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目的比较罗马Ⅲ和罗马Ⅱ标准诊断肠易激综合征(IBS)的符合情况和患者的临床特点。方法面访式问卷调查消化内科门诊连续就诊病例3014例。结果 (1)符合罗马Ⅲ标准的 IBS患者480例,检出率15.9%(480/3014)。其中便秘型 IBS(C-IBS)27.9%(134/480),腹泻型 IBS(D-IBS)32.7%(157/480),混合型 IBS(M-IBS)6.7%(32/480),未分型 IBS(U-IBS)32.7%(157/480),检出率在各年龄组和性别间差异无统计学意义(P>0.05)。符合罗马Ⅱ标准的 IBS 患者558例,检出率为18.5%(558/3014),其中便秘主导型33.2%(185/558),腹泻主导型38.2%(213/558),其他占28.7%(160/558),女性检出率显著高于男性(P=0.002),各年龄组间检出率差异无统计学意义。罗马Ⅲ标准对 IBS 的检出率低于罗马Ⅱ标准(P=0.008),但两者诊断 IBS 有较好的一致性。(2)与罗马Ⅱ标准的 IBS 患者相比,罗马Ⅲ标准的 IBS 患者腹部症状(P=0.04)和异常排便习惯(P<0.001)均较严重,最近3个月患者的就诊率也较高(26.5%、35.6%,P=0.02)。(3)罗马Ⅲ标准各亚型的IBS 患者的异常排便习惯严重程度差异有统计学意义(C-IBS、M-IBS>D-IBS>U-IBS,P<0.005),但腹部症状严重程度和患者最近3个月的就诊率之间差异无统计学意义(P>0.05)。结论罗马Ⅲ和罗马Ⅱ标准诊断 IBS 具有较好的一致性。与罗马Ⅱ标准相比,罗马Ⅲ标准对 IBS 的检出率较低,症状频率定义和分型方法相对简单,在临床中更实用,符合其诊断标准的患者症状相对较重,就诊率较高,也较适合于临床试验。
Objective To compare the compliance of Rome Ⅲ and Rome Ⅱ in the diagnosis of irritable bowel syndrome (IBS) and the clinical features of patients. Methods interview questionnaire survey of digestive medicine outpatient 3014 consecutive cases. Results (1) According to Rome Ⅲ standard 480 cases of IBS patients, the detection rate was 15.9% (480/3014). 27.9% (134/480) of constipation type IBS, 32.7% (157/480) of diarrhea type IBS (D-IBS), 6.7% (32/480) of mixed IBS The detection rate of IBS (U-IBS) was 32.7% (157/480) in all age groups and genders. There was no significant difference (P> 0.05). Among 558 IBS patients who met Rome II criteria, the detection rate was 18.5% (558/3014), of which 33.2% (185/558) were constipation-predominant, 38.2% (213/558) were diarrhea-predominant, and 28.7% were other 160/558). The detection rate of females was significantly higher than that of males (P = 0.002). There was no significant difference in the detection rates among all age groups. The detection rate of IBS in Rome III was lower than that of Rome II (P = 0.008), but there was a good agreement between IBS and IBS in diagnosing IBS. (2) The abdominal symptoms (P = 0.04) and abnormal bowel habits (P <0.001) were significantly worse in Roman Ⅲ standard IBS patients than in Roman II standard IBS patients, and were also higher in the last 3 months (26.5%, 35.6%, P = 0.02). (3) The severity of abnormal defecation in IBS patients with different subgroups of Rome Ⅲ was significantly different (C-IBS, M-IBS> D-IBS> U-IBS, P <0.005) And the patient’s visit rate in the recent 3 months had no statistical significance (P> 0.05). Conclusion The diagnostic accuracy of Roman Ⅲ and Roman Ⅱ IBS is consistent. Compared with Rome Ⅱ standard, the detection rate of IBS in Rome III is lower, and the frequency of symptom definition and typing is relatively simple, and is more practical in clinical practice. Patients who meet the diagnostic criteria have relatively severe symptoms and high visiting rate , Is also more suitable for clinical trials.