中国北方五市儿童功能性便秘症状学诊断标准的初步研究  

Preliminary study on diagnostic standard of functional constipation in children from five cities in North China

作　　者：张树成[1] 王维林[1] 曲日斌[1] 苏鹏俊[1] 张世伟 张浩然 谭士勇 陈晓娟[4] 张威[5] 吴海涛[6] 王剑利[7] 何艳[8] 董光辉[9] 

机构地区：[1]中国医科大学附属盛京医院儿外,沈阳110004 [2]哈尔滨市儿童医院外科 [3]吉林市儿童医院外科 [4]天津中国协和医科大学血液研究所 [5]天津市第一中心医院移植外科 [6]北京市丰台区卢沟桥医院儿科 [7]北京市朝阳医院妇产科 [8]北京中国协和医科大学协和医院急诊科 [9]沈阳中国医科大学公共卫生学院

出　　处：《中华胃肠外科杂志》2010年第9期656-660,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（30700917）

摘　　要：目的 探讨适用于我国儿童功能性便秘（FC）的症状学诊断标准.方法 应用分层、整群随机抽样方法对中国北方五市（北京、天津、沈阳、长春和哈尔滨）常住人口中4～14岁的儿童进行问卷调查,按儿童罗马Ⅲ标准筛选确定便秘组,了解便秘组和非便秘组各症状发生的频率并进行分析评价.结果 共发放问卷20 000份,回收19 638份（98.2%）.便秘组1593例,非便秘组17 693例.χ2检验显示：排粪次数每周少于3次、粪干硬成团块状、每隔一段时间就有1次特别多的排粪、排粪费力且时间长、粪便带血、腹痛、腹胀等15个症状（包括上、下消化道及少数邻近器官症状）与便秘有关（P＜0.01和P＜0.05）.Logistic回归分析显示：排粪次数每周少于3次、粪干硬成团块状、排粪费力和需要泻药协助排粪为最具显著性的症状（均P＜0.01）.具备其中2条者的标准与儿童罗马Ⅲ标准具有较高的一致性,特异度和灵敏度分别为92.29%和94.85%,诊断准确率高达94.33%.结论 我国儿童FC的症状学诊断标准可考虑为：（1） 排粪次数每周少于3次;（2）粪干硬成团块状;（3）排粪费力;（4）需要泻药协助排粪.城市儿童在连续2个月内持续出现其中任意2条可初步考虑为FC.Objective To explore the symptomatic criteria for diagnosis in children with functional constipation（FC） in North China. Methods A screening program for FC in children was carried out in 5 northern cities （Beijing, Tianjin, Shenyang, Changchun, Harbin） of China according to symptoms using RomeⅢ criteria. Random clustered sampling of the inhabitants was carried out under stratification of city, region and school or kindergarten. Sample size of each area was in proportion to the population of the area. The range of age was 4-14. All the subjects were requested to fill in a questionnaire distributed by the teacher. The screening program was carried out immediately after a plot survey. A total of 20,000 questionnaires were distributed and 19,638 retrieved. According to the result of the screening, a small number of patients who fulfilled the criteria were further selected to undergo detail clinical examinations in the hospital including laboratory examination, colonic transit time, defecography or/and barium enema, electromyologram and anorectal manometry to exclude organic disease of the colon. A detailed questionnaire was filled in with the assistance from a trained doctor or a medical student. Potential risk factors and the relative symptoms were explored by comparing frequencies between FC group and non-FC group using χ2 and Logistic analysis. Results Eighteen symptoms （defecation less than 3 times per week, dry hard sausage-shape stool, difficulty in defecation, abdominal pain, nausea and vomiting, etc） could exist in control group, but FC group had a higher frequency. The difference was statistically significant. Multivariable stepwise logistic regression analysis showed that defecation less than 3 times per week, hard sausage-shape feces, difficulty in defecation, and the need for laxative were associated with FC. The absence of other symptoms had no influence on diagnosis of FC. The sensitivity, specificity and diagnostic accuracy of symptomatic standard diagnostic test based on RomeⅢ criteri

关 键 词：功能性便秘 儿童 流行病学 诊断 中国人 

分 类 号：R72[医药卫生—儿科]