2型糖尿病合并胃食管反流病患者的临床特征及相关危险因素分析
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摘要
目的分析2型糖尿病(type 2 diabetes mellitus,T2DM)合并胃食管反流病(gastroesophageal reflux disease,GERD)患者临床特征及相关危险因素。方法选取2013年1月至2017年12月收治的125例T2DM患者作为研究对象,比较合并GERD患者及非GERD患者的基本临床资料、血生化检查结果、症状、积分、内镜分级、食管测压、24 h食管p H值监测结果,分析T2DM合并GERD患者临床特征及相关危险因素。结果 125例T2DM患者中53例(42. 40%)合并GERD。两组患者在饮酒史、BMI、服用NSAIDs类药物、职业、病程、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、血清胰岛素水平(SIL)、胰高血糖素(Glucagon)、烧心、反酸、嗳气典型症状的差异具有统计学意义(P <0. 05),且食管动力障碍程度、食管炎的发生率均较高。NSAIDs药物、FPG、Hb A1c、胰岛素与GERD发生具有显著相关性(P <0. 05)。结论 T2DM合并GERD与多种因素有关,积极控制血糖、慎用损伤胃食管黏膜药物对预防T2DM合并GERD的发生具有重要意义。
Objective To analyze the clinical characteristics and related risk factors of type 2 diabetes mellitus( T2DM) with gastroesophageal reflux disease( GERD) patients. Methods One hundred and twenty-five T2 DM patients were choosen as the research objects from Jan. 2013 to Dec. 2017. Basic clinical data,blood biochemical examination results,symptoms,score,endoscopic grading,esophageal pressure measurement,and 24 hours esophageal pH monitoring results were compared in T2 DM patients with and without GERD,clinical characteristics and related risk factors of T2 DM patients with GERD were analyzed. Results The number of patients with GERD was 53 cases( 42. 40%)among the total 125 cases. Drinking,BMI,NSAIDs drugs,disease course,FPG,HbA1 c,SIL,Glucagon,heart-burn,acid reflux,belching had significant differences between two groups,and the degree of esophageal dysplasia and the incidence of esophagitis were higher in T2 DM with GERD patients. NSAIDs,FPG,Hb A1 c,insulin were significantly correlatted GERD( P < 0. 05). Conclusion Many factors are related to T2 DM with GERD. Active glycemic management and cautious gastrointestinal mucosa injuring drugs usement have great significance to prevent T2 DM with GERD.
Objective To analyze the clinical characteristics and related risk factors of type 2 diabetes mellitus( T2DM) with gastroesophageal reflux disease( GERD) patients. Methods One hundred and twenty-five T2 DM patients were choosen as the research objects from Jan. 2013 to Dec. 2017. Basic clinical data,blood biochemical examination results,symptoms,score,endoscopic grading,esophageal pressure measurement,and 24 hours esophageal pH monitoring results were compared in T2 DM patients with and without GERD,clinical characteristics and related risk factors of T2 DM patients with GERD were analyzed. Results The number of patients with GERD was 53 cases( 42. 40%)among the total 125 cases. Drinking,BMI,NSAIDs drugs,disease course,FPG,HbA1 c,SIL,Glucagon,heart-burn,acid reflux,belching had significant differences between two groups,and the degree of esophageal dysplasia and the incidence of esophagitis were higher in T2 DM with GERD patients. NSAIDs,FPG,Hb A1 c,insulin were significantly correlatted GERD( P < 0. 05). Conclusion Many factors are related to T2 DM with GERD. Active glycemic management and cautious gastrointestinal mucosa injuring drugs usement have great significance to prevent T2 DM with GERD.
引文
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[14] ERSOZ F,DUZKOYLU Y,DENIZ M M,et al. Laparoscopic Rouxen-Y gastric bypass with ileal transposition-an alternative surgical treatment for type 2 diabetes mellitus and gastroesophageal reflux[J].Wideochir Inne Tech Maloinwazyjne,2015,10(3):481-485. DOI:10. 5114/wiitm. 2015. 54224.
[15]王新玲,罗蕴之. 2型糖尿病与胃食管反流病[J].中华胃食管反流病电子杂志,2015,2(3):171-174. DOI:10. 3877/cma. j.issn. 1674-6899. 2015. 03. 012.
[16] PAK J,KWON Y,LO MENZO E,et al. Impact of gastrointestinal bypass on nonmorbidly obese type 2 diabetes mellitus patients after gastrectomy[J]. Surg Obes Relat Dis,2015,11(6):1266-1272.DOI:10. 1016/j. soard. 2014. 12. 008.
[2]向旭,朱妍,朱海杭.糖尿病与胃食管反流病临床流行病学研究[J].胃肠病学和肝病学杂志,2014,23(3):292-295. DOI:10.3969/j. issn. 1006-5709. 2014. 03. 017.XIANG X,ZHU Y,ZHU H H. The clinical epidemiological study between diabetes mellitus and gastroesophageal reflux disease[J]. Chin J Gastroenterol Hepatol,2014,23(3):292-295. DOI:10. 3969/j.issn. 1006-5709. 2014. 03. 017.
[3] SIAVASH M,TABBAKHIAN M,SABZGHABAEE A M,et al. Severity of gastrointestinal side effects of metformin tablet compared to metformin capsule in type 2 diabetes mellitus patients[J]. J Res Pharm Pract,2017,6(2):73-76. DOI:10. 4103/jrpp. JRPP_17_2.
[4] HASHIMI S,BREMNER R M. Complications following surgery for gastroesophageal reflux disease and achalasia[J]. Thorac Surg Clin,2015,25(4):485-498. DOI:10. 1016/j. thorsurg. 2015. 07. 010.
[5] LEE S D,KEUM B,CHUN H J,et al. Gastroesophageal reflux disease in type II diabetes mellitus with or without peripheral neuropathy[J]. J Neurogastroenterol Motil,2011,17(3):274-278. DOI:10. 5056/jnm.2011. 17. 3. 274.
[6]ZDAS S,OLT S,SIRIK M. The role of sleeve gastrectomy on preventing type 2 diabetes mellitus[J]. Open Access Maced J Med Sci,2017,5(3):316-318. DOI:10. 3889/oamjms. 2017. 074.
[7] FUJISHIRO M,KUSHIYAMA A,YAMAZAKI H,et al. Gastrointestinal symptom prevalence depends on disease duration and gastrointestinal region in type 2 diabetes mellitus[J]. World J Gastroenterol,2017,23(36):6694-6704. DOI:10. 3748/wjg. v23. i36. 6694.
[8] DE JONG R G P J,BURDEN A M,DE KORT S,et al. Impact of detection bias on the risk of gastrointestinal cancer and its subsites in type2 diabetes mellitus[J]. Eur J Cancer,2017,79:61-71. DOI:10.1016/j. ejca. 2017. 03. 039.
[9] HA J O,LEE T H,LEE C W. Prevalence and risk factors of gastroesophageal reflux disease in patients with type 2 diabetes mellitus[J].Diabetes Metab J,2016,40(4):297-307. DOI:10. 4093/dmj.2016. 40. 4. 297.
[10] CAMILLERI M,MCCALLUM R W,TACK J,et al. Efficacy and safety of relamorelin in diabetics with symptoms of gastroparesis:a randomized,placebo-controlled study[J]. Gastroenterology,2017,153(5):1240-1250. e2. DOI:10. 1053/j. gastro. 2017. 07. 035.
[11] OSPANOV O,MALECKAS A,OREKESHOVA A. Gastric greater curvature plication combined with nissen fundoplication in the treatment of gastroesophageal reflux disease and obesity[J]. Medicina(Kaunas),2016,52(5):283-290. DOI:10. 1016/j. medici.2016. 08. 001.
[12] IKEDA Y,FURUKAWA S,SAKAI T,et al. Age and prevalence of esophageal reflux disease in Japanese patients with type 2 diabetes mellitus:the dogo study[J]. Dig Dis Sci,2016,61(12):3530-3536. DOI:10. 1007/s10620-016-4311-2.
[13] REYES-ORTIZ A,SANCHEZ-GONZLEZ Y,ROMERO-FIGUEROA MDEL S. Prevalence of gastroesophageal reflux disease in patients with type 2 diabetes mellitus[J]. Med Clin(Barc),2014,143(5):232-233. DOI:10. 1016/j. medcli. 2013. 09. 004.
[14] ERSOZ F,DUZKOYLU Y,DENIZ M M,et al. Laparoscopic Rouxen-Y gastric bypass with ileal transposition-an alternative surgical treatment for type 2 diabetes mellitus and gastroesophageal reflux[J].Wideochir Inne Tech Maloinwazyjne,2015,10(3):481-485. DOI:10. 5114/wiitm. 2015. 54224.
[15]王新玲,罗蕴之. 2型糖尿病与胃食管反流病[J].中华胃食管反流病电子杂志,2015,2(3):171-174. DOI:10. 3877/cma. j.issn. 1674-6899. 2015. 03. 012.
[16] PAK J,KWON Y,LO MENZO E,et al. Impact of gastrointestinal bypass on nonmorbidly obese type 2 diabetes mellitus patients after gastrectomy[J]. Surg Obes Relat Dis,2015,11(6):1266-1272.DOI:10. 1016/j. soard. 2014. 12. 008.