罗马Ⅳ与罗马Ⅲ标准诊断高校大学生功能性胃肠病的比较研究

Comparative Study Between RomeⅢand RomeⅣCriteria in College Students With Functional Gastrointestinal Disorders

背景:2016年新发布的罗马Ⅳ标准与罗马Ⅲ标准相比,对功能性胃肠病(FGIDs)具有更严格和精确的定义。罗马Ⅳ标准对诊断标准的调整和完善可能影响FGIDs的临床诊断。目的:比较罗马Ⅳ与罗马Ⅲ标准对诊断高校大学生FGIDs的一致性和差异。方法:选取前期研究团队建立的浙江省大学生FGIDs数据库资料,根据罗马Ⅳ标准对数据进行重新评估和分析,计算各FGIDs的患病率、心理症状评分、疾病重叠情况,并与罗马Ⅲ标准进行比较。结果:共纳入1 870份资料,其中符合罗马Ⅳ标准的FGIDs患者1 025例(54.81%),符合罗马Ⅲ标准的FGIDs患者1 111例(59.41%),两种标准的检出率差异有统计学意义(P<0.01)。罗马Ⅳ标准组嗳气症(2.14%对5.83%,P<0.01)、肠易激综合征(IBS)(2.78%对6.90%,P<0.01)、功能性腹胀(1.28%对4.12%,P<0.01)患病率均显著低于罗马Ⅲ标准组,而功能性腹泻患病率显著升高(3.85%对0.70%,P<0.01)。符合罗马Ⅳ标准的患者具有更高的强迫、抑郁和焦虑评分(P<0.05)。罗马Ⅳ标准使33例(25.58%)原IBS患者纳入功能性腹泻,使6例(4.65%)原IBS患者纳入功能性便秘。两种标准在诊断功能性肠病重叠其他FGIDs(嗳气症、功能性消化不良)的差异有统计学意义(P<0.01,P<0.05)。结论:罗马Ⅳ标准对于FGIDs具有更严格和精准的定义,能更好地反映患者的精神心理和临床特征,准确识别真正需要治疗的患者,在临床实践和科学研究中的应用更高效和可行。

Background:The newly released Rome Ⅳ criteria in 2016 has a stricter and more precise definition of functional gastrointestinal disorders(FGIDs)when compared with Rome Ⅲ criteria.The adjustment and improvement of diagnostic criteria by Rome Ⅳ criteria may affect the clinical diagnosis of FGIDs.Aims:To investigate the differences and the similarities between Rome Ⅲ and Rome Ⅳcriteria in the diagnosis of FGIDs in college students.Methods:The FGIDs database of college students in Zhejiang Province established by our previous research team were further evaluated and analyzed by RomeⅣcriteria,and the incidence,psychological symptom score,overlapping of disease of FGIDs were calculated,and compared with RomeⅢcriteria.Results:Of the 1870 cases in database,1025(54.81%)met RomeⅣcriteria of FGIDs;while 1111(59.41%)met RomeⅢcriteria,the difference in detection rate was statistically significant(P<0.01).In RomeⅣgroup,incidences of belching disorders(2.14%vs.5.83%,P<0.01),irritable bowel syndrome(IBS)(2.78%vs.6.90%,P<0.01),functional abdominal bloating/distension(1.28%vs.4.12%,P<0.01)were significantly lower than those in RomeⅢgroup,while incidence of functional diarrhea was significantly higher(3.85%vs.0.70%,P<0.01).Patients met RomeⅣcriteria showed a higher score of obsession⁃compulsion,depression and anxiety(P<0.05).RomeⅣcriteria caused 33(25.58%)original IBS patients included in functional diarrhea,and 6(4.65%)original IBS patients included in function constipation.The diagnosis of functional bowel disease overlapping with other FGIDs(belching disorders,functional dyspepsia)according to RomeⅢand RomeⅣcriteria were statistically different(P<0.01,P<0.05).Conclusions:RomeⅣcriteria has a stricter and more accurate definition of FGIDs,reflecting a more accurate psychological and clinical features,and identification of patients who really need treatment,resulting in a more efficient and feasible application in clinical practice and scientific research.