无症状糜烂性食管炎的危险因素分析

doi:10.16138/j.1673-6087.2021.03.010

摘要/Abstract

摘要：

目的：探讨无症状糜烂性食管炎（asymptomatic erosive esophagitis, AEE）的患病率、危险因素、预后及治疗。方法：回顾性分析我院5 184例无症状体检人群的胃镜检查资料,其中475例（9.2%）糜烂性食管炎（erosive esophagitis,EE）纳入AEE组。在无食管炎的人群中选择950名年龄和性别匹配且内镜检查无食管炎的受试者作为对照组。比较2组间的危险因素,分析AEE的独立危险因素、预后及对治疗的反应。结果：高体质量指数（body mass index,BMI）[优势比（odds ratio,OR）=1.101, P=0.001]、脂肪肝（OR=1.635, P=0.013）、食管裂孔疝（OR=2.302, P=0.039）和高γ-谷氨酰转移酶（gamma-glutamyl transferase,GGT）（OR=1.008, P=0.013）是AEE的危险因素。对140例AEE患者的随访发现,无论是否接受治疗,约有2/3患者的食管炎严重程度有所改善（82.4%比65.3%）。此外,质子泵抑制剂（proton pump inhibitor,PPI）治疗组食管炎改善比例远高于未治疗组（P<0.005）。结论：脂肪肝、肥胖、食管裂孔疝及高GGT为AEE危险因素。AEE的预后良好,PPI能明显改善AEE严重程度。

关键词: 胃食管反流病, 食管裂孔疝, 内镜检查, 质子泵抑制剂

Abstract:

Objective To explore the prevalence, risk factors, prognosis, and management of asymptomatic erosive esophagitis(AEE). Methods A total of 5 184 asymptomatic individuals who underwent gastroscopy for routine health checkup were included in our study. 475 (9.2%) patients with EE devoid of gastroesophageal reflux disease(GERD) symptoms were selected as AEE group. A total of 950 age- and gender-matched subjects with negative endoscopic findings were selected as healthy control group. The clinical data between the two groups were compared. The independent risk factors, prognosis, and treatment of AEE were analyzed. Results A higher body mass index (BMI) [odds ratio（OR）=1.101, P=0.001], fatty liver（OR=1.635, P=0.013）, hiatus hernia（OR=2.302, P=0.039）, and higher gamma-glutamyl transferase (GGT)(OR=1.008, P=0.013) were independent risk factors for AEE. A total of 140 patients were followed up after they were diagnosed with AEE. Regardless of treatment, improved esophagitis occurred in about 2/3 AEE patients（82.4% vs 65.3%）. However, the proportion of subjects with improved esophagitis was much higher in the proton pump inhibitor(PPI) treatment group than that in the non-treatment group. Conclusions Higher BMI, fatty liver, hiatus hernia, and higher GGT are independent risk factors for AEE. The prognosis of AEE is good and PPI treatment could improve AEE.

Key words: Gastroesophageal reflux disease, Hiatus hernia, Gastroscopy, Proton pump inhibitor

中图分类号:

R571

孙超, 姚玮艳, 黄佳, 朱颖, 汤玉茗. 无症状糜烂性食管炎的危险因素分析[J]. 内科理论与实践, 2021, 16(03): 188-192.

SUN Chao, YAO Weiyan, HUANG Jia, ZHU Ying, TANG Yuming. Risk factors of asymptomatic erosive esophagitis[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(03): 188-192.

图/表 5

表1

AEE组与对照组临床特点及实验室检查比较[n(%)/$\bar{x}\pm s$]

临床特点	对照组 (n=950）	AEE组 (n=475)	t/χ²	P
年龄(岁)	51.63±0.30	51.63±0.43	-0.012	0.963
男性[n(%)]	790(83.2)	395(83.2)	0
BMI（kg/m²）	23.01±0.10	23.95±0.15	5.177	0.001
食管裂孔疝[n(%)]	63(6.6)	62（13.1）	2.526	<0.001
C反应蛋白(mg/L)	1.6±0.2	1.4±0.08	0.741	0.045
白细胞计数(×10⁹/L)	6.11±0.07	6.16±0.09	-0.434	0.669
红细胞计数(×10¹²/L)	4.87±0.02	4.94±0.03	-1.987	0.091
血红蛋白(g/L)	148.03±0.57	150.18±0.80	-2.222	0.031
血小板(×10⁹/L)	208.05±2.17	207.81±3.15	0.065	0.866
糖化血红蛋白(%)	5.62±0.03	5.75±0.05	2.526	0.003
空腹血糖(mmol/L)	5.52±0.04	5.60±0.06	1.172	0.242
胰岛素抵抗(mmol·mU/L²)	2.24±0.11	2.84±0.19	3.251	0.001
前白蛋白(mg/L)	288.02±2.04	288.32±2.99	0.035	0.696
谷丙转氨酶(U/L)	28.36±0.70	28.95±1.01	0.406	0.534
谷草转氨酶(U/L)	24.56±0.41	24.25±0.46	-0.666	0.800
碱性磷酸酶(U/L)	67.67±0.70	69.06±1.05	1.434	0.252
GGT(U/L)	35.69±1.39	44.27±3.01	3.007	0.034
总胆红素(μmol/L)	15.62±0.23	15.54±0.35	-0.512	0.678
直接胆红素(μmol/L)	2.562±0.04	2.515±0.05	-0.699	0.692
总蛋白(g/L)	72.45±0.17	72.33±0.21	-0.694	0.938
白蛋白(g/L)	44.80±0.12	44.75±0.16	-0.107	0.694
总胆汁酸(μmol/L)	3.50±0.11	3.99±0.28	1.527	0.823
血尿素氮(mmol/L)	5.31±0.05	5.21±0.06	-1.576	0.306
肌酐(μmol/L)	80.16±0.51	80.42±0.78	0.522	0.935
尿酸(μmol/L)	344.70±2.94	356.32±4.19	2.243	0.041
三酰甘油(mmol/L)	1.82±0.06	1.85±0.07	0.165	0.192
总胆固醇(mmol/L)	5.12±0.04	5.13±0.05	0.247	0.940
高密度脂蛋白(mmol/L)	1.30±0.01	1.30±0.02	-0.836	0.298
低密度脂蛋白(mmol/L)	3.17±0.03	3.17±0.04	0.338	0.873
游离脂肪酸(mmol/L)	0.49±0.01	0.52±0.02	1.240	0.237
游离三碘甲状腺原氨酸(pmol/L)	4.48±0.02	4.44±0.04	-0.903	0.183
游离甲状腺素(pmol/L)	13.36±0.07	13.22±0.15	-2.951	0.010
促甲状腺素(mU/L)	1.95±0.13	1.85±0.09	1.263	0.310
甲状腺球蛋白抗体 (U/mL)	9.51±2.14	7.69±3.53	-0.467	0.132
甲状腺过氧化物酶抗体 (U/mL)	12.65±3.55	16.27±6.40	-0.440	0.456
幽门螺杆菌感染(n/N)	128/509	68/306	0.175	0.551
病理	72/276	43/182	0.353	0.552
¹³C呼气试验	16/63	13/34	1.737	0.188
幽门螺杆菌抗体	40/170	12/90	3.824	0.051
影像学(n/N)
脂肪肝	191/429	137/244	8.414	0.004
胆结石	30/429	11/244	3.087	0.195
胆囊息肉	17/429	9/244	0.031	0.859
肾结石	13/429	9/244	0.213	0.644

表1

表2

表3

表4

图1

参考文献 28

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变量	P	OR	95%CI
脂肪肝	0.013	1.495	1.089~2.052
BMI	0.001	1.093	1.056~1.131
GGT	0.006	1.004	1.001~1.008
尿酸	0.022	1.004	1.000~1.004
胰岛素抵抗	0.007	1.233	1.060~1.434
糖化血红蛋白	0.021	1.275	1.038~1.566
血红蛋白	0.027	1.012	1.001~1.023
食管裂孔疝	<0.001	2.114	1.461~3.059

指标	PPI治疗组(n=68)	非治疗组(n=72)
进展	2(2.9)	7(9.7)
分级不变	10(14.7)	18(25.0)
改善	56(82.4)	47(65.3)