问询表诊断老年人胃食管反流病的临床评价  

DIAGNOSTIC VALUE OF QUESTIONNAIRE IN ELDER WITH GASTROESOPHAGEAL REFLUX DISEASE

作　　者：夏俊[1] 刘健[1] 姚健凤[1] 尹曙明[1] 虞阳[1] 于晓峰[1] 赵尚敏[1] 

机构地区：[1]华东医院消化内科,上海市200040

出　　处：《老年医学与保健》2004年第1期35-37,共3页Geriatrics & Health Care

摘　　要：目的探讨问询表调查在我国诊断老年胃食管反流病(GERD)的临床价值。方法选取有烧心,反酸,胸痛等症状,且连续发作一周以上的老年患者。进行胃镜检查,胃镜阳性者归入反流性食管炎组(RE组),胃镜阴性者进一步行食道测压及24小时胃食管pH监测,根据结果分为非糜烂性胃食管反流病组(NERD组)和正常对照组(Normal组)。所有患者均填写Carlsson-Dent自我症状问询表并给予PPI试验一周,以胃镜及24小时胃食管pH监测阳性为GERD确诊标准,统计问询表诊断胃食管反流病的敏感性、特异性和准确率。结果共78例老年患者入选,经检查分为RE组21例、NERD组31例和正常对照组26例。三组的问询表得分分别为5.86±2.90、5.00±3.14和3.69±1.57,RE组和NERD组得分与Normal组比较有显著差异(P<0.05);RE组和NERD组比较无明显差异。以4分为临界值,Carlsson-Dent问卷诊断胃食管反流病的敏感性为69.23%、特异性为38.46%、准确率为58.97%;PPI抑制试验结合Carlsson-Dent问卷诊断胃食管反流病的敏感性为88.46%、特异性为26.92%、准确率为67.94%。结论Carlsson-Dent问卷可用于筛选老年GERD,结合PPI试验可提高诊断的敏感性。Objective To assess the diagnostic value of Carlsson-Dent GERD questionnaire in elder population with GERD. Methods The patients with suggestive symptoms of GERD entered the study. All patients completed the questionnaire and endoscopy. Those with erosive esophagitis were included in RE group. If no abnormalities were found by endoscopy, the patients underwent ambulatory esophageal pH monitoring for 24h. The NERD was determined by 24h esophageal pH monitoring. All patients then received rebeprazole 10mg bid for 1 week. The test was considered positive when score of symptoms was reduced >or=50% compared with pretreatment. Using 24h esophageal pH monitoring and endoscopy as the “gold standard” for the diagnosis of GERD. The sensitivity, specificity and accuracy of questionnaire were calculated. Results Of the 78 patients included, RE was found in 21 (26.92%), NERD was found in 31 (39.74%)by pH monitoring. The other 26 patients were classified as normal group. The score of three groups were 5.86±2.90, 5.00±3.14 and 3.69±1.57,respectively. The difference of score was statistically significant between RE, NERD groups and normal groups(P< 0.05). But no difference was found between RE groups and NERD groups(P >0.05). A cut off score of equal or greater than 4 was determined to discriminate between GERD and normal patients with sensitivity, specificity and accuracy of 69.23%, 38.46% and 58.97%. However, the sensitivity and accuracy of questionnaire increased to 88.46% and 67.94% after adding patients with positive PPI test. Conclusions The Carlsson-Dent GERD questionnaire could be used in epidemiological studies to assess GERD in elder and in interventional studies of GERD.

关 键 词：胃食管反流 问卷 老年人 

分 类 号：R571[医药卫生—消化系统]