1、北京上海胃食管反流症状的流行病学调查【摘要】目的了解北京、上海成人胃食管反流病(GERD)和反流性食管炎(RE)，在1996年79月调查时一年内的患病率及其相关性疾病和危险因素等。方法对两市1870岁城乡常住人口5 000例，进行整群、分层、随机抽样的问卷调查。以反酸、烧心、反食症状程度和频度的积分(Sc,最高18分)作为反流的指标，Sc6表明存在症状性反流(GER)；再抽取一部分反流阳性病人和对照者用胃镜和24小时pH监测作精查，根据精查的正确率对普查结果校正后测算出患病率。结果(1) 共4 992例完成了筛查，人群中每日有烧心者占2.5%；Sc6者448例占8.97%，男女之比为11.1；
2、精查正确率为64%，据此推测GERD的患病率为5.77%，RE为1.92%。(2) 分层分析显示，有反流症状者北京(10.19%)多于上海(7.76%)，北京的男性病人、体力劳动者及农村的患病率均高于上海；此外，40岁以上的患病率增多。(3) 反流组伴发口咽喉病患、哮喘和支气管炎的频率比非病人人群明显为高。结论调查结果显示，GERD为多发病，但我国南北方的患病率有差别。GERD和RE的比值为31。年龄(OR 1.01)、饱食(OR 1.99)、油腻食物(OR 6.56)、劳累(OR 2.35)、精神情绪(OR 2.22)、妊娠(OR 6.80)、排便困难(OR 1.65)等因素和反流有密切关系
3、。【关键词】反流胃食管反流病反流性食管炎 An epidemiologic study on symptomatic GER in Beijing and ShanghaiPAN Guozong, XU Guoming, GUO Huiping, et al.Peking Union Medical College Hospital, Beijing 100730, and Changhai Hospital, The Second Military Medical University, Shanghai 200433【Abstract】ObjectiveTo explore the one
4、 year-point prevalences (Jul-Sep,1996) of symptomatic gastroesophageal reflux (GER), gastroesophageal reflux disease (GERD) and reflux esophagitis (RE) among adult population in Beijing and Shanghai and to identify the risk factors of GERD. Methods5 000 residences of the two cities, age between 18-7
5、0 were studied through questionaire. Study was done by clustering sampling from city, surburban and rural areas using simple random sampling. Symptom scores (Sc) of the intensity and frequency of heartburn, acid reflux and regurgitation within one year at the time of study were taken as indices of a
6、cid reflux (highest Sc=18) and Sc6 indicated the presence of symptomatic GER. A case control study was also performed in some subjects from the survey to confirm the diagnosis of GERD and RE using gastroscopy and 24h pH monitoring. An estimation of the prevalence of GERD and RE was made on the basis
7、 of correct diagnostic rates of the diseases. Results(1) 4 992 subjects completed the survey, 2.5% of the people had heartburn once a day, 448 people accounted for 8.97% of the population screened had symptomatic GER (Sc6), and male to female ratio was 11.1. Estimated prevalences for GERD and RE wer
8、e 5.77% and 1.92% respectively. (2) Stratified analysis indicated that the prevalence of symptomatic GER in Beijing (10.19%) was higher than that in Shanghai (7.76%), and there was also a higher prevalence of GER in male, in laboring people and in people of rural areas in Beijing as compared with Sh
9、anghai. (3) Logistic analysis indicated that GER had a close relatioship with dental, pharnyngo-laryngeal disorders and respiratory diseases, such as asthma and bronchitis, etc. ConclusionsGERD is different in the northern and southern area of China. Ratio between GERD and RE is 31 in our study. Age
10、40 (OR 1.01), greasy food (OR 6.56), big appetite (OR 1.99), tiredness (OR 2.35), emotional stress (OR 2.22), pregnancy (OR 6.80) and constipation (OR 1.65) are the risk factors of GERD.【Key words】Gastroesophageal refluxGastroesophageal reflux diseaseReflux esophagitis胃食管反流病(gastroesophageal reflux
11、disease,GERD)是指过多的胃、十二指肠内容物反流入食管，引起烧心、反酸、反食等，甚至有食管粘膜的病理性损害反流性食管炎(reflux esophagitis,RE)。但GERD病人不一定均伴有RE。本症还可引起口咽、喉、气道等食管外的组织损害。关于人群中症状性胃食管反流(GER)、GERD和RE的患病率，西方国家报道，人群中约7%15%可有胃食管反流症状1。北京协和医院1986年对3 000例接受胃镜检查病人的调查表明，RE占5.8%2；台湾一所医院对2 044例病人作胃镜检查，RE为5%3。但对GERD在人群中患病率的随机调查在国内缺乏系统性的资料。本研究的目的：(1) 了解北京、
12、上海两市成人症状性GER的发生情况及GERD和RE的患病率，(2) 研究GER和呼吸道、口咽部疾患的关系，(3) 了解与GERD发病有关的危险因素等。调查方法一、筛查1996年79月。采用整群、分层和单纯随机抽样的方法，对北京及上海市(简称两市)1870岁的常住城乡居民各2 500例进行问卷调查。根据市统计局提供的资料，按人口比例设计，对两市城区、近郊、远郊区、县的办事处到居委会和村委会，逐级进行整群、随机抽签抽样。对抽到的居委会符合年龄条件的居民，每户每人，由经过培训的调查员(多数为医师，少数为医学生和护士)在居(村)委会人员的陪同下，分别入户进行问卷调查。问卷内容涉及反流症状、发生频度、伴
13、随症状及疾病、职业、饮食习惯、生活方式、既往病史和危险因素等94个项目。样本覆盖人群：北京市常住人口为1 100万、上海市为1 300万，1870岁的人占两市常住人口的73%；样本量5 000例，覆盖两市各年龄组人群为：500073%=6 844例。调查结束后，选择部分被调查者的问卷由另人复核，正确率为95.6%。二、症状评分及统计调查反酸、反食、烧心、胸骨后痛、咽部异物感、腹胀等18个症状的发生情况。以烧心、反酸、反食作为评分症状：无症状为0分，症状轻为1分，症状中等为2分，症状重为3分。另根据频变，如每月有症状为1分，每周为2分，每日为3分。根据症状程度及频度，积分之和为总分(Sc)，最高
14、18分。将调查资料输入电脑，分档统计，结果见表1。以上Sc6共448例，占总调查人数的8.97%，其中Sc10共138例，占2.76%；Sc6的人占91.05%。我们以Sc6作为症状性GER的诊断标准，将Sc6设定为非反流(或称非病人)人群组，作为对照。以这段时间内有反流症状人群的检出率代表患病率。表1调查人群症状积分(Sc)Sc02569101213人数3 63985131010236%74.0017.056.212.040.72对症状性GER人群的患病率、不同年龄和职业的人群患病率、北京和上海之间及脑力、体力劳动者患病率的差别以及不同饮食、生活方式与患病率之间的关系等进行了调查。所有资料均
15、经中国协和医科大学统计教研室复核，用卡方或Logistic回归作统计学分析。三、精查在5 000例普查人群中，按反流症状积分高低分组，随机抽签，对低分组(Sc 69)23例，中高分组(Sc10)19例及对照组(Sc6)25例，作了进一步精查，以除外伴随器质性疾病并确定胃食管反流病(GERD)的诊断。精查项目包括体格检查，常规化验，血生化，心电，胸透，B超肝、胆、胰、脾；并均作胃镜和24小时pH监测。胃镜下观察有无食管炎，按Savary-Miller标准分级。24小时pH监测采用Diggitrapper MK pH监测仪(瑞典CTD-Synectics公司)。24小时内pH4总时间百分率4%和/或总反流次数50即为异常胃食管反流。若24小时pH监测有异常胃食管反流指标和/或胃镜下有食管炎(RE)，可诊断为GERD。根据精查的诊断符合率来推测筛查中GERD和RE的阳性率。 结果一、有GER症状者的患病率(一) 不同年龄的患病率：表2显示，3039岁年龄组Sc6的反流症状患病率已明显增高，并在40各组仍然增高。表2不同年龄症状性GER的患病率年龄(岁)调查人数Sc6患病率(%)1829925464.9730391 090908.26*40491 16813111.22*50598428
