老年2型糖尿病患者反流性食管炎临床特点和疗效的影响因素

摘要

背景：糖尿病（ DM）合并胃食管反流病（ GERD）的发病率不断增加，两者之间的相互关系是研究热点。目的：研究老年2型糖尿病（ T2DM）患者反流性食管炎（ RE）的临床特点和疗效的影响因素。方法：收集2011年3月-2013年10月经胃镜确诊为RE的老年患者200例，并分为T2DM伴RE组（ T2DM组）和单纯RE组。分析两组患者的临床表现、RE内镜分级和药物治疗效果，同时分析T2DM组DM病程和血糖控制对RE疗效的影响。结果：T2DM组主要表现为食管外症状，典型的食管症状较少；RE治疗总缓解率随着内镜分级的升高而降低，但食管外症状明显改善。随着DM病程延长，T2DM组RE病变程度加重，血糖控制越差。在血糖控制良好者，随着病程延长， RE治疗总缓解率明显降低。结论：老年T2DM伴RE患者以食管外症状较多见，RE内镜分级较高，血糖较难控制，而DM病程和血糖控制情况可影响RE的疗效。%Background:The prevalence rate of diabetes mellitus ( DM ) associated with gastroesophageal reflux disease ( GERD)is increasing recently,and the relationship between DM and GERD has become a research hotspot. Aims:To study clinical features and influential factors of therapeutic efficacy of reflux esophagitis( RE)in elderly patients with type 2 DM(T2DM). Methods:Two hundred elderly patients with RE diagnosed by gastroscopy from March 2011 to October 2013 were enrolled,and divided into T2DM associated with RE( T2DM)group and RE group. The clinical features, endoscopic findings and therapeutic efficacy of the two groups were analyzed,and the influences of DM course and control of blood glucose on efficacy of RE were also analyzed. Results:The main manifestations of RE were extraesophageal symptoms,typical esophageal symptoms were less common. The overall efficacy rate decreased with the increase of endoscopic grade of RE,however,extraesophageal symptoms improved significantly. With the prolonging of DM course,the endoscopic grade of RE was increased,and the control of blood glucose was worse. The overall therapeutic efficacy was significantly reduced with the prolonging of DM course in patients with well controlled blood glucose. Conclusions:Extraesophageal symptoms are common,endoscopic grade of RE is worse and blood glucose is difficult to control in elderly T2DM patients associated with RE. DM course and status of blood glucose control have influences on the therapeutic efficacy of RE.