南昌地区消化性溃疡的临床特点和季节变化规律

目的 了解南昌地区消化性溃疡(PU)的临床特点和季节变化规律,为PU的防治提供理论依据.方法 回顾性分析2003年10月至2008年5月经临床和胃镜检查确诊为PU的患者资料.将PU分为胃溃疡(GU)、十二指肠溃疡(DU)和复合性溃疡(CU)三种类型,其中GU病变部位按胃底贲门、胃体、胃角、胃窦、幽门管5个部位统计,DU病变部位按十二指肠球部前壁、后壁、大弯、小弯、球后5个部位统计,发病季节分为春季(3～5月),夏季(6～8月)、秋季(9～11月)和冬季(12～2月),统计不同类型PU检出率,并按性别、年龄、溃疡部位、发病季节、幽门螺杆菌(Hp)感染、并发症等情况进行分析及比较.结果 在83 888例胃镜检查者中,检出21 308例(25.4%)Pu患者,其中DU占66.33%,GU占24.88%,CU占8.79%;男女性别比为2.44 : 1,其中DU为2.53 : 1,GU为2.26 : 1,CU为2.33:1.GU患者平均年龄为48.02岁,比DU患者大6.7岁.DU发病以30～39岁年龄组最多见,GU以50～59岁组最多见.PU均以冬季发病率(30.17%)最高,夏季最低(22.54%),差异有统计学意义(P<0.01).在DU的病变部位中,依次为球部前壁57.43%、大弯18.26%、小弯13.21%、后壁7.34%;GU则依次为胃窦45.69%、胃角20.54%、胃体15.54%,幽门管9.36%、胃底和贲门8.87%.PU病例中,行Hp检查13 414例,阳性12 318例(占91.83%).Hp感染在不同类型的PU中差异无统计学意义(P0.05).PU的并发症发生率分别为出血4.94%、梗阻3.51%、慢性穿孔0.04%.结论 南昌地区的PU内镜检出率为25.4%,高于中国北方地区,PU的发生和性别,年龄、季节和溃疡部位密切相关,合并Hp感染率较高,并发症发生率低.

Clinical characteristics and the regularity of seasonal changes of peptic ulcer in Nanchang area

Objectives To investigate the clinical characteristics and the regularity of seasonal changes that influence peptic ulcer (PU) in Nanehang area and to provide a theoretical basis for the treatment and prevention of PU.Methods Data collected from patients with PU diagnosed by clinic and gastroendoseopy between October 2003 to May 2008 were retrospectively analyzed.The PU was further divided into gastric ulcer,duodenal ulcer and complex ulcer.The lesion of gastric ulcer was calculated by five locations that were antral,angular,corporal,pyloric canal,fundic and cardia.The lesion of duodenal ulcer was calculated by five locations that were anterior wall of bulb,posterior wall,lesser curvature, greater curvature and postbulbar.The climate changes that influnced the incidence of PU disease were also observed.The detective rates of different types of PU were analyzed and its association with gender,age, lesion locations,seasons,Helicobacter pylori (Hp) infection and complications were also investigated. Results Among 83 888 patients who underwent endoscopy,PU was found in 21 308 patients (25.4%) including 66.33% duodenal ulcer,24.88% gastric ulcer and 8.79% complex ulcer.The male and femal ratio was 2.44 : 1 in PU,2.53 : 1 in duodenal ulcer,2.26 : 1 in gastric ulcer,and 2.33 : 1 in complex ulcer.The average age of patients with gastric ulcer was 48.0 years that was about 6.7 years higher than that of patients with duodenal ulcer.The prevalence of duodenal ulcer and gastric ulcer peaked in the 30- 39 years and 50-59 years,respectively.PU was more common from December to February (30.17%) and less common from June to August (22.54%) (P＜0.01) .The 57.43% of duodenal ulcer was found on anterior wall of bulb,18.26% on greater curvature,13.21% on lesser curvature,7.34% on posterior wall and 3.76% on postbulbar.The 45.69% of gastric ulcer was found on antral,20.54% on angular, 15.54% on corporal,9.36% on pyloric canal,and 8.87% on fundic and cardia.The 91.83% (12 318/ 13 414) of patients were positive for Hp infection.There was no significant difference of Hp infection among patients with different types of PU.The complications in patients with PU were bleeding (4.94%),pyloric obstruction (3.51%) and chronic perforation(0.04%).Conclusions The detective rate of PU in Nanchang area is 25.4%,which is higher than that in northern area of China.The incidence of PU is highly associated with sex,age,seasons and ulcer locations,with high Hp infections and a low incidence of complications.