肠易激综合征相关因素分析及诊断标准的评价
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摘要
目的：本研究通过比较IBS患者与健康对照组人群在相关症状、大便类型、相关危险因素、焦虑程度、抑郁程度、应对方式及经历生活事件七个方面之间的异同，得出我国IBS患者好发的腹部症状、大便习惯及性状特点、相关危险因素等。同时，对Manning、罗马Ⅰ、罗马Ⅱ、罗马Ⅲ标准从诊断率、诊断覆盖及重叠率、腹部症状特点、大便习惯及性状特点、危险因素等方面的异同，进行深入的分析比较，旨在阐明适合我国人群的IBS诊断标准，并为制定更加完善新IBS诊断标准和科学合理的防治措施提供参考依据。
方法：研究对象收集自2010年1月至2013年1月间海军总医院消化内科就诊的患者和健康体检中心的体检人员。选择因腹部症状就诊消化内科的5000名患者为观察组，发放调查问卷，同时完善血常规、大小便、肝肾功、影像学及胃肠镜等检查排除器质性疾病，结合调查问卷筛选出IBS患者。选择同期在健康体检中心体检的1602名体检人员为对照组，完善调查问卷及常规筛查。调查问卷包括诊断标准问卷、大便分型问卷、相关危险因素问卷、焦虑自评量表、抑郁自评量表、应对方式问卷、生活事件量表七个部分。对两组问卷结果进行统计分析，采用SPSS19.0，STATA12.0及Excel2007软件进行统计分析和图形处理，主要是进行logistic单因素、多因素及卡方检验，以P值<0.05为显著性。
结果：
一、IBS研究对象患病情况
1、发病诊断率
因腹部不适症状就诊消化科的5000例患者中，有3242例为IBS患者，发病率为64.84%。具体到四种标准中，Manning标准2718例（83.84%）、罗马Ⅰ标准1871例（57.71%）、罗马Ⅱ标准1912例（58.98%）、罗马Ⅲ标准340例（10.49%）。符合罗马I、罗马Ⅲ标准诊断的IBS人群大部分都符合Manning标准，罗马Ⅱ标准诊断的IBS患者接近1/3的人不符合Manning标准。
2、症状分布特点
调查的IBS人群不适症状的分布显示，腹痛89.02%、腹部不适86.92%、腹痛伴腹部不适75.94%、腹胀60.61%、大便频率异常56.57%、大便性状异常87.88%、排便不尽55.56%、排便困难或便急40.40%、粘液便38.38%，具体到四个标准而言，在罗马Ⅱ、罗马Ⅲ标准中，腹部不适的发生频率均超过腹痛，排便症状异常的发生频率各个标准与总体IBS人群基本一致。
3、排便性状分类分布特点
七种便型分类中，光滑腊肠便或蛇状便、软片便或糊状便在IBS患者中所在比例较高，三种亚型便分类中，便秘型亚型便在IBS患者中所在比例最高。
4、IBS影响因素分析
（1）一般情况中，不同性别、年龄、地域、民族、收入、学历、婚姻状况在IBS患者中的分布不同。女性、41-50岁年龄段、已婚、月收入大于5000元及低于3000元的人群患病率较高，而30岁以下年龄段、学历较高和学历较低的人群患病率较低；
（2）饮食因素中，食物过敏史、经常节食、喜好甜食、频繁喝咖啡或饮茶、频繁进食生冷食品、频繁进食高蛋白食物、饮水量过大、进食乳制品频率大于3天每周、进食过快或过慢均为IBS的患病的危险因素；而进食早餐、经常进食粗粮、经常进食高纤维食物、经常进食水果蔬菜为IBS的保护因素；
（3）生活习惯及工作状况中，每周活动1-2天、每周运动1-4小时、较长的周工作天数、较长的日工作时数、每日睡眠时间在6-8小时之间为IBS的保护因素。频繁的失眠、睡眠质量差、居住环境脏乱是IBS发生的危险因素；
（4）病史研究显示，疾病病史、急性胃肠炎病史及有腹部手术史为IBS患病的危险因素；
（5）服用药物研究中，服用抗生素、非甾体类消炎药、硝酸甘油均为IBS患病的危险因素，且硝酸甘油的影响最为显著；
（6）遗传因素研究中，发现近亲患有IBS是一个独立的危险因素；
（7）吸烟饮酒研究中，吸烟对IBS患病有显著影响，且吸烟的烟龄越长，患病率越高；但吸烟量对IBS患病无显著影响。而饮酒的影响则不显著；但在吸烟人群中，IBS的患病率与饮酒呈正相关，并且同时吸烟喝酒的人比只吸烟的人更容易患IBS；
（8）社会心理因素研究中，焦虑、抑郁程度对IBS患病有显著影响，且焦虑、抑郁程度越严重，越容易患病；在应对方式中得出，解决问题型、求助型、退避型应对方式为保护因素，而自责型、合理化型则为危险因素，尤其是合理化型为影响最为显著的危险因素；生活事件的研究中，IBS组患者可能经历了更多的负性事件，有影响的负性事件、负性事件得分也显著高于对照组。
二、IBS研究对象患病情况在四种标准中的比较
1、四种标准的诊断重叠率
Manning标准与罗马I、罗马Ⅱ、罗马Ⅲ标准的诊断重叠率分别为65.89%、51.07%、12.21%；罗马Ⅰ标准与Manning、罗马Ⅱ、罗马Ⅲ标准的诊断重叠率分别为95.72%、63.50%、15.87%；罗马Ⅱ标准与Manning、罗马I、罗马Ⅲ标准的诊断重叠率分别为72.59%、62.13%、17.78%；罗马Ⅲ标准与Manning、罗马I、罗马Ⅱ标准诊断重叠率分别为97.65%、87.35%、100.00%；完全符合四种标准的IBS患者有9.16%；符合Manning、罗马I、罗马Ⅱ三种标准的诊断率为25.02%；符合Manning、罗马Ⅱ及罗马Ⅲ标准三种标准的诊断率为1.08%；符合Manning、罗马Ⅰ两种标准的诊断率为21.07%；符合Manning、罗马Ⅱ诊断两种标准的IBS诊断率为7.56%；符合罗马I、罗马Ⅱ两种标准的诊断率为2.47%；符合罗马Ⅱ、罗马Ⅱ两种标准的诊断率为0.25%；仅符合Manning一种标准的诊断率为19.96%；仅符合罗马Ⅱ一种标准的诊断率为13.45%。
2、不适症状在四种标准中的表达
腹痛、腹部不适、腹痛伴腹部不适、腹胀、大便频率异常、大便性状异常、排便不尽、排便困难或便急、粘液便在Manning标准中的分布分别为，100.00%、84.40%、84.40%、65.82%、63.32%、92.09%、66.56%、43.82%和45.88%；在罗马Ⅰ标准中的分布为，100.00%、81.08%、81.08%、66.11%、70.28%、99.47%、64.08%、40.51%和41.69%；在罗马Ⅱ标准中的分布为，81.38%、100.00%、81.38%、66.95%、76.26%、95.71%、57.11%、47.75%和40.06%；在罗马Ⅲ标准的分布为，97.65%、100.00%、97.65%、63.53%、92.06%、100.00%、66.76%、33.82%和30.59%。
3、排便性状特点分类在四种标准中的比较
七种便型分类中，Manning标准与多块腊肠便、裂缝腊肠便、软片便或糊状便呈显著的正相关关系；罗马Ⅰ标准与7种便型都有显著关系，除了与干球便负相关，与其他便型都正相关；罗马Ⅱ标准仅与裂缝腊肠便呈显著正相关性；与柔软团块便、软片便或糊状便及水样便呈负相关；罗马Ⅲ标准与软片便或糊状便呈正相关，与干球便、多块腊肠便、光滑腊肠便或蛇状便、柔软团块便、水样便均呈负相关。三种亚型便分类中，Manning标准与便秘型亚型便为显著性负相关；罗马Ⅰ标准与腹泻型、混合型亚型便呈正相关，与便秘型亚型便相关性无统计学意义；罗马Ⅱ标准与便秘型亚型便呈正相关；而与腹泻型亚型便呈负相关；罗马Ⅲ标准与便秘型亚型便呈显著性正相关，腹泻型亚型便仅为弱正相关（P<0.1）。
4、影响因素在四种标准中的比较一般因素中，Manning标准中得出的影响因素包括性别、年龄、区域、居住环境、学历；罗马Ⅰ标准中相关因素包括性别、居住环境；罗马ⅠI标准中影响因素包括性别、区域、居住环境；罗马Ⅲ标准中影响因素包括性别、工资、居住环境。饮食习惯中，Manning标准中保护因素包括进食早餐、粗粮、高纤维食物频率高、水果及蔬菜频率高；危险因素经常节食、进食甜食、喝咖啡或饮茶、高蛋白食物频率、饮水量多、饮食口味重；罗马Ⅰ标准中保护因素包括进食早餐、粗粮、高纤维食物频率高、水果及蔬菜频率高、进食时间长、饮食口味重，危险因素包括经常节食、进食甜食、喝咖啡或饮茶、高蛋白食物频率、饮水量多；罗马Ⅱ标准中保护因素包括进食早餐、高纤维食物频率高、水果及蔬菜频率高、进食时间长、饮食口味重，危险因素包括经常节食、进食甜食、喝咖啡或饮茶、高蛋白食物频率、饮食口味重；罗马Ⅲ标准中保护因素包括服用水果及蔬菜频率高、进食时间长，危险因素包括食物过敏史、经常节食、乳制品频率高、高蛋白食物频率、饮水量多。
（3）生活习惯中，Manning标准中保护因素包括周累计运动时间长；危险因素包括睡前2小时进餐、平均每日睡眠时间多、平均每周失眠频率高、居住环境脏乱；罗马Ⅰ标准中保护因素包括周累计运动时间，危险因素包括平均每日睡眠时间长、平均每周失眠频率、居住环境脏乱；罗马Ⅱ标准中保护因素包括周运动天数多，危险因素包括睡前2小时进餐、平均每周失眠频率高、居住环境脏乱；罗马Ⅲ标准中保护因素包括周运动天数多、周累计运动时间长、平均失眠频率高，危险因素包括居住环境洁净脏乱。
（4）工作状况中，Manning标准中保护因素包括周工作天数多、日工作时数长；罗马Ⅰ标准保护因素包括周工作天数多；罗马Ⅱ标准周工作天数及日工作时数无统计学意义；罗马Ⅲ标准保护因素为周工作天数多。
（5）病史因素中，Manning标准中危险因素包括痢疾史、急性肠胃炎史、腹部手术史；罗马Ⅰ标准保护因素包括痢疾史、腹部手术史；罗马Ⅱ标准保护因素包括痢疾史、腹部手术史；罗马Ⅲ标准保护因素包括痢疾史，危险因素为手术史。
（6）服用药物因素中，Manning标准中危险因素包括服用抗生素、服用非甾体消炎药累计时间长、服用硝酸甘油频率高；罗马Ⅰ标准中危险因素包括服用抗生素频率高、服用非甾体消炎药累计时间长、服用硝酸甘油频率高；罗马Ⅱ标准中危险因素包括服用抗生素频率、服用非甾体消炎药累计时间、服用硝酸甘油频率；罗马Ⅲ标准中保护因素包括服用非甾体消炎药累计时间。
（7）遗传因素中，除罗马Ⅱ标准与对照组差别不大外，近亲患有IBS在另外三个标准中都为危险因素，且罗马Ⅲ标准差异最为显著。
（8）烟酒因素中，可见吸烟在罗马Ⅱ与罗马Ⅲ标准中都为典型的危险因素，吸烟年数在Manning、罗马Ⅲ标准在中为危险因素，日吸烟量在罗马Ⅲ标准中为危险因素。饮酒在四个标准中均无显著影响。
（9）焦虑抑郁状态，四个标准中焦虑、抑郁均为危险因素，且除罗马Ⅲ标准中抑郁程度无显著影响外，其他标准中焦虑程度及抑郁程度均为危险因素。
（10）应对方式，可见解决问题型、自责型、求助型、退避型应对方式在四个标准中均为保护因素。合理化型应对方式在四个标准中均为危险因素。幻想型应对方式除在罗马Ⅲ标准中无显著影响外，在另三个标准中均为危险因素。
（11）生活事件中，四个标准诊断出的IBS人群经历了更多负性事件数及有影响负性事件数，在Manning标准、罗马Ⅲ标准中IBS人群人均负性事件得分也显著高于健康对照组。
结论：
1、IBS相关影响因素较多。本研究表明，与健康对照组相比，IBS观察组在性别、年龄、地域、民族、收入、学历、婚姻状况分布不同。IBS的主要危险因素包括：合理化型应对方式、频繁服用硝酸甘油、焦虑状态、经常节食、睡眠质量差、频繁进食生冷食品。进一步对相关因素在四种标准的比较研究中证实，Manning标准中主要危险因素包括：合理化应对方式、频繁服用硝酸甘油、经常节食、焦虑、半年内有痢疾病史、居住环境差；罗马Ⅰ标准中主要危险因素包括：合理化应对方式、频繁服用硝酸甘油、半年内有痢疾病史、经常节食、女性、焦虑；罗马Ⅱ标准中主要危险因素包括：合理化应对方式、经常节食、频繁服用硝酸甘油、半年内有痢疾病史、睡眠质量差；罗马Ⅲ标准中主要危险因素包括：经常节食、合理化应对方式、食物过敏史、焦虑、居住环境差。
2、IBS患病率较高，约占因腹部症状就诊患者的2/3。通过对四个标准比较得出，Manning标准诊断范围最宽泛，本研究中有84.4%的患者有腹部不适症状，92.09的患者有排便性状改变，但Manning标准未将这两项症状纳入诊断标准，且标准中缺乏时间的限定，对排便习惯及性状也无多样性分类，诊断标准有一定局限性，容易漏诊器质性肠道疾病患者，该诊断标准适合因腹部症状就诊患者的初步筛查；罗马Ⅰ标准首次将时间限制纳入诊断标准，且进一步细化排便性状及习惯的分类，与Manning标准相比，诊断标准更加严格，我们的研究中接近60%的IBS患者通过罗马Ⅰ标准筛选出，诊断率较高，但研究同时显示，符合罗马I标准的患者中81.08%有腹部不适症状，但该标准仍未将此症状纳入诊断标准；罗马Ⅱ标准适当了宽泛了时间的限定，且将腹部不适症状纳入诊断标准，我们的研究显示，罗马Ⅱ标准中诊断的IBS患者接近1/3的人群不符合Manning标准，因此罗马Ⅱ标准为Manning标准做了很好的补充，但同时本研究显示，符合罗马Ⅱ标准的IBS患者中，有接近60%的患者有排便不尽感，接近50%的患者有排便困难或便急，而罗马Ⅱ标准未将此两项症状纳入诊断标准；罗马Ⅲ标准最严格限制了症状发在时间，诊断准确性较高，和本研究得出结论基本一致，此标准更适合用于科研研究，但同时该标准和罗马Ⅱ标准一样未将排便异常纳入诊断标准，我们的研究显示有接近2/3的患者有排便不尽感，接近1/3的患者有排便困难或便急，因此，此标准虽相对严格，但也容易漏诊部分IBS患者。
3、在IBS人群的症状分布中，腹痛、腹部不适和排便性状改变为好发症状，而粘液便及排便困难或便急为相对较少出现的症状，这与四种标准分别得出的症状分布基本相同，无显著性差异。
4、通过对排便性状特点分类进行四种标准的对比研究证实，七种便型分类方法在不同诊断标准下相关一致性高于三种亚型便分类方法，罗马Ⅰ标准不易受大便类型影响，诊断IBS的稳定性可能高于其它诊断标准。本研究在国内外尚属首次提出，希望能为IBS诊断标准的完善提供依据。
Objective to explore the major abdominal symptoms, the habit and shapes of stools,and related risk factors the Chinese patients with IBS through comparing patients withIBS and healthy adults in related symptoms, type of stool, related risk factors, contentof nervous and depression, types of response and experiences, etc. Furthermore, tocompare and analysis standard classification of Manning, Rome Ⅰ, Rome Ⅱ and RomeIII in diagnostic accuracy，diagnostic coverage and overlapping, characteristic ofabdominal symptoms, habit of stool and its shapes, risk factors, etc., in order to makemore well diagnostic standard and more reliable reference evidences in preventing andtherapy of the IBS.
Methods all research objects collected in clinic patients and routine physicalexamination adults between Jan,2009and Jan,2013.5000patients with abdominalsymptoms were divided into observing groups and questionnaires were performedaccompanied with blood test, stool and urine test, liver and kidney function tests,images studies and GI endoscopy exams to exclude the organic diseases and find thepatients with IBS. The control group(1602cases) were collected from routine physicalexamination adults in Center of Medical Examination. All the research objectsaccepted investigation questionnaires covering7tables including diagnostic standard,stool classification, related risk factors, nervous self-estimate, depression self-estimate,response types and living conditions. Statistics analyses performed using SPSS19.0,STATA12.0and Excel2007software in logistic single factor, multiple factors test andX2test. And P<0.05was considered significant differences.
Results
1.Prevalence study of IBS
(1)Incidence rate of diagnosis
In the observing groups(5000objects),3242patients were diagnosed with IBS, occupied64.84%of all visiting patients. The diagnostic rates in4different standardswere as followed,2718/5000(83.84%) in Manning standard,1871/5000(57.71%) inRome Ⅰ standard,1912/5000(58.98%) in Rome Ⅱ standard and340/5000(10.49%) inRome Ⅲ standard, Almost all the patients with IBS diagnosed by Rome Ⅰ and Rome Ⅲstandards were accordance by Manning standard, whereas patients with IBS diagnosedby Rome Ⅱ standard wasn’t accordance in1/3by Manning standard.Distribution of symptoms
The symptoms distribution in the patients with IBS was as followed, abdominalpain89.02%, abdominal discomfort86.92%, abdominal pain with discomfort75.94%,abdominal distention60.61%, abnormal stool frequency56.57%，stool abnormalities87.88%, defecation55.56%, difficult in defecation or tenesmus40.40%, mucousstool38.38%.The distribution of defecation traits classificationIn the7stools shapes classification studies, smooth dachshund stools shape orsnake-like stools and soft sheet stools shape or pasty stools shape take a highproportion in IBS. In the3stools shapes classification studies,constipation stools takethe highest proportion in IBS.Related factors
a.There were also some different distributions in the patients with IBS in gender,age, region, race, income, education condition, marriage.Ladies,patients between41to50ys,married race,people with more than5000RMB monthly or less than3000RMBmonthly offered higher incidence.Patients under30ys and patients with highereducation offered lower incidence.
b.In the studies on diet factor, people, who had food allergy, commonly on diet,sweet fancy, coffee or tea fancy, cold or raw food taken, too much high proteins, drinktoo much water, milk food more than3time a week, food intake too fast or slow, hadhigher risk factor for IBS. And people, who routinely had breakfast, coarse grains andfrequent intake food with high fiber, obtained better preventing factor for IBS.
c.There were also some correlationship between life habits, work condition and IBS suffering.1-2days activities each week or1-4hours exercises each week had lesspossibilities for IBS. Insomnia often offered risk for IBS. People sleep6-8hours eachday had less incidence for IBS, whereas longer or shorter sleep had higher incidence.Living condition bad was another risk factor. Longer working days each week andlonger hours each day could prevent the people from IBS.
d.In the history studies, the diseases suffering in half year and the history of acutegastroenteritis were the risk factor for IBS. Abdominal surgery history was also a riskfactor.
e.As for the medicine history studies, antibiotics, non-steroidal anti-inflammatorydrugs, especially nitric acid glycerol were risk factor for IBS.
f.The study of genetic factors finds that close relatives suffering from IBS is anindependent risk factor.
g.Smoking had correlationship with the onset of IBS, as the long history the peoplesmoke, the higher incidence the smoker had, but the quantity had no relationship withIBS. Although there was no relationship between drinking and IBS, there was positiverelationship in the people who smoke and drink.
h.In psychological studies, anxious and depression had close influence to IBS thatwas the more serious the people had, the more possibilities the people suffered fromIBS. In the response studies, problem-solving type，help-requiring type, backoff typehad less possibilities for IBS. Self-blame type, especially rationalization type were therisk factor for IBS. Patients with IBS had more negative experiences compared to thecontrol group.
2.Comparison of the prevalence of IBS study in four standard(1) Diagnostic overlap rates of four standard
Manning criteria, Rome Ⅰ, Rome Ⅱ, Rome Ⅲ criteria diagnostic overlap rate were65.89%,51.07%,12.21%; Rome Ⅰ criteria and Manning, Rome Ⅱ, Rome Ⅲ criteriadiagnostic overlap rates were95.72%,63.50%,15.87%; Rome Ⅱ criteria and Manning,Rome Ⅰ, Rome Ⅲ criteria diagnostic overlap rate was72.59%,62.13%,17.78%; RomeIII criteria Manning, Rome Ⅰ, Rome Ⅱ criteria diagnostic overlap rates were97.65%, 87.35%,100.00%; IBS patients are fully in line with the four standard9.16%; complywith Manning, Rome Ⅰ, Rome Ⅱ three standard diagnostic rate was25.02%; complywith Manning, Rome Ⅱ and Rome Ⅲ criteria in three standard diagnosis rate was1.08%; comply with Manning, Rome Ⅰ standard diagnostic rate was21.07%; in linewith Manning, Rome Ⅱ diagnostic two standard IBS diagnosis was7.56%; meet theRome Ⅰ, Rome Ⅱ standard diagnostic rate2.47%; meet Rome Ⅱ, Rome Ⅱ diagnosticrate of0.25%; Only in line with the Manning diagnostic rate was19.96%; Only inline with the Rome Ⅱ diagnostic rate was13.45%.(2)Expression of symptoms in the four standardThe symptoms(abdominal pain, abdominal discomfort, abdominal pain withdiscomfort, abdominal distention, abnormal stool frequency，stool abnormalities,defecation, difficult in defecation or tenesmus,mucous stool) distribution in the patientswith IBS in four standard was as followed: Manning criteria100.00%、84.40%,84.40%,65.82%,63.32%,92.09%,66.56%,43.82%,45.88%;Rome Ⅰ criteria100.00%,81.08%,81.08%,66.11%,70.28%,99.47%,64.08%,40.51%,41.69%;Rome Ⅱcriteria81.38%,100.00%,81.38%,66.95%,76.26%,95.71%,57.11%,47.75%,40.06%;RomeIIIcriteria97.65%,100.00%,97.65%,63.53%,92.06%,100.00%,66.76%,33.82%,30.59%.Comparison of defecation characters and features in four standard
In the7stools shapes classification studies, Manning criteria had positiverelationship with multi-block sausage stools shape,crack sausage stools shape and softsheet stools shape or pasty stools shape;Rome Ⅰ criteria had negative relationship withdry bulb stools shape and had positive relationship the other stools shapes;Rome Ⅱcriteria had positive relationship with crack sausage stools shape and had constipationtype soft clumps stools shape,soft sheet stools shape or pasty stools shape,watery stoolsshape;Rome Ⅲ criteria had positive relationship with pasty stools shape and hadnegative relationship with dry bulb stools shape,multi-block sausage stoolsshape,smooth dachshund stools shape or snake-like stools,soft clumps stools shape andwatery stools shape.In the3stools shapes classification studies, Manning criteria had negative relationship with constipation type;Rome Ⅰ criteria had positive relationshipwith diarrhea type and hybrid type;Rome Ⅲ criteria had positive relationship withconstipation type and had negative relationship with diarrhea type;Rome Ⅲ criteriahad positive relationship with constipation type and diarrhea type.Comparison of related factor in four standard
a.Gender,age,region,education condition were related factors in Manningcriteria;gender was related factor in Rome Ⅰ criteria;gender, region were related factorsin Rome Ⅱ criteria;gender, income were related factors in Rome Ⅲ criteria.
b.In the studies on diet factor, having breakfast,frequent intake food with high fiberand frequent intake fruits and vegetables were protective factors in Manningcriteria;commonly on diet, sweet fancy, coffee or tea fancy, too much high proteins,drink too much water, high-salt diet were risk factors.In Rome Ⅰ criteria,havingbreakfast,frequent intake food with high fiber,frequent intake fruits andvegetables,food intake too slow were protective factors;commonly on diet, sweet fancy,coffee or tea fancy, too much high proteins, drink too much water were risk factors.InRome Ⅱ criteria,having breakfast,frequent intake food with high fiber,frequent intakefruits and vegetables,food intake too slow were protective factors;commonly on diet,sweet fancy, coffee or tea fancy, too much high proteins, high-salt diet were riskfactors.In Rome Ⅲ criteria,frequent intake fruits and vegetables,food intake too slowwere protective factors; food allergy,commonly on diet,milk food, too much highproteins,drink too much water were risk factors.
c.There were some differences of related factors between four standards in lifehabits.In Manning criteria,long week cumulative exercise time was protectivefactor;within two hours of bedtime meal, long daily sleep time,high frequency ofinsomnia,bad living condition were risk factors.In Rome Ⅰ criteria,long weekcumulative exercise time was protective factor; long daily sleep time,high frequency ofinsomnia,bad living condition were risk factors.In Rome Ⅱ criteria,more sports dayswas protective factor;within two hours of bedtime meal,high frequency ofinsomnia,bad living condition were risk factors.In Rome Ⅲ criteria,more sports days,long week cumulative exercise time,high frequency of insomnia were protectivefactors;bad living condition was risk factors.
d.Working conditions were different too.In Manning criteria,longer working dayseach week and longer hours each day was protective factors. In Rome Ⅰ criteria,longerworking days was protective factor.In Rome Ⅲ criteria,longer working days each weekwas protective factors.
e.There were some differences of related factors between four standards in historystudies.In Manning criteria,the history of dysentery, the history of gastroenteritis andthe history of abdominal surgery were risk factors.In Rome Ⅰ criteria,the history ofdysentery, the history of abdominal surgery were protective factor.In Rome Ⅱcriteria,the history of dysentery, the history of abdominal surgery were protectivefactor.In Rome Ⅲ criteria,the history of dysentery was protective factors;the history ofabdominal surgery was risk factors.
f.There were some differences of related factors between four standards inmedicine history studies.In Manning criteria,antibiotics, non-steroidalanti-inflammatory drugs, nitric acid glycerol were risk factors.In Rome Ⅰcriteria,antibiotics,non-steroidal anti-inflammatory drugs,nitric acid glycerol were riskfactors.In Rome Ⅱ criteria,antibiotics,non-steroidal anti-inflammatory drugs,nitric acidglycerol were risk factors.In Rome Ⅲ criteria,non-steroidal anti-inflammatory drugswas protective factors.
g.Close relatives suffering from IBS was risk factor in Manning criteria,Rome Ⅰcriteria,Rome Ⅲ criteria.
h.Smoking was risk factor in Rome Ⅱ and Rome Ⅲ criteria. Long history thepeople smoke was risk factor in Manning and Rome Ⅲ criteria.The quantity ofsmoking was risk factor in Rome Ⅲ criteria.There was no relationship betweendrinking and four standards.
i. Anxiety and depression were risk factors in four standards.Anxiety level anddepression level were risk factors in four standards except depression level in Rome Ⅲcriteria.
j.In the response studies, problem-solving type，help-requiring type,self-blame type,back-off type were protective factors in four standards.Rationalization type was riskfactor in four standards.Fantasy type was risk factor in Manning criteria,Rome Ⅰcriteria,Rome Ⅱ criteria.
k.Negative experiences was risk factor in four standards.Per capita negative eventsscore was risk factor in Manning criteria,Rome Ⅲ criteria.
Conclusion
1.There were lots of factors which might influence the onset of IBS includinggender, age, region, races, income, education, marriage. There were also many riskfactors correlated with IBS onset such as rationalization type response,taking nitricacid glycero,habit on diet, poor sleeping,anxiety，the diseases suffering in half year，living condition bad.The main risk factors of Rome Ⅰ criteria include:rationalizationtype response,taking nitric acid glycero,the diseases suffering in half year，habit on diet,Ladies，anxiety.The main risk factors of Rome Ⅱ criteria include：rationalization typeresponse,habit on diet, ladies，taking nitric acid glycero,the diseases suffering in halfyear，poor sleeping. The main risk factors of Rome Ⅲ criteria include：habit on diet,Ladies，rationalization type response,food allergy,anxiety,poor sleeping.
2.The incidence of IBS is higher than what we expected, which is occupied2/3ofthe clinical patients with abdominal symptoms. In the four diagnostic criteria, Manningcriteria offered the widest covering of the diseases, but the abdominal discomfortoccurred in84.4%patients and defecation changes in92.09%patients which were notconsidered the evidences in Manning criteria. It’s also no limitation of the time rangeand no diversity classification of defecation habit or stool shapes which might miss theorganic intestinal diseases. Manning criteria should use in the screening in the patientswith abdominal symptoms for its defects. Rome Ⅰ criteria first covered time range andfurthermore made classification of defecation habit and stool shapes which is differentcompared with Manning criteria and more strict in the diagnosis of IBS, thereforeapproximately60%of patients with IBS found through Rome Ⅰ criteria. The researchalso showed that there had81.08%of patients with IBS who had abdominal discomfort, but this symptom was not covered in Rome Ⅰ criteria. Rome Ⅱ criteria, which is broadthe time range and cover abdominal discomfort, showed1/3of the patients with IBSwhich didn’t meet the criteria of Manning and was considered as the complement ofthe Manning criteria. There was still60%patients with defecation,50%patients withdifficult in defecation or tenesmus which wasn’t contained in Rome Ⅱ criteria.Although Rome Ⅲ criteria which limits the time of symptoms occurred offers higheraccuracy in the diagnosis of IBS as our results showed and more suitable for scientificresearch, this criteria could miss part of the patients with IBS because defecationoccurred in2/3patients and difficult in defecation or tenesmus occurred in1/3patientsweren’t covered in the criteria.
3.In the symptom distribution of the patients with IBS, abdominal pain, abdominaldiscomfort and defecation traits changes were most commonly met symptoms, whereasmucous stools shapes, difficult defecation or tenesmus was relatively rare symptoms.
4.Seven stools shape classification had higher recognition in IBS comparing tothree stool shape classification in any diagnoses standards. And Rome Ⅰ seemed hadless influence by different stool shapes which might offer higher sensitivities to theremaining diagnostic standards. The research is the first time in the world, hoping toprovide a basis for the improvement of the diagnostic criteria of IBS.
方法：研究对象收集自2010年1月至2013年1月间海军总医院消化内科就诊的患者和健康体检中心的体检人员。选择因腹部症状就诊消化内科的5000名患者为观察组，发放调查问卷，同时完善血常规、大小便、肝肾功、影像学及胃肠镜等检查排除器质性疾病，结合调查问卷筛选出IBS患者。选择同期在健康体检中心体检的1602名体检人员为对照组，完善调查问卷及常规筛查。调查问卷包括诊断标准问卷、大便分型问卷、相关危险因素问卷、焦虑自评量表、抑郁自评量表、应对方式问卷、生活事件量表七个部分。对两组问卷结果进行统计分析，采用SPSS19.0，STATA12.0及Excel2007软件进行统计分析和图形处理，主要是进行logistic单因素、多因素及卡方检验，以P值<0.05为显著性。
结果：
一、IBS研究对象患病情况
1、发病诊断率
因腹部不适症状就诊消化科的5000例患者中，有3242例为IBS患者，发病率为64.84%。具体到四种标准中，Manning标准2718例（83.84%）、罗马Ⅰ标准1871例（57.71%）、罗马Ⅱ标准1912例（58.98%）、罗马Ⅲ标准340例（10.49%）。符合罗马I、罗马Ⅲ标准诊断的IBS人群大部分都符合Manning标准，罗马Ⅱ标准诊断的IBS患者接近1/3的人不符合Manning标准。
2、症状分布特点
调查的IBS人群不适症状的分布显示，腹痛89.02%、腹部不适86.92%、腹痛伴腹部不适75.94%、腹胀60.61%、大便频率异常56.57%、大便性状异常87.88%、排便不尽55.56%、排便困难或便急40.40%、粘液便38.38%，具体到四个标准而言，在罗马Ⅱ、罗马Ⅲ标准中，腹部不适的发生频率均超过腹痛，排便症状异常的发生频率各个标准与总体IBS人群基本一致。
3、排便性状分类分布特点
七种便型分类中，光滑腊肠便或蛇状便、软片便或糊状便在IBS患者中所在比例较高，三种亚型便分类中，便秘型亚型便在IBS患者中所在比例最高。
4、IBS影响因素分析
（1）一般情况中，不同性别、年龄、地域、民族、收入、学历、婚姻状况在IBS患者中的分布不同。女性、41-50岁年龄段、已婚、月收入大于5000元及低于3000元的人群患病率较高，而30岁以下年龄段、学历较高和学历较低的人群患病率较低；
（2）饮食因素中，食物过敏史、经常节食、喜好甜食、频繁喝咖啡或饮茶、频繁进食生冷食品、频繁进食高蛋白食物、饮水量过大、进食乳制品频率大于3天每周、进食过快或过慢均为IBS的患病的危险因素；而进食早餐、经常进食粗粮、经常进食高纤维食物、经常进食水果蔬菜为IBS的保护因素；
（3）生活习惯及工作状况中，每周活动1-2天、每周运动1-4小时、较长的周工作天数、较长的日工作时数、每日睡眠时间在6-8小时之间为IBS的保护因素。频繁的失眠、睡眠质量差、居住环境脏乱是IBS发生的危险因素；
（4）病史研究显示，疾病病史、急性胃肠炎病史及有腹部手术史为IBS患病的危险因素；
（5）服用药物研究中，服用抗生素、非甾体类消炎药、硝酸甘油均为IBS患病的危险因素，且硝酸甘油的影响最为显著；
（6）遗传因素研究中，发现近亲患有IBS是一个独立的危险因素；
（7）吸烟饮酒研究中，吸烟对IBS患病有显著影响，且吸烟的烟龄越长，患病率越高；但吸烟量对IBS患病无显著影响。而饮酒的影响则不显著；但在吸烟人群中，IBS的患病率与饮酒呈正相关，并且同时吸烟喝酒的人比只吸烟的人更容易患IBS；
（8）社会心理因素研究中，焦虑、抑郁程度对IBS患病有显著影响，且焦虑、抑郁程度越严重，越容易患病；在应对方式中得出，解决问题型、求助型、退避型应对方式为保护因素，而自责型、合理化型则为危险因素，尤其是合理化型为影响最为显著的危险因素；生活事件的研究中，IBS组患者可能经历了更多的负性事件，有影响的负性事件、负性事件得分也显著高于对照组。
二、IBS研究对象患病情况在四种标准中的比较
1、四种标准的诊断重叠率
Manning标准与罗马I、罗马Ⅱ、罗马Ⅲ标准的诊断重叠率分别为65.89%、51.07%、12.21%；罗马Ⅰ标准与Manning、罗马Ⅱ、罗马Ⅲ标准的诊断重叠率分别为95.72%、63.50%、15.87%；罗马Ⅱ标准与Manning、罗马I、罗马Ⅲ标准的诊断重叠率分别为72.59%、62.13%、17.78%；罗马Ⅲ标准与Manning、罗马I、罗马Ⅱ标准诊断重叠率分别为97.65%、87.35%、100.00%；完全符合四种标准的IBS患者有9.16%；符合Manning、罗马I、罗马Ⅱ三种标准的诊断率为25.02%；符合Manning、罗马Ⅱ及罗马Ⅲ标准三种标准的诊断率为1.08%；符合Manning、罗马Ⅰ两种标准的诊断率为21.07%；符合Manning、罗马Ⅱ诊断两种标准的IBS诊断率为7.56%；符合罗马I、罗马Ⅱ两种标准的诊断率为2.47%；符合罗马Ⅱ、罗马Ⅱ两种标准的诊断率为0.25%；仅符合Manning一种标准的诊断率为19.96%；仅符合罗马Ⅱ一种标准的诊断率为13.45%。
2、不适症状在四种标准中的表达
腹痛、腹部不适、腹痛伴腹部不适、腹胀、大便频率异常、大便性状异常、排便不尽、排便困难或便急、粘液便在Manning标准中的分布分别为，100.00%、84.40%、84.40%、65.82%、63.32%、92.09%、66.56%、43.82%和45.88%；在罗马Ⅰ标准中的分布为，100.00%、81.08%、81.08%、66.11%、70.28%、99.47%、64.08%、40.51%和41.69%；在罗马Ⅱ标准中的分布为，81.38%、100.00%、81.38%、66.95%、76.26%、95.71%、57.11%、47.75%和40.06%；在罗马Ⅲ标准的分布为，97.65%、100.00%、97.65%、63.53%、92.06%、100.00%、66.76%、33.82%和30.59%。
3、排便性状特点分类在四种标准中的比较
七种便型分类中，Manning标准与多块腊肠便、裂缝腊肠便、软片便或糊状便呈显著的正相关关系；罗马Ⅰ标准与7种便型都有显著关系，除了与干球便负相关，与其他便型都正相关；罗马Ⅱ标准仅与裂缝腊肠便呈显著正相关性；与柔软团块便、软片便或糊状便及水样便呈负相关；罗马Ⅲ标准与软片便或糊状便呈正相关，与干球便、多块腊肠便、光滑腊肠便或蛇状便、柔软团块便、水样便均呈负相关。三种亚型便分类中，Manning标准与便秘型亚型便为显著性负相关；罗马Ⅰ标准与腹泻型、混合型亚型便呈正相关，与便秘型亚型便相关性无统计学意义；罗马Ⅱ标准与便秘型亚型便呈正相关；而与腹泻型亚型便呈负相关；罗马Ⅲ标准与便秘型亚型便呈显著性正相关，腹泻型亚型便仅为弱正相关（P<0.1）。
4、影响因素在四种标准中的比较一般因素中，Manning标准中得出的影响因素包括性别、年龄、区域、居住环境、学历；罗马Ⅰ标准中相关因素包括性别、居住环境；罗马ⅠI标准中影响因素包括性别、区域、居住环境；罗马Ⅲ标准中影响因素包括性别、工资、居住环境。饮食习惯中，Manning标准中保护因素包括进食早餐、粗粮、高纤维食物频率高、水果及蔬菜频率高；危险因素经常节食、进食甜食、喝咖啡或饮茶、高蛋白食物频率、饮水量多、饮食口味重；罗马Ⅰ标准中保护因素包括进食早餐、粗粮、高纤维食物频率高、水果及蔬菜频率高、进食时间长、饮食口味重，危险因素包括经常节食、进食甜食、喝咖啡或饮茶、高蛋白食物频率、饮水量多；罗马Ⅱ标准中保护因素包括进食早餐、高纤维食物频率高、水果及蔬菜频率高、进食时间长、饮食口味重，危险因素包括经常节食、进食甜食、喝咖啡或饮茶、高蛋白食物频率、饮食口味重；罗马Ⅲ标准中保护因素包括服用水果及蔬菜频率高、进食时间长，危险因素包括食物过敏史、经常节食、乳制品频率高、高蛋白食物频率、饮水量多。
（3）生活习惯中，Manning标准中保护因素包括周累计运动时间长；危险因素包括睡前2小时进餐、平均每日睡眠时间多、平均每周失眠频率高、居住环境脏乱；罗马Ⅰ标准中保护因素包括周累计运动时间，危险因素包括平均每日睡眠时间长、平均每周失眠频率、居住环境脏乱；罗马Ⅱ标准中保护因素包括周运动天数多，危险因素包括睡前2小时进餐、平均每周失眠频率高、居住环境脏乱；罗马Ⅲ标准中保护因素包括周运动天数多、周累计运动时间长、平均失眠频率高，危险因素包括居住环境洁净脏乱。
（4）工作状况中，Manning标准中保护因素包括周工作天数多、日工作时数长；罗马Ⅰ标准保护因素包括周工作天数多；罗马Ⅱ标准周工作天数及日工作时数无统计学意义；罗马Ⅲ标准保护因素为周工作天数多。
（5）病史因素中，Manning标准中危险因素包括痢疾史、急性肠胃炎史、腹部手术史；罗马Ⅰ标准保护因素包括痢疾史、腹部手术史；罗马Ⅱ标准保护因素包括痢疾史、腹部手术史；罗马Ⅲ标准保护因素包括痢疾史，危险因素为手术史。
（6）服用药物因素中，Manning标准中危险因素包括服用抗生素、服用非甾体消炎药累计时间长、服用硝酸甘油频率高；罗马Ⅰ标准中危险因素包括服用抗生素频率高、服用非甾体消炎药累计时间长、服用硝酸甘油频率高；罗马Ⅱ标准中危险因素包括服用抗生素频率、服用非甾体消炎药累计时间、服用硝酸甘油频率；罗马Ⅲ标准中保护因素包括服用非甾体消炎药累计时间。
（7）遗传因素中，除罗马Ⅱ标准与对照组差别不大外，近亲患有IBS在另外三个标准中都为危险因素，且罗马Ⅲ标准差异最为显著。
（8）烟酒因素中，可见吸烟在罗马Ⅱ与罗马Ⅲ标准中都为典型的危险因素，吸烟年数在Manning、罗马Ⅲ标准在中为危险因素，日吸烟量在罗马Ⅲ标准中为危险因素。饮酒在四个标准中均无显著影响。
（9）焦虑抑郁状态，四个标准中焦虑、抑郁均为危险因素，且除罗马Ⅲ标准中抑郁程度无显著影响外，其他标准中焦虑程度及抑郁程度均为危险因素。
（10）应对方式，可见解决问题型、自责型、求助型、退避型应对方式在四个标准中均为保护因素。合理化型应对方式在四个标准中均为危险因素。幻想型应对方式除在罗马Ⅲ标准中无显著影响外，在另三个标准中均为危险因素。
（11）生活事件中，四个标准诊断出的IBS人群经历了更多负性事件数及有影响负性事件数，在Manning标准、罗马Ⅲ标准中IBS人群人均负性事件得分也显著高于健康对照组。
结论：
1、IBS相关影响因素较多。本研究表明，与健康对照组相比，IBS观察组在性别、年龄、地域、民族、收入、学历、婚姻状况分布不同。IBS的主要危险因素包括：合理化型应对方式、频繁服用硝酸甘油、焦虑状态、经常节食、睡眠质量差、频繁进食生冷食品。进一步对相关因素在四种标准的比较研究中证实，Manning标准中主要危险因素包括：合理化应对方式、频繁服用硝酸甘油、经常节食、焦虑、半年内有痢疾病史、居住环境差；罗马Ⅰ标准中主要危险因素包括：合理化应对方式、频繁服用硝酸甘油、半年内有痢疾病史、经常节食、女性、焦虑；罗马Ⅱ标准中主要危险因素包括：合理化应对方式、经常节食、频繁服用硝酸甘油、半年内有痢疾病史、睡眠质量差；罗马Ⅲ标准中主要危险因素包括：经常节食、合理化应对方式、食物过敏史、焦虑、居住环境差。
2、IBS患病率较高，约占因腹部症状就诊患者的2/3。通过对四个标准比较得出，Manning标准诊断范围最宽泛，本研究中有84.4%的患者有腹部不适症状，92.09的患者有排便性状改变，但Manning标准未将这两项症状纳入诊断标准，且标准中缺乏时间的限定，对排便习惯及性状也无多样性分类，诊断标准有一定局限性，容易漏诊器质性肠道疾病患者，该诊断标准适合因腹部症状就诊患者的初步筛查；罗马Ⅰ标准首次将时间限制纳入诊断标准，且进一步细化排便性状及习惯的分类，与Manning标准相比，诊断标准更加严格，我们的研究中接近60%的IBS患者通过罗马Ⅰ标准筛选出，诊断率较高，但研究同时显示，符合罗马I标准的患者中81.08%有腹部不适症状，但该标准仍未将此症状纳入诊断标准；罗马Ⅱ标准适当了宽泛了时间的限定，且将腹部不适症状纳入诊断标准，我们的研究显示，罗马Ⅱ标准中诊断的IBS患者接近1/3的人群不符合Manning标准，因此罗马Ⅱ标准为Manning标准做了很好的补充，但同时本研究显示，符合罗马Ⅱ标准的IBS患者中，有接近60%的患者有排便不尽感，接近50%的患者有排便困难或便急，而罗马Ⅱ标准未将此两项症状纳入诊断标准；罗马Ⅲ标准最严格限制了症状发在时间，诊断准确性较高，和本研究得出结论基本一致，此标准更适合用于科研研究，但同时该标准和罗马Ⅱ标准一样未将排便异常纳入诊断标准，我们的研究显示有接近2/3的患者有排便不尽感，接近1/3的患者有排便困难或便急，因此，此标准虽相对严格，但也容易漏诊部分IBS患者。
3、在IBS人群的症状分布中，腹痛、腹部不适和排便性状改变为好发症状，而粘液便及排便困难或便急为相对较少出现的症状，这与四种标准分别得出的症状分布基本相同，无显著性差异。
4、通过对排便性状特点分类进行四种标准的对比研究证实，七种便型分类方法在不同诊断标准下相关一致性高于三种亚型便分类方法，罗马Ⅰ标准不易受大便类型影响，诊断IBS的稳定性可能高于其它诊断标准。本研究在国内外尚属首次提出，希望能为IBS诊断标准的完善提供依据。
Objective to explore the major abdominal symptoms, the habit and shapes of stools,and related risk factors the Chinese patients with IBS through comparing patients withIBS and healthy adults in related symptoms, type of stool, related risk factors, contentof nervous and depression, types of response and experiences, etc. Furthermore, tocompare and analysis standard classification of Manning, Rome Ⅰ, Rome Ⅱ and RomeIII in diagnostic accuracy，diagnostic coverage and overlapping, characteristic ofabdominal symptoms, habit of stool and its shapes, risk factors, etc., in order to makemore well diagnostic standard and more reliable reference evidences in preventing andtherapy of the IBS.
Methods all research objects collected in clinic patients and routine physicalexamination adults between Jan,2009and Jan,2013.5000patients with abdominalsymptoms were divided into observing groups and questionnaires were performedaccompanied with blood test, stool and urine test, liver and kidney function tests,images studies and GI endoscopy exams to exclude the organic diseases and find thepatients with IBS. The control group(1602cases) were collected from routine physicalexamination adults in Center of Medical Examination. All the research objectsaccepted investigation questionnaires covering7tables including diagnostic standard,stool classification, related risk factors, nervous self-estimate, depression self-estimate,response types and living conditions. Statistics analyses performed using SPSS19.0,STATA12.0and Excel2007software in logistic single factor, multiple factors test andX2test. And P<0.05was considered significant differences.
Results
1.Prevalence study of IBS
(1)Incidence rate of diagnosis
In the observing groups(5000objects),3242patients were diagnosed with IBS, occupied64.84%of all visiting patients. The diagnostic rates in4different standardswere as followed,2718/5000(83.84%) in Manning standard,1871/5000(57.71%) inRome Ⅰ standard,1912/5000(58.98%) in Rome Ⅱ standard and340/5000(10.49%) inRome Ⅲ standard, Almost all the patients with IBS diagnosed by Rome Ⅰ and Rome Ⅲstandards were accordance by Manning standard, whereas patients with IBS diagnosedby Rome Ⅱ standard wasn’t accordance in1/3by Manning standard.Distribution of symptoms
The symptoms distribution in the patients with IBS was as followed, abdominalpain89.02%, abdominal discomfort86.92%, abdominal pain with discomfort75.94%,abdominal distention60.61%, abnormal stool frequency56.57%，stool abnormalities87.88%, defecation55.56%, difficult in defecation or tenesmus40.40%, mucousstool38.38%.The distribution of defecation traits classificationIn the7stools shapes classification studies, smooth dachshund stools shape orsnake-like stools and soft sheet stools shape or pasty stools shape take a highproportion in IBS. In the3stools shapes classification studies,constipation stools takethe highest proportion in IBS.Related factors
a.There were also some different distributions in the patients with IBS in gender,age, region, race, income, education condition, marriage.Ladies,patients between41to50ys,married race,people with more than5000RMB monthly or less than3000RMBmonthly offered higher incidence.Patients under30ys and patients with highereducation offered lower incidence.
b.In the studies on diet factor, people, who had food allergy, commonly on diet,sweet fancy, coffee or tea fancy, cold or raw food taken, too much high proteins, drinktoo much water, milk food more than3time a week, food intake too fast or slow, hadhigher risk factor for IBS. And people, who routinely had breakfast, coarse grains andfrequent intake food with high fiber, obtained better preventing factor for IBS.
c.There were also some correlationship between life habits, work condition and IBS suffering.1-2days activities each week or1-4hours exercises each week had lesspossibilities for IBS. Insomnia often offered risk for IBS. People sleep6-8hours eachday had less incidence for IBS, whereas longer or shorter sleep had higher incidence.Living condition bad was another risk factor. Longer working days each week andlonger hours each day could prevent the people from IBS.
d.In the history studies, the diseases suffering in half year and the history of acutegastroenteritis were the risk factor for IBS. Abdominal surgery history was also a riskfactor.
e.As for the medicine history studies, antibiotics, non-steroidal anti-inflammatorydrugs, especially nitric acid glycerol were risk factor for IBS.
f.The study of genetic factors finds that close relatives suffering from IBS is anindependent risk factor.
g.Smoking had correlationship with the onset of IBS, as the long history the peoplesmoke, the higher incidence the smoker had, but the quantity had no relationship withIBS. Although there was no relationship between drinking and IBS, there was positiverelationship in the people who smoke and drink.
h.In psychological studies, anxious and depression had close influence to IBS thatwas the more serious the people had, the more possibilities the people suffered fromIBS. In the response studies, problem-solving type，help-requiring type, backoff typehad less possibilities for IBS. Self-blame type, especially rationalization type were therisk factor for IBS. Patients with IBS had more negative experiences compared to thecontrol group.
2.Comparison of the prevalence of IBS study in four standard(1) Diagnostic overlap rates of four standard
Manning criteria, Rome Ⅰ, Rome Ⅱ, Rome Ⅲ criteria diagnostic overlap rate were65.89%,51.07%,12.21%; Rome Ⅰ criteria and Manning, Rome Ⅱ, Rome Ⅲ criteriadiagnostic overlap rates were95.72%,63.50%,15.87%; Rome Ⅱ criteria and Manning,Rome Ⅰ, Rome Ⅲ criteria diagnostic overlap rate was72.59%,62.13%,17.78%; RomeIII criteria Manning, Rome Ⅰ, Rome Ⅱ criteria diagnostic overlap rates were97.65%, 87.35%,100.00%; IBS patients are fully in line with the four standard9.16%; complywith Manning, Rome Ⅰ, Rome Ⅱ three standard diagnostic rate was25.02%; complywith Manning, Rome Ⅱ and Rome Ⅲ criteria in three standard diagnosis rate was1.08%; comply with Manning, Rome Ⅰ standard diagnostic rate was21.07%; in linewith Manning, Rome Ⅱ diagnostic two standard IBS diagnosis was7.56%; meet theRome Ⅰ, Rome Ⅱ standard diagnostic rate2.47%; meet Rome Ⅱ, Rome Ⅱ diagnosticrate of0.25%; Only in line with the Manning diagnostic rate was19.96%; Only inline with the Rome Ⅱ diagnostic rate was13.45%.(2)Expression of symptoms in the four standardThe symptoms(abdominal pain, abdominal discomfort, abdominal pain withdiscomfort, abdominal distention, abnormal stool frequency，stool abnormalities,defecation, difficult in defecation or tenesmus,mucous stool) distribution in the patientswith IBS in four standard was as followed: Manning criteria100.00%、84.40%,84.40%,65.82%,63.32%,92.09%,66.56%,43.82%,45.88%;Rome Ⅰ criteria100.00%,81.08%,81.08%,66.11%,70.28%,99.47%,64.08%,40.51%,41.69%;Rome Ⅱcriteria81.38%,100.00%,81.38%,66.95%,76.26%,95.71%,57.11%,47.75%,40.06%;RomeIIIcriteria97.65%,100.00%,97.65%,63.53%,92.06%,100.00%,66.76%,33.82%,30.59%.Comparison of defecation characters and features in four standard
In the7stools shapes classification studies, Manning criteria had positiverelationship with multi-block sausage stools shape,crack sausage stools shape and softsheet stools shape or pasty stools shape;Rome Ⅰ criteria had negative relationship withdry bulb stools shape and had positive relationship the other stools shapes;Rome Ⅱcriteria had positive relationship with crack sausage stools shape and had constipationtype soft clumps stools shape,soft sheet stools shape or pasty stools shape,watery stoolsshape;Rome Ⅲ criteria had positive relationship with pasty stools shape and hadnegative relationship with dry bulb stools shape,multi-block sausage stoolsshape,smooth dachshund stools shape or snake-like stools,soft clumps stools shape andwatery stools shape.In the3stools shapes classification studies, Manning criteria had negative relationship with constipation type;Rome Ⅰ criteria had positive relationshipwith diarrhea type and hybrid type;Rome Ⅲ criteria had positive relationship withconstipation type and had negative relationship with diarrhea type;Rome Ⅲ criteriahad positive relationship with constipation type and diarrhea type.Comparison of related factor in four standard
a.Gender,age,region,education condition were related factors in Manningcriteria;gender was related factor in Rome Ⅰ criteria;gender, region were related factorsin Rome Ⅱ criteria;gender, income were related factors in Rome Ⅲ criteria.
b.In the studies on diet factor, having breakfast,frequent intake food with high fiberand frequent intake fruits and vegetables were protective factors in Manningcriteria;commonly on diet, sweet fancy, coffee or tea fancy, too much high proteins,drink too much water, high-salt diet were risk factors.In Rome Ⅰ criteria,havingbreakfast,frequent intake food with high fiber,frequent intake fruits andvegetables,food intake too slow were protective factors;commonly on diet, sweet fancy,coffee or tea fancy, too much high proteins, drink too much water were risk factors.InRome Ⅱ criteria,having breakfast,frequent intake food with high fiber,frequent intakefruits and vegetables,food intake too slow were protective factors;commonly on diet,sweet fancy, coffee or tea fancy, too much high proteins, high-salt diet were riskfactors.In Rome Ⅲ criteria,frequent intake fruits and vegetables,food intake too slowwere protective factors; food allergy,commonly on diet,milk food, too much highproteins,drink too much water were risk factors.
c.There were some differences of related factors between four standards in lifehabits.In Manning criteria,long week cumulative exercise time was protectivefactor;within two hours of bedtime meal, long daily sleep time,high frequency ofinsomnia,bad living condition were risk factors.In Rome Ⅰ criteria,long weekcumulative exercise time was protective factor; long daily sleep time,high frequency ofinsomnia,bad living condition were risk factors.In Rome Ⅱ criteria,more sports dayswas protective factor;within two hours of bedtime meal,high frequency ofinsomnia,bad living condition were risk factors.In Rome Ⅲ criteria,more sports days,long week cumulative exercise time,high frequency of insomnia were protectivefactors;bad living condition was risk factors.
d.Working conditions were different too.In Manning criteria,longer working dayseach week and longer hours each day was protective factors. In Rome Ⅰ criteria,longerworking days was protective factor.In Rome Ⅲ criteria,longer working days each weekwas protective factors.
e.There were some differences of related factors between four standards in historystudies.In Manning criteria,the history of dysentery, the history of gastroenteritis andthe history of abdominal surgery were risk factors.In Rome Ⅰ criteria,the history ofdysentery, the history of abdominal surgery were protective factor.In Rome Ⅱcriteria,the history of dysentery, the history of abdominal surgery were protectivefactor.In Rome Ⅲ criteria,the history of dysentery was protective factors;the history ofabdominal surgery was risk factors.
f.There were some differences of related factors between four standards inmedicine history studies.In Manning criteria,antibiotics, non-steroidalanti-inflammatory drugs, nitric acid glycerol were risk factors.In Rome Ⅰcriteria,antibiotics,non-steroidal anti-inflammatory drugs,nitric acid glycerol were riskfactors.In Rome Ⅱ criteria,antibiotics,non-steroidal anti-inflammatory drugs,nitric acidglycerol were risk factors.In Rome Ⅲ criteria,non-steroidal anti-inflammatory drugswas protective factors.
g.Close relatives suffering from IBS was risk factor in Manning criteria,Rome Ⅰcriteria,Rome Ⅲ criteria.
h.Smoking was risk factor in Rome Ⅱ and Rome Ⅲ criteria. Long history thepeople smoke was risk factor in Manning and Rome Ⅲ criteria.The quantity ofsmoking was risk factor in Rome Ⅲ criteria.There was no relationship betweendrinking and four standards.
i. Anxiety and depression were risk factors in four standards.Anxiety level anddepression level were risk factors in four standards except depression level in Rome Ⅲcriteria.
j.In the response studies, problem-solving type，help-requiring type,self-blame type,back-off type were protective factors in four standards.Rationalization type was riskfactor in four standards.Fantasy type was risk factor in Manning criteria,Rome Ⅰcriteria,Rome Ⅱ criteria.
k.Negative experiences was risk factor in four standards.Per capita negative eventsscore was risk factor in Manning criteria,Rome Ⅲ criteria.
Conclusion
1.There were lots of factors which might influence the onset of IBS includinggender, age, region, races, income, education, marriage. There were also many riskfactors correlated with IBS onset such as rationalization type response,taking nitricacid glycero,habit on diet, poor sleeping,anxiety，the diseases suffering in half year，living condition bad.The main risk factors of Rome Ⅰ criteria include:rationalizationtype response,taking nitric acid glycero,the diseases suffering in half year，habit on diet,Ladies，anxiety.The main risk factors of Rome Ⅱ criteria include：rationalization typeresponse,habit on diet, ladies，taking nitric acid glycero,the diseases suffering in halfyear，poor sleeping. The main risk factors of Rome Ⅲ criteria include：habit on diet,Ladies，rationalization type response,food allergy,anxiety,poor sleeping.
2.The incidence of IBS is higher than what we expected, which is occupied2/3ofthe clinical patients with abdominal symptoms. In the four diagnostic criteria, Manningcriteria offered the widest covering of the diseases, but the abdominal discomfortoccurred in84.4%patients and defecation changes in92.09%patients which were notconsidered the evidences in Manning criteria. It’s also no limitation of the time rangeand no diversity classification of defecation habit or stool shapes which might miss theorganic intestinal diseases. Manning criteria should use in the screening in the patientswith abdominal symptoms for its defects. Rome Ⅰ criteria first covered time range andfurthermore made classification of defecation habit and stool shapes which is differentcompared with Manning criteria and more strict in the diagnosis of IBS, thereforeapproximately60%of patients with IBS found through Rome Ⅰ criteria. The researchalso showed that there had81.08%of patients with IBS who had abdominal discomfort, but this symptom was not covered in Rome Ⅰ criteria. Rome Ⅱ criteria, which is broadthe time range and cover abdominal discomfort, showed1/3of the patients with IBSwhich didn’t meet the criteria of Manning and was considered as the complement ofthe Manning criteria. There was still60%patients with defecation,50%patients withdifficult in defecation or tenesmus which wasn’t contained in Rome Ⅱ criteria.Although Rome Ⅲ criteria which limits the time of symptoms occurred offers higheraccuracy in the diagnosis of IBS as our results showed and more suitable for scientificresearch, this criteria could miss part of the patients with IBS because defecationoccurred in2/3patients and difficult in defecation or tenesmus occurred in1/3patientsweren’t covered in the criteria.
3.In the symptom distribution of the patients with IBS, abdominal pain, abdominaldiscomfort and defecation traits changes were most commonly met symptoms, whereasmucous stools shapes, difficult defecation or tenesmus was relatively rare symptoms.
4.Seven stools shape classification had higher recognition in IBS comparing tothree stool shape classification in any diagnoses standards. And Rome Ⅰ seemed hadless influence by different stool shapes which might offer higher sensitivities to theremaining diagnostic standards. The research is the first time in the world, hoping toprovide a basis for the improvement of the diagnostic criteria of IBS.
引文
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