难治性胃食管反流病159例不同亚型生命质量和精神心理因素研究  

Study on the quality of life and psychological factors of 159 patients with different subtypes of refractory gastroesophageal reflux disease

作　　者：姜佳丽[1] 郭子皓[1] 李莉[1] 郭宝娜[1] 陈婧[1] 展玉涛[1] 伍冀湘 张川[1] Jiang Jiali;Guo Zihao;Li Li;Guo Baona;Chen Jing;Zhan Yutao;Wu Jixiang;Zhang Chuan(Department of Gastroenterology,Beijing Tongren Hospital Affiliated to Capital Medical University,Beijing 100730,China;Department of General Surgery,Beijing Tongren Hospital Affiliated to Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院消化内科,100730 [2]首都医科大学附属北京同仁医院普外科,100730

出　　处：《中华消化杂志》2020年第9期595-600,共6页Chinese Journal of Digestion

基　　金：北京市医院管理中心2018年度消化内科学科协同发展中心特色项目(XXT09)。

摘　　要：目的探讨难治性胃食管反流病(rGERD)患者的生命质量和精神心理因素。方法回顾性选择2016年9月至2019年3月就诊于首都医科大学附属北京同仁医院消化内科的rGERD患者159例,根据胃镜下有无远端食管黏膜损伤,将患者分成难治性反流性食管炎(RE)组(58例)和难治性非糜烂性反流病(NERD)组(101例)。记录并比较两组患者的一般资料、24 h食管阻抗-pH值测定结果、食管高分辨率测压(HRM)结果、胃食管反流病问卷(GerdQ)评分、简明健康状况调查量表(SF-36)评分、焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分。统计学方法采用独立样本t检验、秩和检验、卡方检验和多元线性回归分析。结果两组患者性别构成比、年龄、腹围、BMI差异均无统计学意义(P均>0.05)。难治性NERD组食管外症状发生率高于难治性RE组[45.5%(46/101)比24.1%(14/58)],差异有统计学意义(χ2=7.185,P=0.010)。难治性NERD组患者气体反流、弱酸反流、非酸反流次数均多于难治性RE组[分别为66.20次(45.20次,111.60次)比38.40次(23.50次,59.63次)、34.70次(9.05次,52.75次)比6.35次(3.10次,24.00次)、12.60次(2.15次,24.20次)比2.15次(0次,10.30次)],GerdQ评分高于难治性RE组[(8.9±2.5)分比(7.8±2.3)分],DeMeester评分、症状指数和症状相关可能性均低于难治性RE组[分别为5.16分(1.75分,14.48分)比15.19分(2.78分,45.96分)、33.3%(0,60.0%)比57.5%(40.5%,78.0%)、87.8%(0,97.8%)比94.0%(82.7%,98.2%)],差异均有统计学意义(Z=-5.548、-5.384、-4.338,t=3.306,Z=-2.607、-4.313、-2.468;P均<0.05)。难治性NERD组食管远端收缩积分低于难治性RE组[334.0 mmHg·s·cm(182.5 mmHg·s·cm,492.0 mmHg·s·cm)比399.0 mmHg·s·cm(216.5 mmHg·s·cm,756.3 mmHg·s·cm)(1 mmHg=0.133 kPa)],差异有统计学意义(Z=-2.204,P=0.030),两组食管下括约肌压力和蠕动中断长度差异均无统计学意义(P均>0.05)。两组患者的生理功能、生理职能、躯体疼痛、总体健康、活力Objective To explore the quality of life and psychological factors of patients with refractory gastroesophageal reflux disease(rGERD).Methods From September 2016 to March 2019,159 rGERD patients visiting the Department of Gastroenterology,Beijing Tongren Hospital Affiliated to Capital Medical University were retrospectively selected.According to the presence or absence of distal esophageal mucosal injury under gastroscopy,the patients were divided into refractory reflux esophagitis(RE)group(58 cases)and refractory non-erosive reflux disease(NERD)group(101 cases).The general data,the results of 24 h esophageal impedance pH,esophageal high-resolution manometry(HRM)and the scores of gatroesophageal reflux disease-questionnaire(GerdQ),36-item short-form health survey(SF-36),self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were recorded and compared between the two groups.Independent sample t test,rank sum test,chi-square test and multiple linear regression analysis were used for statistical analysis.Results There were no significant differences in gender,age,abdominal circumference or body mass index between the two groups(all P>0.05).The incidence of extraesophageal symptoms of refractory NERD group was higher than that of refractory RE group(45.5%,46/101 vs.24.1%,14/58),and the difference was statistically significant(χ2=7.185,P=0.010).The episodes of gas reflux,weak-acid reflux and non-acid reflux were all more than those of refractory RE group(66.20 times,45.20 times to 111.60 times vs.38.40 times,23.50 times to 59.63 times;34.70 times,9.05 times to 52.75 times vs.6.35 times,3.10 times to 24.00 times;12.60 times,2.15 times to 24.20 times vs.2.15 times,0 times to 10.30 times),GerdQ score of refractory NERD group was higher than that of refractory RE group(8.9±2.5 vs.7.8±2.3),and DeMeester score,the symptom index and symptom association probability of refractory NERD group were all lower than those of refractory RE group(5.16,1.75 to 14.48 vs.15.19,2.78 to 45.96;33.3%,0 to 60.0%vs.57.5%,40.5%to

关 键 词：难治性胃食管反流病 生命质量 焦虑 抑郁 

分 类 号：R571[医药卫生—消化系统]