消化道症状与胃镜检查结果相关性的前瞻性研究  

Correlation of endoscopy findings with symptoms in patients undergoing gastroscopy:a prospective study

作　　者：张维[1] 黄宇 李慧一 朱琦[1,2] 李小刚 戈之铮[1] 陆红[1] Zhang Wei;Huang Yu;Li Huiyi;Zhu Qi;Li Xiaogang;Ge Zhizheng;Lu Hong(Departmengt of Gastroenterology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai Institute of Digestive Diseases,Shanghai 200001,China;Departmengt of Gastroenterology,Baoshan Branch of Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 201900,China)

机构地区：[1]上海交通大学医学院附属仁济医院消化内科,上海市消化疾病研究所,上海200001 [2]上海交通大学医学院附属仁济医院宝山分院消化内科,上海201900

出　　处：《中华消化内镜杂志》2022年第9期714-718,共5页Chinese Journal of Digestive Endoscopy

基　　金：上海交通大学医学院附属仁济医院宝山分院医学重点专科建设项目(rbzdzk‑2019‑004)。

摘　　要：目的探讨初次胃镜检查患者的检查结果与消化道症状的相关性。方法2017年1—12月,在上海交通大学医学院附属仁济医院门诊行初次胃镜检查者作为问卷调查对象,详细登记消化道主要症状,之后2周内完成胃镜检查,将胃镜下诊断与病理诊断结合作为最终胃镜诊断,根据最终胃镜诊断结果将患者分为主要病变(消化性溃疡和恶性肿瘤)组和非主要病变(慢性胃炎、反流性食管炎及其他)组。分析消化道症状与胃镜检查结果的相关性,并采用多因素Logistic回归分析评估消化道不同症状者胃镜检出主要病变(消化性溃疡和恶性肿瘤)的风险。结果共5885例完成问卷调查,其中5496例(93.4%)完成胃镜检查。在消化不良症状、反流症状、报警症状、其他症状和无症状患者中,消化性溃疡的检出率分别为12.3%(373/3028)、12.6%(52/412)、17.9%(49/273)、9.5%(64/675)和9.2%(102/1108),恶性肿瘤的检出率分别为1.2%(36/3028)、0.7%(3/412)、7.7%(21/273)、0.7%(5/675)和0.4%(4/1108)。消化性溃疡和恶性肿瘤患者最常见的均为消化不良症状,分别占58.3%(373/640)和52.2%(36/69)。恶性肿瘤患者出现报警症状占30.4%(21/69)。15.9%(102/640)的消化性溃疡患者和5.8%(4/69)的恶性肿瘤患者无消化道症状。相对于消化道无症状者,有消化不良症状者(P<0.001,OR=1.52,95%CI:1.21~1.92)、有报警症状者(P<0.001,OR=2.87,95%CI:2.02~4.08)胃镜检出主要病变(消化性溃疡及恶性肿瘤)的风险均明显增加。结论尽管消化不良症状和报警症状与上消化道主要病变(消化性溃疡及恶性肿瘤)有一定相关性,但对上消化道主要病变的预测作用有限。Objective To investigate the correlation of endoscopy findings with symptoms in patients undergoing gastroscopy.Methods Patients who underwent gastroscopy for the first time in Renji Hospital of Shanghai Jiao Tong University School of Medicine from January to December 2017 were included in the questionnaire survey.The participants were asked to report their main symptoms of the digestive tract in details,and gastroscopy was completed within 2 weeks.Final gastroscopic diagnosis was made based on both gastroscopy and pathology,then patients were divided into the major-lesion(peptic ulcer and malignancy)group and the non-major-lesion(chronic gastritis,reflux esophagitis and others)group.The correlation of gastrointestinal symptoms with gastroscopic findings was analyzed.The risk for major gastroscopic lesions(peptic ulcer and malignant tumors)was assessed by multivariate Logistic regression analysis.Results A total of 5885 patients completed the questionnaire,5496(93.4%)of whom completed gastroscopy.The detection rates of peptic ulcer were 12.3%(373/3028),12.6%(52/412),17.9%(49/273),9.5%(64/675)and 9.2%(102/1108)in patients with dyspepsia,reflux,alarm,other symptoms and no symptoms,respectively,the detection rates of malignant tumors were 1.2%(36/3028),0.7%(3/412),7.7%(21/273),0.7%(5/675)and 0.4%(4/1108),respectively in these patients.The most common symptoms was dyspepsia,accounted for 58.3%(373/640)and 52.2%(36/69)patients with peptic ulcer and malignant tumors,respectively.Alarm symptoms were found in 30.4%(21/69)patients with malignant tumors,and 15.9%(102/640)peptic ulcer patients and 5.8%(4/69)malignant tumor patients had no gastrointestinal symptoms.Compared to asymptomatic individuals,patients with dyspepsia(P<0.001,OR=1.52,95%CI:1.21-1.92)and those with warning symptoms(P<0.001,OR=2.87,95%CI:2.02-4.08)had significantly increased risk for major lesions(peptic ulcer and malignant tumors)detected by gastroscopy.Conclusion Although dyspepsia and alarm symptoms are positively associated with upper gastrointestin

关 键 词：体征和症状 消化系统 胃镜检查 消化性溃疡 恶性肿瘤 

分 类 号：R57[医药卫生—消化系统]