在SF-36总分、PCS和MCS两个领域以及PF、RP、GH、VT、SF、RE、MH7个维度方面差异无统计学意义(P>0.05),BP维度方面差异有统计学意义(P<0.05);该研究有痔核脱出者135例,便血127,肛门疼痛116例,瘙痒21例,潮湿感6例,Goligher各分级比较,在疼痛、便血、肛门潮湿感方面差异无统计学意义(P>0.05),在瘙痒症状方面差异有统计学意义(Z=7.99,P=0.046);有疼痛症状组和无疼痛症状组比较,在SF-36总分(Z=-3.73,P<0.001)、PCS(Z=-3.62,P<0.001)和MCS(Z=-3.03,P=0.002)两个领域和以及PF、RP、BP、VT、SF、RE 6个维度方面差异有统计学意义,在GH和MH维度方面差异无统计学意义(P>0.05);有便血症状组和无便血症状组比较,仅GH(Z=-2.29,P=0.022)和VT(Z=-2.84,P=0.004)两个维度方面差异有统计学意义;有瘙痒症状组和无瘙痒症状组比较,仅PF维度(Z=-2.05,P=0.040)方面差异有统计学意义。结论Goligher分级不能反映痔病病人的生命质量和严重程度,缺少对疼痛和生命质量的评估是影响其评价能力的主要因素。

Objective Goligher classification is the most widely used hemorrhoid severity score system,but it lacks the evaluation of clinical symptoms and quality of life beyond prolapse.This study aims to explore the ability of Goligher classification to evaluate the severity of hemorrhoids from the perspective of quality of life and clinical symptoms.Methods The demographic and disease status of patients with hemorrhoids in Dongzhimen Hospital,Beijing University of Chinese Medicine from May 2017 to September 2018 were investigated,and Goligher classification was given.SF-36 scale was used to evaluate the quality of life of patients.The differences of quality of life and other symptoms except prolapse among different Goligher classification of hemorrhoids were statistically analyzed.Results A total of 209 patients with hemorrhoids completed the survey,including 74 cases of Goligher classfication I,27 cases of Goligher classificationⅡ,42 cases of Goligher classficationⅢand 66 cases of Goligher classificationⅣ.There was no significant difference in SF-36 total score,PCS and MCS,PF,RP,GH,VT,SF,RE and MH7 dimensions(P>0.05),but there was significant difference in BP dimension(P<0.05).There were 135 cases of prolapse of hemorrhoids,127 cases of hematochezia,116 cases of anal pain,21 cases of pruritus and 6 cases of dampness.There was no significant difference in pain,hematochezia and anal dampness among Goligher classfication(P>0.05),but there was significant difference in pruritus(Z=7.99,P=0.046).There were significant differences in SF-36 total score(Z=-3.73,P<0.001),PCS(Z=-3.62,P<0.001),MCS(Z=-3.03,P=0.002)and PF,RP,BP,VT,SF and RE between patients with and without pain,but there were no significant differences in GH and MH(P>0.05).Only GH(Z=-2.29,P=0.022)and VT(Z=-2.84,P=0.004)were significantly different between patients with and without hematochezia.There was only significant difference in PF dimension(Z=-2.05,P=0.040)between pruritus and non pruritus.Conclusion Goligher classification can not reflect the quality of life and severity of hemorrhoids patients.Lack of assessment of pain and quality of life is the main factor affecting the evaluation ability.