中华消化杂志
中華消化雜誌
중화소화잡지
Chinese Journal of Digestion
2011年
1期
45-49
,共5页
顾清%王虹%顾而立%高建萍%周磊%孙一骏%张悦
顧清%王虹%顧而立%高建萍%週磊%孫一駿%張悅
고청%왕홍%고이립%고건평%주뢰%손일준%장열
胃食管反流%问卷调查%监测,生理学%氢离子浓度%肥胖症
胃食管反流%問捲調查%鑑測,生理學%氫離子濃度%肥胖癥
위식관반류%문권조사%감측,생이학%경리자농도%비반증
Gastroesophageal reflux%Questionaire%Monitoring,physiologic%Hydrogen-Ion concentration%Obesity
目的 确定胃食管反流病问卷(GerdQ)症状评分能否反映胃食管反流病(GERD)患者由24 h食管动态pH监测显示的酸暴露情况,进一步验证GerdQ的临床应用价值.方法 纳入2008年11月至2010年3月因烧心等上消化道症状就诊的门诊GERD病例134例,均完成胃镜检查、24 h食管动态pH监测和GerdQ量表.根据24 h食管动态pH监测结果,分别以DeMeester评分≥14.72或pH＜4时间百分比≥4.2%为标准判定食管酸暴露并评价GerdQ评分差异.分别以DeMeester评分≥14.72和pH＜4时间百分比≥4.2%为标准绘制GerdQ评分的受试者工作特征(ROC)曲线.采用SPSS 17.0统计软件,率的比较用U检验和卡方检验,组间比较采用t检验.结果 以DeMeester评分≥14.72为标准,酸暴露组患者的体重指数(BMI)高于非酸暴露组(t=2.365,P=0.019),酸暴露组患者的GerdQ评分[(8.51±2.34)分]高于非酸暴露组[(6.67±2.79)分,t=4.002、P＜0.01],GerdQ评分的ROC曲线下面积(AUC)为0.70,当GerdQ评分临界值为7.5分时,Youden指数最大为0.3365,诊断的敏感度为0.6909,特异度为0.6456.以pH＜4的时间百分比≥4.2%为标准,GerdQ评分的AUC为0.663,当GerdQ评分临界值为7.5分时,Youden指数最大为0.2790,诊断的敏感度为0.6600,特异度为0.6190.结论 GerdQ评分＞7.5分能较好反映食管下端的酸暴露,以DeMeester评分≥14.72作为酸暴露判定标准较以pH＜4时间百分比≥4.2为判定标准和GerdQ评分的关联更强.肥胖可能加重下食管括约肌的一过性松弛从而导致GERD症状的发生.
目的 確定胃食管反流病問捲(GerdQ)癥狀評分能否反映胃食管反流病(GERD)患者由24 h食管動態pH鑑測顯示的痠暴露情況,進一步驗證GerdQ的臨床應用價值.方法 納入2008年11月至2010年3月因燒心等上消化道癥狀就診的門診GERD病例134例,均完成胃鏡檢查、24 h食管動態pH鑑測和GerdQ量錶.根據24 h食管動態pH鑑測結果,分彆以DeMeester評分≥14.72或pH＜4時間百分比≥4.2%為標準判定食管痠暴露併評價GerdQ評分差異.分彆以DeMeester評分≥14.72和pH＜4時間百分比≥4.2%為標準繪製GerdQ評分的受試者工作特徵(ROC)麯線.採用SPSS 17.0統計軟件,率的比較用U檢驗和卡方檢驗,組間比較採用t檢驗.結果 以DeMeester評分≥14.72為標準,痠暴露組患者的體重指數(BMI)高于非痠暴露組(t=2.365,P=0.019),痠暴露組患者的GerdQ評分[(8.51±2.34)分]高于非痠暴露組[(6.67±2.79)分,t=4.002、P＜0.01],GerdQ評分的ROC麯線下麵積(AUC)為0.70,噹GerdQ評分臨界值為7.5分時,Youden指數最大為0.3365,診斷的敏感度為0.6909,特異度為0.6456.以pH＜4的時間百分比≥4.2%為標準,GerdQ評分的AUC為0.663,噹GerdQ評分臨界值為7.5分時,Youden指數最大為0.2790,診斷的敏感度為0.6600,特異度為0.6190.結論 GerdQ評分＞7.5分能較好反映食管下耑的痠暴露,以DeMeester評分≥14.72作為痠暴露判定標準較以pH＜4時間百分比≥4.2為判定標準和GerdQ評分的關聯更彊.肥胖可能加重下食管括約肌的一過性鬆弛從而導緻GERD癥狀的髮生.
목적 학정위식관반류병문권(GerdQ)증상평분능부반영위식관반류병(GERD)환자유24 h식관동태pH감측현시적산폭로정황,진일보험증GerdQ적림상응용개치.방법 납입2008년11월지2010년3월인소심등상소화도증상취진적문진GERD병례134례,균완성위경검사、24 h식관동태pH감측화GerdQ량표.근거24 h식관동태pH감측결과,분별이DeMeester평분≥14.72혹pH＜4시간백분비≥4.2%위표준판정식관산폭로병평개GerdQ평분차이.분별이DeMeester평분≥14.72화pH＜4시간백분비≥4.2%위표준회제GerdQ평분적수시자공작특정(ROC)곡선.채용SPSS 17.0통계연건,솔적비교용U검험화잡방검험,조간비교채용t검험.결과 이DeMeester평분≥14.72위표준,산폭로조환자적체중지수(BMI)고우비산폭로조(t=2.365,P=0.019),산폭로조환자적GerdQ평분[(8.51±2.34)분]고우비산폭로조[(6.67±2.79)분,t=4.002、P＜0.01],GerdQ평분적ROC곡선하면적(AUC)위0.70,당GerdQ평분림계치위7.5분시,Youden지수최대위0.3365,진단적민감도위0.6909,특이도위0.6456.이pH＜4적시간백분비≥4.2%위표준,GerdQ평분적AUC위0.663,당GerdQ평분림계치위7.5분시,Youden지수최대위0.2790,진단적민감도위0.6600,특이도위0.6190.결론 GerdQ평분＞7.5분능교호반영식관하단적산폭로,이DeMeester평분≥14.72작위산폭로판정표준교이pH＜4시간백분비≥4.2위판정표준화GerdQ평분적관련경강.비반가능가중하식관괄약기적일과성송이종이도치GERD증상적발생.
Objective To evaluate whether the gastroesophageal reflux disease (GERD) questionnaire (GerdQ) symptom score could reflect the acid exposure indicated by 24-hour esophageal pH monitoring in patients with GERD, and to further validate the clinical application value of GerdQ.Methods From November 2008 to March 2010, 134 GERD patients from outpatient department with heartburn and acid reflux symptoms were enrolled.All the patients had undergone endoscopy examination, 24-hour esophageal pH monitoring and GerdQ scoring.According to 24-hour esophageal pH monitoring result, acid exposure group and none acid exposure group was divided by the percentage of time that pH was lower than 4 over 4.2% or DeMeester score over 14.72, the difference of GerdQ score was assessed.The receiver operating characteristic (ROC) curve of GerdQ score was drawn according to DeMeester score and the percentage of time that pH was lower than 4 as the gold standard.With SPSS 17.0 statistical software, the ratio was compared with the u test and Chi-square test, comparison between groups with t test.Results The BMI of acid exposure group was higher than that of none acid exposure group(t= 2.365, P= 0.019).The GerdQ score of acid exposure group (8.51± 2.34) was significantly higher than that of none acid exposure group (6.67 ± 2.79), the difference was statistically significant (t = 4.002, P = 0.000) .ROC curve was drawn according to DeMeester score over 14.72 as gold standard; the area under curve (AUC) was 0.70.When the critical value of GerdQ score was 7.5, Youden index was up to 0.3365, the sensitivity of diagnosis was 0.6909 and specificity was 0.6454.The percentage of time that PH was lower than 4 over 4.2% as the gold standard, the AUC of GerdQ score was 0.663.When the critical value of GerdQ score was 7.5, Youden index was up to 0.2790, the sensitivity of diagnosis was 0.6600 and specificity was 0.6190.Conclusions GerdQ score greater than 7.5 can better reflect acid exposure at the lower esophageal.There is stronger association between GerdQ score with the DeMeester acid exposure score over 14.72 than with the percentage of time that pH lower than 4 over 4.2% as the critical value for acid exposure.Obesity may aggravate the transient lower esophageal sphincter relaxation leading to occurrence of GERD symptoms.
