基于横断面调查的儿童胃镜检查适应证及其与胃显著病变的相关性分析
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摘要
目的行胃镜适应证的调查,分析消化道症状、体征和病史与胃显著病变的相关性。方法采用横断面研究设计调查行胃镜检查时消化道症状、体征和病史,自拟胃镜检查适应证调查表(简称调查表);对调查表项目(消化道症状、体征和病史)先行单因素分析,再行多因素分析。胃显著病变:胃镜检查黏膜隆起增生、解剖学异常、胃内发现胆汁返流、快速尿素酶染色阳性和消化道异物报告,和/或胃黏膜病理诊断炎症中至重级。结果 2016年6月10日至2016年10月7日符合本文纳入和排除标准的儿童行胃镜检查并取得调查表1 298份,男766例,年龄0.1~17.6(8.0±0.1)岁,仅以主诉中第一个症状或体征或病史统计,行胃镜检查的患儿中,腹痛占78.0%,其次是纳差31.3%、口气24.9%、幽门螺旋杆菌感染18.0%、恶心17.0%、呕吐16.7%、主要抚养人Hp感染史13.4%,余症状、体征和病史均低于10%。胃显著病变率49.9%(648/1 298),幽门螺旋杆菌感染证据、呕吐和可疑消化道异物与胃显著病变呈正相关,OR分别为5.10(95%CI:3.58~7.28)、1.48(95%CI:1.07~2.03)和3.25(95%CI:1.31~8.02),腹痛、反酸与胃显著病变呈负相关,OR为0.73(95%CI:0.54~0.98)、0.25(95%CI:0.09~0.70)。鉴于78.0%患儿以腹痛为主诉行胃镜检查,以调查表的腹痛时间均值(≥7个月)、腹痛频率均值(≥11天/月)、腹痛程度均值(≥5分,Wong-Banker面部表情评分法)为自变量,以胃镜发现显著病变作为因变量,多因素回归分析显示,腹痛程度≥5分与胃显著病变正相关,OR为1.37(95%CI:1.07~1.74)。结论行胃镜检查的患儿78.0%以腹痛为主诉,幽门螺旋杆菌感染证据、呕吐和可疑消化道异物患儿与胃显著病变呈正相关,腹痛程度≥5分与胃显著病变正相关。
ObjectiveAn investigation about esophageal gastroduodenoscopy(EGD)was performed,and the associationbetween the symptoms or history and significant findings was analyzed.MethodsThis cross-sectional study was conducted through aquestionnaire formulated by ourselves. Then we chi-square statistical test and multivariate Logistical regression were used to analyzethe correlation between indications and significant findings.ResultsThe study was conducted from June 10,2016 to October 7,2016. And 1298 cases(male 766)were enrolled. The age was from 0.1 to 17.6(average age:8.0+0.01)years. Patients withabdominal pain accounted for 78.0%,then anorexia 31.3%,having breath 24.9%,having evidence for Helicobacter pylori infection 18%,nausea 17%,vomiting 16.7%,having a family history of Helicobacter pylori infection 13.4%. Others were all below 10%.There were 49.9 % having a significant lesion through EGD. Evidence of infection of helicobacter pylori(OR= 5.10,95% CI:3.58~7.28),vomiting(OR= 1.48,95% CI:1.08~2.04)and suspicious foreign body injection 3.25(95%CI:1.31~8.02)were relatedwith significant findings. While abdominal pain was related with significant findings(OR = 0.73,95% CI:0.54 ~ 0.98),furtherinvestigation was made for abdominal pain. And it was found that the degree value of abdominal pain beyond 5 was related withsignificant findings(OR= 1.37,95% CI:1.07~ 1.74).Conclusion 78% of EGD patients are with the complain of abdominalpain. Evidence of infection of helicobacter pylori,vomiting and suspicious foreign body injection are positively related withsignificant findings. And the degree value of abdominal pain beyond 5 is positively related with significant findings.
ObjectiveAn investigation about esophageal gastroduodenoscopy(EGD)was performed,and the associationbetween the symptoms or history and significant findings was analyzed.MethodsThis cross-sectional study was conducted through aquestionnaire formulated by ourselves. Then we chi-square statistical test and multivariate Logistical regression were used to analyzethe correlation between indications and significant findings.ResultsThe study was conducted from June 10,2016 to October 7,2016. And 1298 cases(male 766)were enrolled. The age was from 0.1 to 17.6(average age:8.0+0.01)years. Patients withabdominal pain accounted for 78.0%,then anorexia 31.3%,having breath 24.9%,having evidence for Helicobacter pylori infection 18%,nausea 17%,vomiting 16.7%,having a family history of Helicobacter pylori infection 13.4%. Others were all below 10%.There were 49.9 % having a significant lesion through EGD. Evidence of infection of helicobacter pylori(OR= 5.10,95% CI:3.58~7.28),vomiting(OR= 1.48,95% CI:1.08~2.04)and suspicious foreign body injection 3.25(95%CI:1.31~8.02)were relatedwith significant findings. While abdominal pain was related with significant findings(OR = 0.73,95% CI:0.54 ~ 0.98),furtherinvestigation was made for abdominal pain. And it was found that the degree value of abdominal pain beyond 5 was related withsignificant findings(OR= 1.37,95% CI:1.07~ 1.74).Conclusion 78% of EGD patients are with the complain of abdominalpain. Evidence of infection of helicobacter pylori,vomiting and suspicious foreign body injection are positively related withsignificant findings. And the degree value of abdominal pain beyond 5 is positively related with significant findings.
引文
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[4]许春娣,王茂贵.小儿纤维胃镜检查操作常规(试行).中华儿科杂志,1996(5):7-8
[5]蒋宗滨,马相飞.疼痛的评估方法与临床应用新进展.实用疼痛学杂志,2007(3):56-58
[6]爯中华儿科杂志爲编辑委员会,中华医学会儿科学分会感染消化学组.小儿慢性胃炎、消化性溃疡胃镜诊断标准.中华儿科杂志,2003,(3):33.
[7]房静远,刘文忠,李兆申,等.中国慢性胃炎共识意见.胃肠病学,2013,(1):24-36
[8]Franciosi JP,Fiorino K,Ruchelli E,et al.Changing indications for upper endoscopy in children during a 20-year period.J Pediatr Gastroenterol Nutr,2010,51(4):443-447
[9]金建敏,汪建秀,许春娣,等.幽门螺杆菌与小儿上消化道疾病的探讨.中华消化杂志,1999(1):55-56
[10]包云光,韦翊,郎爱素,等.儿童口腔幽门螺杆菌感染与胃内感染和上消化道疾病的相关性研究.中华儿科杂志,2003,41(6):465-466
[11]黄洁,周颖,黄瑛,等.2014年上海市闵行区7~18岁在校学生幽门螺杆菌感染率调查.中华儿科杂志,2016,54(7):496-499
[12]何婉儿,区文玑,潘瑞芳,等.婴幼儿反复呕吐消化道检查的两种方法比较.中国临床医学,2004(4):529-530
[13]侯林毅,闫慧敏,王春莲,等.儿童胃溃疡42例临床分析.实用儿科临床杂志,2002,(4):330-331
[14]宋华,张书红,徐晓华,等.小儿长期呕吐病因分析.中国当代儿科杂志,2007(4):385-386.
[15]朱莉,刘文莉,靳蓉,等.儿童上消化道异物的内镜处理.实用儿科临床杂志,2010,25(13):1031-1032,1036
[2]Lightdale JR,Acosta R,Shergill AK,et al.Modifications in endoscopic practice for pediatric patients.Gastrointest Endosc,2014,79(5):699-710
[3]Tringali A,Thomson M,Dumonceau JM,et al.Pediatric gastrointestinal endoscopy:European Society of Gastrointestinal Endoscopy(ESGE)and European Society for Paediatric Gastroenterology Hepatology and Nutrition(ESPGHAN)Guideline Executive summary.Endoscopy,2017,49(1):83-91
[4]许春娣,王茂贵.小儿纤维胃镜检查操作常规(试行).中华儿科杂志,1996(5):7-8
[5]蒋宗滨,马相飞.疼痛的评估方法与临床应用新进展.实用疼痛学杂志,2007(3):56-58
[6]爯中华儿科杂志爲编辑委员会,中华医学会儿科学分会感染消化学组.小儿慢性胃炎、消化性溃疡胃镜诊断标准.中华儿科杂志,2003,(3):33.
[7]房静远,刘文忠,李兆申,等.中国慢性胃炎共识意见.胃肠病学,2013,(1):24-36
[8]Franciosi JP,Fiorino K,Ruchelli E,et al.Changing indications for upper endoscopy in children during a 20-year period.J Pediatr Gastroenterol Nutr,2010,51(4):443-447
[9]金建敏,汪建秀,许春娣,等.幽门螺杆菌与小儿上消化道疾病的探讨.中华消化杂志,1999(1):55-56
[10]包云光,韦翊,郎爱素,等.儿童口腔幽门螺杆菌感染与胃内感染和上消化道疾病的相关性研究.中华儿科杂志,2003,41(6):465-466
[11]黄洁,周颖,黄瑛,等.2014年上海市闵行区7~18岁在校学生幽门螺杆菌感染率调查.中华儿科杂志,2016,54(7):496-499
[12]何婉儿,区文玑,潘瑞芳,等.婴幼儿反复呕吐消化道检查的两种方法比较.中国临床医学,2004(4):529-530
[13]侯林毅,闫慧敏,王春莲,等.儿童胃溃疡42例临床分析.实用儿科临床杂志,2002,(4):330-331
[14]宋华,张书红,徐晓华,等.小儿长期呕吐病因分析.中国当代儿科杂志,2007(4):385-386.
[15]朱莉,刘文莉,靳蓉,等.儿童上消化道异物的内镜处理.实用儿科临床杂志,2010,25(13):1031-1032,1036