海勤人员十二指肠胃反流与胃黏膜肠化的关系探讨  

Discussion on the relationship between duodenogastric reflux and intestinal metaplasia in gastric mucosa among sea service personnel

作　　者：吕礁[1] 施云星[1] 覃林花[1] 刘长云[1] 曾晓虹[1] 郑智武[1] 张莉[1] 李琳[1] 周国中[1] 

机构地区：[1]解放军第四一一医院消化内科,上海200081

出　　处：《中华航海医学与高气压医学杂志》2013年第6期398-401,共4页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的 通过反流性疾病问卷（reflux diagnostic questionnaire,RDQ）调查、胃镜下观察以及胃黏膜活组织检查,了解舰船人员反流症状、胃镜下十二指肠胃反流以及胃黏膜肠化等情况.方法 舰船生活工作≥12个月的375名海勤人员为海勤组,同期无舰船生活工作史的陆勤人员922名为陆勤组,以50岁为界,各分为高龄组、低龄组,以上人员均为男性.以反酸、烧心、反食、胸骨后疼痛等症状的程度和频度分值作为RDQ积分,用带有窄带成像与放大染色功能（narrow-band imaging,NBI）的电子胃镜观察胃黏膜,以RDQ积分≥13作为症状性十二指肠-胃-食管反流的诊断标准,根据胃镜下胆汁反流出现与否分别观察胃黏膜肠化发生情况.结果 海勤低龄组262人,胃黏膜肠化发生率11.1％;陆勤低龄组697人,肠化发生率5.3％;2组胃黏膜肠化发生率差异有统计学意义（P＜0.01）.按RDQ积分≥13作为有反流症状标准,海勤低龄组有此症状者115例（43.9％）,陆勤低龄组201例（28.8％）,2组比较差异有统计学意义（P＜0.01）;但胆汁反流发生情况差异无统计学意义（P＞0.05）.RDQ积分≥13的人群中,海勤低龄组肠化发生率16.5％,与陆勤低龄组（8.5％）和海勤高龄组（31.9％）相比,差异均有统计学意义（P＜0.05）;海勤低龄组伴胆汁反流的肠化发生率44.0％,显著高于同组不伴胆汁反流（6.7％）、陆勤低龄组伴胆汁反流者（16.7％）和不伴胆汁反流者（5.3％）,差异均有统计学意义（P＜0.05）.结论 海勤人员长时间在海上工作和生活,会产生较为明显的十二指肠胃反流,并对胃黏膜病变产生一定的影响.Objective To investigate the medical conditions of reflux symptoms,duodenogastric reflux and intestinal metaplasia in gastric mucosa among sea service personnel through reflux diagnostic questionnaire,gastroscopy and gastric mucosa biopsy.Methods Three hundred and seventy-five male sea service personnel who had a sea service history for 12 months or over 1 year were assigned to the afloat group,and 922 male naval personnel who did not have a sea service history at the same period were assigned to the ashore group.With the age of 50 as the line of demarcation,the above 2 groups were further divided into the senior age groups and junior age groups.Severity and frequency of acid regurgitation,heartburn,regurgitation,retrosternal chest pain were recorded as scores of reflux diagnostic questionnaire （RDQ）.Gastric mucosa was observed with the narrow-band imaging/amplifying staining electron gastroscopy.Accumulated RDQ scores of ≥ 13 were used as diagnostic standards of symptomatic duodenogastric-gastroesophageal reflux.The occurrence of intestinal metaplasia depended on whether or not there was reflux of bile.Results The incidence of intestinal metaplasia in gastric mucosa for the 262 people of the junior age afloat group was 11.1%,while that for the 697 people of the junior age ashore group was 5.3%.Statistical differences could be noted,when comparisons were made between the 2 groups （P 〈 0.01）.With the accumulated RDQ scores of ≥ 13 as diagnostic standards of reflux,115 cases were diagnosed as having duodenogastric-gastroesophageal reflux among people of the junior age afloat group （43.9%）,while there were only 201 cases among people of the junior age ashore group （28.8%）.Statistical significance could be seen,when comparisons were made between the 2 groups （P 〈 0.01）.However,no statistical differences could be noted in bile reflux between the 2 groups（P 〉 0.05）.Among the population with the accumulated RDQ scores of ≥ 13,the incidence of intestinal metaplasia in the junior age af

关 键 词：海勤人员 十二指肠胃反流 肠化生胃黏膜 反流性疾病 

分 类 号：R83[医药卫生—航空、航天与航海医学]