不同亚型胃食管反流病临床特点的调查研究

目的 探讨非糜烂性反流病（NERD）和糜烂性食管炎（RE）的人口、症状谱、患者生活质量和精神心理状态特点。方法连续入组具有反酸、反胃、烧心或非心源性胸痛病程超过6个月的胃食管反流病（GERD）患者。除外有消化性溃疡、系统性疾病、继发性食管炎或有胃肠手术史者。所有入组患者均需要完成症状问卷调查（包括反流症状、食管外症状及重叠症状）、GERD生活质量（GERD—HRQL）调查（0～50分，高分代表生活质量差）、SF-36（包括生理功能、生理职能、心理职能、活力、精神健康、社会功能、疼痛和总体健康8个维度，每个维度0～100分，高分代表生活质量高）、精神心理状态（Zung氏焦虑抑郁白评量表，超过50分为异常）。所有人组患者均行胃镜检查，根据内镜检查结果分为NERD和RE。结果共纳入158例患者，平均年龄为（52．96±15．73）岁，其中NERD94例，RE64例，男性占42．4％。（1）婚姻状态、教育、职业、饮食习惯和体重指数，两组间差异无统计学意义。（2）反流症状积分两组差异无统计学意义；但与RE组比较，NERD组同时具有食管外症状和重叠症状的比率明显升高（分别为77．7％vs56．3％和77．7％vs59．4％，P〈0．05）。（3）NERD患者存在精神心理异常的比率高于RE患者（68．1％vs45．3％，P〈0．05）。（4）RE患者生活质量优于NERD，RE患者GERD—HRQL为（13．53±6．68），NERD患者为（18．17±6．65）；跟RE患者相比，NERD患者SF-36问卷8个维度中的5个差异无统计学意义。结论NERD和RE具有不同的临床特征。NERD食管外症状、重叠症状、精神心理异常、生活质量下降的发生率较RE高，提示NERD和RE可能具有不同的发病机制，NERD的发生可能与脑-肠相互作用有部分关系。

Investigation on clinical features of subtypes of gastroesophageal reflux disease

Objective To analyze population distribution,symptoms,quality of life and psychological factors of patients with NERD and RE. Method GERD Patients with sour regurgitation,regurgitation, hearthum and （or） non-cardiac chest pain more than six months were included. Exclusive criteria： subjects who having a history of gastrointestinal surgery,peptic ulcer, secondary esophagitis, and other systemic diseases were excluded. All patients selected were asked to complete the symptom questionnaire survey （including regurgitation symptom,extra-esophageal manifestations and overlap symptom）, the GERD quality of life （GERD-HRQL） survey, SF-36 survey （including 8 dimensions：physiological functioning, physical functioning, psychological functioning,vitality,mental health ,social functioning,body pain and general health） ,the mental and psy- chological state survey （Zung Self-rating Depression Scale and Self-Rating Anxiey Scsle）. All patients with GERD symptoms were diagnosed NERD or RE after gastrosoopy. Result 158 patients were solected, including 94 NERD and 64 RE. The average age of the patients was （52.96 ±15.73 ）years old,the male accounts for 42.4%. There were no significant deviations between the two group patients （ NERD and RE）on marital condition,education, occupation, food habit and body weight index. No significant deviation was found on regnrgitation symptom between the two groups, while rates of extra-esophagus symptom and overlap symptom in NERD patients were much higher than RE patients（ rates of esophagus symptom： RE ,77.7% ;NERD,56. 3%. Rates of overlap symptom：RE,77.7% ;NERD,59.4% ）. The ratio of abnormal psychological of NERD patients was higher than that of RE patients （NERD ,68.1% ;RE ,45.3% ;P 〈 0.05 ）. The quality of life of patients with RE was superior than patients with NERD（ RE-HRQL in patients with GERD for 13.53±6.68 ,NERD patients 18.17±6.65） ,there were 5 dimensions in SF-36 survey were found significant abnormal in NERD patients compared with R