目的 调查甘肃省胃食管反流病(gastroesophageal reflux disease,GERD)患病情况,探讨其患病的相关危险因素并构建胃食管反流病发生风险的列线图模型,评价其效能.方法 于2021年10月-2022年5月,使用自制《胃食管反流病调查问卷》,采用多阶段分层整群随机抽样方法进行多中心合作流行病学调查.对抽样区域中成年人(年龄≥18岁)且在本地居住3年以上的居民,由经过培训的调查人员进行问卷调查,详细记录受访者基本信息及胃食管反流病可能的危险因素暴露情况.根据危险因素使用R语言建立预测模型,并使用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)及校准图等评价预测效能.结果 共收回有效问卷4 711份,有效回收率为92.26％.其中男性2 425人,女性2 286人,年龄为(39.25±14.81)岁.按GERD-Q评分≥8分为临界值,甘肃省GERD患病率为10.34％,男性患病率为11.34％(275例),高于女性9.27％(212例),两者差异有统计学意义(x2=5.42,P＜0.05).≥60岁人群GERD患病率最高(19.58％).GERD患病率与体质量指数(body max index,IBM)呈正相关,当BMI≥24.0 kg/m2时,GERD患病率明显升高.汉族、回族、藏族的患病率分别为10.03％、11.86％、13.31％,各民族之间差异无统计学意义(x2=5.30,P＞0.05).二元lo-gistic 多因素回归分析显示,男性、年龄≥50岁、BMI≥24.0 kg/m2、吸烟、饮酒、喜食甜食、进食过饱、睡前2h进食、幽门螺杆菌感染、胃十二指肠溃疡或炎症、咽喉炎、心前区疼痛及周围性眩晕均为罹患GERD的独立危险因素;而高脂饮食、碳酸饮料摄入、辛辣饮食、哮喘、慢性咳嗽、阑尾炎病史及腹部手术史与GERD的发生无明显相关性.根据以上风险因素建立列线图预测模型,C指数和AUC在训练集和验证集中分别为0.736和0.742,校正曲线拟合良好.结论 甘肃省GERD患病率较高,并受多种因素影响,男性、年龄≥50岁、吸烟、喜食甜食、进食过饱及睡前2h进食可能与GERD患病率相关.根据本组资料建立的列线图模型预测准确性尚可,为制定临床决策、预防疾病发生提供依据.
Epidemiological characteristics and risk factors of gastroesophageal reflux disease in Gansu Province
Objective To investigate the prevalence of gastroesophageal reflux disease(GERD)in Gansu Province,to explore its risk factors,and to develop and evaluated a nomogram predicting the risk of GERD occurrence.Methods From October 2021 to May 2022,a multi-center epidemiological survey was conducted using a self-developed GERD questionnaire in a sample recruited using multi-stage stratified cluster random sampling method.Adults(aged ≥18 years)having lived in the sampling area for more than 3 years were surveyed by trained investigators,their basic information and exposure to potential risk factors of GERD were recorded in detail.The prediction model incorporating the risk factors was constructed using R.The performance of the model was evaluated using the area under the curve(AUC)of receiver operating characteristic(ROC)and calibration chart.Results A total of 4 711 valid questionnaires were collected(response rate was 92.26％),including 2 425 completed by males and 2 286 by females.The average age of the respondents was(39.25± 14.81)years.Taking 8 as the cut-off value of GERD-Q score,the standardized prevalence of GERD in Gansu Province was 10.34％,and the prevalence in males was statistically significantly higher than that in females[11.34％(275 cases)vs.9.27％(212 cases),x2=5.42,P＜0.05].The prevalence of GERD in people aged 60 years was significantly highest(19.58％).The prevalence of GERD was positively correlated with body mass index(BMI)in that the prevalence of GERD was significantly higher in people with BMI ≥24.0 kg/m2.The prevalence of GERD in Han,Hui and Tibetan ethnic groups showed no statistically significant difference(10.03％vs.11.86％vs.13.31％,x2=5.30,P＞0.05).Logistic regression analysis showed that male,aged ≥50 years,BMI≥24.0 kg/m2,smoking,alcohol drinking,taking much sweet foods,overeating,eating 2 h before going to bed,H.pylori infection,gastroduodenal ulcer or inflammation,pharyngitis,precordial pain and peripheral vertigo were independent risk factors of GERD(P＜0.05);while taking high-fat diet,acidic beverage,spicy diet,having asthma,chronic cough,history of appendicitis and abdominal surgery were not significantly correlated with the occurrence of GERD.The C index and AUC of the nomogram prediction model established based on the above risk factors in the training set and validation set were 0.736 and 0.742,respectively.The calibration curves fitted well.Conclusions The prevalence of GERD in Gansu Province is high and may be affected by various factors.Males,aged ≥50 years,smoking,consuming mush sweet foods,overeating,and eating 2 h before sleep may be associated with having GERD in the study area.The accuracy of nomogram model established based on the data in this study is acceptable,which may provide some help for clinicians to make clinical decisions and prevent GERD.
Gastroesophageal refluxEpidemiological investigationRisk factorsNomogramPrediction model
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