反流性疾病问卷在胃食管反流病诊断中的价值

目的 探讨以反流症状为主的问卷调查(RDQ)在诊断胃食管反流病(GERD)中的价值。方法 上海、北京等10家医院多中心研究，对128例有烧心、胸骨后疼痛、反酸、反食等四种消化道症状的患者，按症状程度与发作频率为记分标准(5级记分制)，最高分可达40分，取症状6分以上为人选患者，以内镜检查有否反流性食管炎(RE)及24h食管pH检测为诊断(3ERE)的金标准，并与RDQ分值进行比较，计算出诊断GERD的临界值。结果 RDQ分值与RE严重程度呈正相关，食管pH检测异常组DeMeester积分显著高于正常组(20．18／16．84)。以RDQ分值12为临界值，Youden指数最大，ROC曲线下面积(Az)为0．71，对GERD诊断阳性符合率达88．07％，阴性符合率为68．42％，敏感度为94．12％，特异度为50．00％。结论 RDQ调查是诊断GERD的一个良好的筛选试验。

The value of reflux diagnostic questionnaires in the diagnosis of gastroesophageal reflux disease

Objective To evaluate the value of reflux diagnostic questionnaires(RDQ) in the diagnosis of gastroesophageal reflux disease (GERD). Methods One hundred and twenty-eight patients with heartburn, substernal chest pain and regurgitation or food reflux were assessed among 10 hospitals in China. Each symptom was scored according to the severity and frequency (five scales). The highest score for one patient was 40. Upper gastrointestinal endoscopy and esophageal 24-hour pH monitoring were carried out in patients with symptom score more than 6, and the results were compared with RDQ score to determine the threshold value for GERD. Results RDQ score correlated positively with the severity of reflux esophagitis. Esophageal pH monitoring showed that patients with abnormal RDQ had higher DeMeester scores compared with those with normal RDQ scores (20.18 vs. 16.84). Taking 12 as RDQ threshold score for GERD, we got the maximal Youden index, area under the receiver operating characteristic curve (ROC) was 0.71, the true positive diagnostic rate was 88.07%, and true negative diagnostic rate was 68.42% with sensitivity of 94.12% and specificity of 50.00%. Conclusion RDQ seem to be useful screening tests for GERD.