老年消化性溃疡患者疾病特征分析

Disease characteristics of elderly patients with peptic ulcer

目的研究老年消化性溃疡(PU)患者疾病特征及其对生活质量的影响。方法选取2021年1月至6月北京王府中西医结合医院老年PU患者120例,入组后完善各项检查并详细记录临床资料,采用匹兹堡睡眠质量指数量表(PSQI)评估患者睡眠质量,采用健康状况调查简表(SF-36)评估患者生活质量,采用自我护理能力量表评估患者消化性溃疡自护能力。统计老年PU患者人口学特征、疾病诱因、发病季节、临床症状、特殊用药情况、并发症等临床特征。采用SPSS 23.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ2检验。采用多元线性回归分析老年PU患者生活质量影响因素。结果老年PU患者以男性为主(男性∶女性=1.67∶1),其中胃溃疡(GU)68例(56.67%)、十二指肠溃疡(DU)52例(43.33%),解热或镇痛类药物应用(50.83%)是诱发老年PU的主要原因;老年PU患者中出现规律腹痛(17.50%)及规律腹胀(21.67%)等PU典型表现者占比较低,出现黑便(41.67%)、乏力(35.00%)及反酸(40.00%)等非典型症状者占比较高;特殊用药史方面,使用非甾体类药物者占比23.33%(28/120),使用抗凝药物者占比33.33%(40/120);老年PU患者中22.50%合并消化性溃疡出血,8.33%合并溃疡穿孔,5.83%合并幽门梗阻;对比发现,GU组患者溃疡直径>2 cm者占比、多发溃疡者占比,以及合并肠上皮化生、合并不典型增生者占比均高于DU组,幽门螺旋杆菌感染者占比低于DU组,差异均有统计学意义(均P<0.05)。此外,老年PU患者生活质量36条目简明健康状况调查问卷中生理功能、生理职能、总体健康、生命力、精神健康及量表总得分均低于国内常模,差异均有统计学意义(均P<0.05)。多元线性回归分析提示,睡眠障碍(β=-0.274;P<0.001)、PU相关并发症(β=-0.343;P<0.001)及焦虑(β=-0.184;P<0.001)能负向预测老年PU患者生活质量;而高水平自护能力(β=0.313;P<0.001)能正向预测其生活质量,其共同解释患者生活质量31.50%的变异度。120例患者经治疗后均进行内镜随访检查,随访期间,除去失访人员,剩余76例患者中有14例(18.42%)在随访期内复发再次入院。结论老年PU患者男性占比高于女性,GU更多见,患者临床症状不典型,PU相关并发症较多,主要为消化性溃疡出血,疾病主要诱因为应用解热或镇痛类药物,此外,患者合并症情况复杂,生活质量明显下降,再次入院率较高。

Objective To study the disease characteristics and influencing factors of quality of life in elderly patients with peptic ulcer(PU).Methods A total of 120 elderly PU patients in Beijing Royal Integrative Medicine Hospital from January to June 2021 were selected.Upon enrollment,various examinations were completed and clinical data were recorded in detail.The sleep quality of the patients was assessed by Pittsburgh Sleep Quality Index(PSQI),the quality of life by MOS 36-item short-rorm health survey(SF-36),and the self-care ability by Exercise of Self-Care Agency Scale(ESCA).The clinical characteristics such as demographic characteristics,disease causes,onset seasons,clinical symptoms,special medication,and complications of the elderly PU patients were statistically analyzed.SPSS 23.0 was used for statistical analysis.Data comparison between two groups was performed using t test orχ2 test,depending on data type.Multivariate linear regression model was used to analyze the factors affecting the quality of life of the elderly PU patients.Results The elderly PU patients were mainly male(male∶female=1.67∶1),including 68(56.67%)of gastric ulcer(GU)and 52(43.33%)of duodenal ulcer(DU).The use of antipyretic or analgesic drugs(50.83%)was the main cause of PU in the elderly.In the elderly PU patients,the proportions of typical PU symptoms such as regular abdominal pain(17.50%)and regular abdominal distension(21.67%)were low,and the proportions of atypical symptoms such as melena(41.67%),fatigue(35.00%)and acid reflux(40.00%)were high.In terms of special medication history,the patients using non-steroidal drugs accounted for 23.33%(28/120),and those using anticoagulant drugs accounted for 33.33%(40/120).Among the elderly PU patients,22.50%had peptic ulcer bleeding,8.33%had ulcer perforation,and 5.83%had pyloric obstruction.By comparison,the proportions of patients with ulcer diameter>2 cm,with multiple ulcers,and with intestinal metaplasia and atypical hyperplasia in the GU group were higher than those in the DU group,while the proportion of patients with Helicobacter pylori infection in the GU group was lower than that in the DU group,and the differences were statistically significant(P<0.05 for all).In addition,the scores of physical function,role physical,general health,vitality,mental health,and the total score on the SF-36 scale in the elderly PU patients were lower than those of the domestic norms,and the differences were statistically significant(P<0.05 for all).Multivariate linear regression analysis showed that sleep disorders(β=-0.274;P<0.001),PU-related complications(β=-0.343;P<0.001),and anxiety(β=-0.184,P<0.001)could negatively predict the quality of life of the elderly PU patients,while high level of self-care ability(β=0.313;P<0.001)could positively predict the quality of life,which together explained 31.50%of the variation of the patients′quality of life.All 120 patients underwent endoscopic follow-up examination after treatment.Excluding those who were lost to follow-up,14(18.42%)of the remaining 76 patients relapsed and were readmitted during follow-up.Conclusion The proportion of the male PU patients is higher than that of the female patients;GU is more common;the clinical symptoms of patients are not typical;PU-related complications are more common,mainly peptic ulcer bleeding;the main cause of the disease is the use of antipyretic or analgesic drugs.In addition,the comorbidities are complex,the quality of life is significantly reduced,and the readmission rate is higher.