CAJ | 학술논문

目的：研究儿童胃食管反流病( GERD)的预后,探讨影响预后的相关因素。方法收集2007年1月至2011年11月就诊于消化科行24 h食管pH监测确诊为GERD的患儿病例资料,入组病例共113例,最终随访病例87例,对患儿进行电话随访,了解其症状缓解的情况。应用生存分析Kaplan-meier乘积极限法计算GERD患儿累积症状缓解率,并对年龄、性别、治疗方式、酸反流指数( RI)、Boix-Ochoa标准综合评分、是否合并食管裂孔疝、是否行手术治疗、是否改善饮食和生活习惯、是否进行抗酸治疗、是否存在过敏史进行单因素Log-rank检验,将有统计学意义的因素引入多因素 COX比例风险模型进行多因素回归分析,分析影响儿童GERD预后的相关因素。结果87例患儿中76例患儿GERD症状明显缓解,应用生存分析方法得出儿童GERD的中位累积症状缓解时间为6个月,最终90.0%的患儿GERD相关症状可消失或明显缓解,所需时间44个月。14.9%(13例)的患儿生长发育受到影响,16.1%(14例)的患儿生活、学习质量受到影响。年龄( P=0．012,Wald=6.376)及是否规律治疗(P=0.000,Wald=13.059)是影响儿童GERD预后的相关因素。结论年龄及治疗方式是影响儿童GERD预后的相关因素,1岁以上发病的儿童预后较1岁之内发病的婴儿预后差,不规律治疗是儿童GERD预后的危险因素。
목적：연구인동위식관반류병( GERD)적예후,탐토영향예후적상관인소。방법수집2007년1월지2011년11월취진우소화과행24 h식관pH감측학진위GERD적환인병례자료,입조병례공113례,최종수방병례87례,대환인진행전화수방,료해기증상완해적정황。응용생존분석Kaplan-meier승적겁한법계산GERD환인루적증상완해솔,병대년령、성별、치료방식、산반류지수( RI)、Boix-Ochoa표준종합평분、시부합병식관렬공산、시부행수술치료、시부개선음식화생활습관、시부진행항산치료、시부존재과민사진행단인소Log-rank검험,장유통계학의의적인소인입다인소 COX비례풍험모형진행다인소회귀분석,분석영향인동GERD예후적상관인소。결과87례환인중76례환인GERD증상명현완해,응용생존분석방법득출인동GERD적중위루적증상완해시간위6개월,최종90.0%적환인GERD상관증상가소실혹명현완해,소수시간44개월。14.9%(13례)적환인생장발육수도영향,16.1%(14례)적환인생활、학습질량수도영향。년령( P=0．012,Wald=6.376)급시부규률치료(P=0.000,Wald=13.059)시영향인동GERD예후적상관인소。결론년령급치료방식시영향인동GERD예후적상관인소,1세이상발병적인동예후교1세지내발병적영인예후차,불규률치료시인동GERD예후적위험인소。
Objective To study the prognosis of gastroesophageal reflux disease ( GERD) in children, and explore the factors which impacts on the prognosis of GERD. Methods One hundred and thirteen children with GERD were enrolled on the basis of positive result of 24-hour pH-monitoring between January 2007 and November 2011. The number of patients who were followed up was 87,and the parents of children were contacted with the telephone. The prognosis was evaluated by comparing the degree of patients′symptom relief,and the cumulative symptom relief rate was calculated by Kaplan-meier product limit method. The univariate Log-rank test and the COX proportional hazardmodel multivariate analysis were applied to detect the factors impacting on the prognosis,including age,gender,the regularity of treatment,reflux index,and Boix-Ochoa standard score,with esophageal hiatal hernia or without,receiving surgical treatment or not,the diet and lifestyle improved or not,receiving anti-acid treatment or not,as well as with allergies his-tory or without. Results At last,76 out of 87 children had symptom relieved. Survival curve showed the cumulative symptom relief rate at different time points,the median cumulative symptom relief rate reached 6 months,the final relief rate was close to 90. 0%,and the continuous treatment time was 44 months. The study showed that 14. 9% (13/87 ca-ses) of children′s growth and development were affected and the life and learning in 16. 1% (14/87 cases) of children were impacted. Age (P=0. 012,Wald=6. 376) and the regularity of treatment (P=0. 000,Wald=13. 059) were the risk factors in the prognosis of GERD. Conclusions Age and the treatment regularity were the factors in the prognosis. The children aged more than 1-year old have poor prognosis compared with those less than 1-year old,and the irregular treatment is the risk factor in the prognosis.