不同年龄食管裂孔疝相关危险因素和常见误诊疾病分析
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摘要
目的分析不同年龄食管裂孔疝的相关危险因素,并对其常见误诊疾病进行分析。方法回顾性分析2012年7月至2016年12月新疆维吾尔自治区人民医院收治的食管裂孔疝患者168例,其中92例<60岁(中青年组),76例≥60岁(老年组)。采用多因素Logistic回归分析筛选不同年龄段食管裂孔疝相关危险因素。同时采用χ2检验比较中青年组与老年组食管裂孔疝患者常见误诊疾病比例差异。结果体重指数、进食过饱、睡前进食是中青年食管裂孔疝的独立危险因素(P=0.013、0.030、0.015);睡前进食、习惯性便秘、慢性咳嗽是老年食管裂孔疝的独立危险因素(P=0.024、0.018、0.039)。中青年组和老年组食管裂孔疝患者误诊为冠状动脉粥样硬化性心脏病的比例最高[21.7%(20/92)、28.9(22/76)],但两者差异无统计学意义;中青年组食管裂孔疝患者误诊为咽喉炎、支气管哮喘的比例高于老年组患者[19.6%(18/92) vs 9.2%(7/76)、13.0%(12/92) vs 6.6%(5/76)],老年组食管裂孔疝患者误诊为慢性支气管炎的比例高于中青年组患者[10.9%(10/92) vs21.1%(17/76)],且差异均有统计学意义(χ~2=10.332,P=0.001;χ~2=7.911,P=0.005;χ~2=9.614,P=0.002)。结论不同年龄食管裂孔疝的危险因素不同,常见误诊疾病也有差异,要根据年龄进行针对性防治,同时减少食管裂孔疝的误诊。
Objective To analyze the risk factors and common misdiagnosed diseases between different age groups of hiatal hernia patients. Methods To retrospectively analyse 168 patients of hiatal hernia who were made a diagnosis and given treatment at Xinjiang Uygur Autonomous Region People's Hospital from July 2012 to December 2016, including 92 patients<60 years old(young and middle-aged group) and 76 patients≥60 years old(old-aged group). Logistic regression analysis was used to analyse the risk factors between different age groups. And χ2 tset was used to compare the common misdiagnosed diseases between the two goups. Results High body mass index(BMI), eating too much, and eating before sleeping were the independent risk factors of young and middle-aged patients with hiatal hernia(P=0.013,0.030, 0.015), and eating before sleeping, habitual constipation and chronic coughing were the independent risk factors of old-aged patients(P=0.024, 0.018, 0.039). The rate of misdiagnosis of hiatal hernia as coronary heart disease was highest in young and middle-aged group and old-aged group [21.7%(20/92), 28.9(22/76)], but there was no difference in the two groups. The rates of misdiagnosis of hiatal hernia as laryngitis, bronchial asthma in young and middle-aged group were higher than that of old-aged group [19.6%(18/92) vs 9.2%(7/76), 13.0%(12/92) vs 6.6%(5/76)], and the rate of misdiagnosis of hiatal hernia as chronic bronchitis in old-aged group was higher than that of young and middle-aged group [10.9%(10/92) vs 21.1%(17/76)], the differences were statistically significant(χ~2=10.332, P=0.001; χ~2=7.911, P=0.005; χ~2=9.614,P=0.002). Conclusions There were different risk factors and common misdiagnosed diseases between different age groups of hiatal hernia patients. Targeted prevention and treatment of hiatal hernia patients should be carried accoding to age, and the misdiagnosis of hiatal hernia patients could be reduced.
Objective To analyze the risk factors and common misdiagnosed diseases between different age groups of hiatal hernia patients. Methods To retrospectively analyse 168 patients of hiatal hernia who were made a diagnosis and given treatment at Xinjiang Uygur Autonomous Region People's Hospital from July 2012 to December 2016, including 92 patients<60 years old(young and middle-aged group) and 76 patients≥60 years old(old-aged group). Logistic regression analysis was used to analyse the risk factors between different age groups. And χ2 tset was used to compare the common misdiagnosed diseases between the two goups. Results High body mass index(BMI), eating too much, and eating before sleeping were the independent risk factors of young and middle-aged patients with hiatal hernia(P=0.013,0.030, 0.015), and eating before sleeping, habitual constipation and chronic coughing were the independent risk factors of old-aged patients(P=0.024, 0.018, 0.039). The rate of misdiagnosis of hiatal hernia as coronary heart disease was highest in young and middle-aged group and old-aged group [21.7%(20/92), 28.9(22/76)], but there was no difference in the two groups. The rates of misdiagnosis of hiatal hernia as laryngitis, bronchial asthma in young and middle-aged group were higher than that of old-aged group [19.6%(18/92) vs 9.2%(7/76), 13.0%(12/92) vs 6.6%(5/76)], and the rate of misdiagnosis of hiatal hernia as chronic bronchitis in old-aged group was higher than that of young and middle-aged group [10.9%(10/92) vs 21.1%(17/76)], the differences were statistically significant(χ~2=10.332, P=0.001; χ~2=7.911, P=0.005; χ~2=9.614,P=0.002). Conclusions There were different risk factors and common misdiagnosed diseases between different age groups of hiatal hernia patients. Targeted prevention and treatment of hiatal hernia patients should be carried accoding to age, and the misdiagnosis of hiatal hernia patients could be reduced.
引文
1陈富强,申英末,陈杰.食道裂孔疝的诊疗现状[J/CD].中华胃食管反流病电子杂志,2014,1(1):49-51.
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3吴继敏.食道裂孔疝诊治中应重视的几个问题[J].临床外科杂志,2013,21(6):419-421.
4苏剑东,江堤,杨巧玲,等.食管裂孔疝的单中心临床流行病学调查及分析[J].中国内镜杂志,2015,21(11):1182-1185.
5 Menon S,Trudill N.Risk factors in the aetiology of hiatushemia:a meta-analysis[J].Eur J Gastroenterol Hepatol,2011,23(2):133-138.
6王春赛尔,谢鹏雁.136例老年食管裂孔疝患者临床特征分析[J].中国医药导报,2015,12(2):103-112.
7张玲,邹多武.胃食管反流病的流行病学及危险因素[J].临床荟萃,2017,32(1):1-4.
8张玲,蓓里·加帕尔,王燕.维吾尔族和汉族老年男性胃食管反流病分型及危险因素分析[J/CD].中华胃食管反流病电子杂志,2015,2(1):30-33.
9郭佳.BMI与食管裂孔疝及反流性食管炎的关系[J].中南医学科学杂志,2016,44(4):432-446.
10 Jorge JX,Almeida CC,Borges CI,et al.Effects of gastroesophageal reflux on esophageal motility[J].Rom J Intern Med,2012,50(3):233-239.
11 Devendran N,Chauhan N,Armstrong D,et al.GERD and obesity:is the autonomic nervous system the missing link?[J].Crit Rev Biomed Eng,2014,42(1):17-24.
12傅梦杰,朱凌云.胃食管反流病相关危险因素的研究进展[J].世界华人消化杂志,2016,24(7):2654-2660.
13 Tsukanov VV,Kasparov EV,Onuchina EV,et al.The frequency andclinical aspects of extraesophageal syndromes in elderly patients with gastroesophageal reflux disease[J].Ter Arkh,2016,88(2):28-32.
14翟英慧,郝咏刚,李海涛,等.食管裂孔疝误诊为冠心病32例[J/CD].中华疝和腹壁外科杂志(电子版),2014,8(6):504-506.
15 Meyer KC.Gastroesophageal reflux and iung disease[J].Expert Rev Respir Med,2015,9(4):383-385.
16高福生,于涛,刘宾,等.食管裂孔疝与胃食管反流病[J/CD].中华胃食管反流病电子杂志,2014,1(1):42-45.
17 Kahrilas PJ,Altman KW,Chang AB,et al.Chronic Cough Due to Gastroesophageal Reflux in Adults:CHEST Guideline and Expert Panel Report[J].Chest,2016,150(6):1341-1360.
18谢胜,陈广文,李蕾,等.老年人胃食管反流病临床特点及诊疗[J].中国老年学杂志,2017,37(18):4667-4670.
2陈旻湖,房殿春,房静远,等.中国胃食管反流病专家共识意见[J].中华消化杂志,2014,34(10):649-656.
3吴继敏.食道裂孔疝诊治中应重视的几个问题[J].临床外科杂志,2013,21(6):419-421.
4苏剑东,江堤,杨巧玲,等.食管裂孔疝的单中心临床流行病学调查及分析[J].中国内镜杂志,2015,21(11):1182-1185.
5 Menon S,Trudill N.Risk factors in the aetiology of hiatushemia:a meta-analysis[J].Eur J Gastroenterol Hepatol,2011,23(2):133-138.
6王春赛尔,谢鹏雁.136例老年食管裂孔疝患者临床特征分析[J].中国医药导报,2015,12(2):103-112.
7张玲,邹多武.胃食管反流病的流行病学及危险因素[J].临床荟萃,2017,32(1):1-4.
8张玲,蓓里·加帕尔,王燕.维吾尔族和汉族老年男性胃食管反流病分型及危险因素分析[J/CD].中华胃食管反流病电子杂志,2015,2(1):30-33.
9郭佳.BMI与食管裂孔疝及反流性食管炎的关系[J].中南医学科学杂志,2016,44(4):432-446.
10 Jorge JX,Almeida CC,Borges CI,et al.Effects of gastroesophageal reflux on esophageal motility[J].Rom J Intern Med,2012,50(3):233-239.
11 Devendran N,Chauhan N,Armstrong D,et al.GERD and obesity:is the autonomic nervous system the missing link?[J].Crit Rev Biomed Eng,2014,42(1):17-24.
12傅梦杰,朱凌云.胃食管反流病相关危险因素的研究进展[J].世界华人消化杂志,2016,24(7):2654-2660.
13 Tsukanov VV,Kasparov EV,Onuchina EV,et al.The frequency andclinical aspects of extraesophageal syndromes in elderly patients with gastroesophageal reflux disease[J].Ter Arkh,2016,88(2):28-32.
14翟英慧,郝咏刚,李海涛,等.食管裂孔疝误诊为冠心病32例[J/CD].中华疝和腹壁外科杂志(电子版),2014,8(6):504-506.
15 Meyer KC.Gastroesophageal reflux and iung disease[J].Expert Rev Respir Med,2015,9(4):383-385.
16高福生,于涛,刘宾,等.食管裂孔疝与胃食管反流病[J/CD].中华胃食管反流病电子杂志,2014,1(1):42-45.
17 Kahrilas PJ,Altman KW,Chang AB,et al.Chronic Cough Due to Gastroesophageal Reflux in Adults:CHEST Guideline and Expert Panel Report[J].Chest,2016,150(6):1341-1360.
18谢胜,陈广文,李蕾,等.老年人胃食管反流病临床特点及诊疗[J].中国老年学杂志,2017,37(18):4667-4670.