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目的进行农民反流性食管炎(RE)发病相关危险因素的调查。方法 2006年5月对山东烟台牟平区高陵镇常住农民进行胃镜及病理组织学检查及症状危险因素调查。结果共调查556例,男性269例,女性287例。年龄34～90(60.7±8.15)岁。内镜发现糜烂性 RE 101例(18.2%);其中洛杉矶分级 A 级37例,B 级57例,C 级3例,D 级4例。RE 在男性中比例更高(P<0.001);患者年龄(P=0.041)、务农时间(P=0.040)、Z 线距离门齿的长度(P=0.001)与发病有相关性。吸烟(OR 1.894,95%CI 1.207～2.974)、饮浓茶(OR 2.900,95%CI 1.651～5.092)、使用非甾体类抗炎药(NSAIDs)(OR 2.159,95%CI 1.166～3.997)、贲门松弛(OR 13.630,95%CI 7.370～25.190)是发病危险因素。而身高、体重、腹围、体重指数、饮酒、特殊饮食习惯、糖尿病、腹部手术史等与之无关(P>0.05)。RE 组合并消化性溃疡的患者12例,高于非 RE 组;RE 组合并胃体萎缩的患者14例,少于非 RE 组,但均未达到统计学意义。本组总调查人群幽门螺杆菌(Hp)感染率为51.3%(273/556),RE 组为37.1%(36/97),非 RE 组为54.5%(237/435)(P=0.002)(OR 0.492,95%CI0.313～0.776)。多因素分析显示,男性、Z 线距门齿长度短、贲门松弛、服用 NSAIDs 是 RE 发病的危险因素,而 Hp 感染可减少 RE 的发病。结论男性、高龄、Z 线距门齿长度短、贲门松弛、无 Hp 感染等因素与 RE 的发病有相关性,吸烟、饮浓茶、服用 NSAIDs、务农时间长是发病的危险因素。
Objective To investigate the risk factors related to the incidence of peasants reflux esophagitis (RE). Methods In May 2006, gastroscopy, histopathological examination and risk factors were investigated in resident peasants in Gaoling, Muping District, Yantai, Shandong Province. Results A total of 556 cases were investigated, including 269 males and 287 females. Age 34 ~ 90 (60.7 ± 8.15) years old. Endoscopic findings of erosive RE 101 cases (18.2%); Los Angeles grade A 37 cases, B 57 cases, C 3 cases, D 4 cases. RE was higher in men than in men (P <0.001). The age of patients (P = 0.041), farm time (P = 0.040), length of Z line from incisors (P = 0.001) were associated with the onset of disease. Smoking (OR 1.894, 95% CI 1.207-2.974), drinking tea (OR 2.900, 95% CI 1.651-5.092) and using NSAIDs (OR 2.159, 95% CI 1.166-3.997) , Cardia relaxation (OR 13.630,95% CI 7.370 ~ 25.190) is the risk factor. The height, weight, abdominal circumference, body mass index, drinking, special diet, diabetes, history of abdominal surgery had nothing to do with it (P> 0.05). RE combined with peptic ulcer in 12 patients, higher than non-RE group; RE combined with gastric atrophy in 14 patients, less than non-RE group, but did not reach statistical significance. The total H.pylori infection rate was 51.3% (273/556) in the study population, 37.1% (36/97) in the RE group and 54.5% (237/435) in the non-RE group (P = 0.002) OR 0.492, 95% CI 0.313-0.776). Multivariate analysis showed that in men, the length of Z line from the incisors was short and the cardia was loose. Taking NSAIDs was a risk factor for the pathogenesis of RE, and Hp infection could reduce the incidence of RE. Conclusions Male, elderly, Z line distance from the incisors is short, cardia relaxation, no Hp infection and other factors associated with the incidence of RE. Smoking, drinking tea, taking NSAIDs, long working time are risk factors.