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目的 分析罗马Ⅲ和罗马Ⅱ标准对功能性消化不良(FD)诊断的临床特点、分型的差异,以及FD患者精神心理状态.方法 随机选取2008年6月至2008年12月间1600例消化科门诊患者(均经胃镜检查)进行问卷调查,按罗马Ⅱ和罗马Ⅲ标准诊断分型并归纳分析.结果 符合罗马Ⅱ标准的FD患者215例(13.44％),符合罗马Ⅲ标准249例(15.56％),两种标准对FD的检出率差异无统计学意义(x2=2.176,P＞0.05).罗马Ⅱ标准诊断的FD患者中71.16％(153/215)同时符合罗马Ⅲ标准；23.26％(50/215)患者有早饱、餐后饱胀不适、上腹痛和上腹烧灼感中的至少一种,但不符合罗马Ⅲ标准.罗马Ⅲ标准诊断的FD中61.45％(153/249)同时符合罗马Ⅱ标准；28.92％(72/249)患者病程不符合罗马Ⅱ标准.按罗马Ⅱ标准分型,溃疡样型51例(23.72％),动力障碍型103例(47.91％),非特异型61例(28.37％).按罗马Ⅲ标准分型,餐后不适综合征(PDS) 190例(76.31％),上腹疼痛综合征(EPS)131例(52.61％),同时符合PDS和EPS诊断72例(28.92％).FD伴焦虑、抑郁者分别为17例(16.83％)和48例(47.52％).符合罗马Ⅲ标准FD患者同时合并焦虑和抑郁时,餐后饱胀不适、早饱、上腹痛和上腹烧灼感症状总积分最高(x2=49.637,P＜0.05).结论 罗马Ⅲ标准更易理解和运用.FD患者常合并精神心理异常,可能加重临床症状.

Objective To analyze Rome Ⅱ and Rome Ⅲ criteria in clinical characteristics of functional dyspepsia (FD) diagnosis and the differences in subtypes of FD,and to assess the psychosocial status of FD patients.Methods From June 2008 to December 2008,1600 random outpatients who underwent upper gastrointestinal endoscopy in department of gastroenterology fulfilled the inquiry questionnaire.The subtype was diagnosed according to Rome Ⅲ and the Rome Ⅱ criteria and the results were analyzed.Results A total of 215 patients (13.44％) were in accordance with Rome Ⅱ criteria and 249 patients (15.56 ％) were in accordance with Rome Ⅲ criteria,there was no difference in FD detection rate between these two criteria (x2=2.176,P＞0.05).About 71.16％(153/215) of the FD patients diagnosed according to Rome Ⅱ criteria were also in accordance with Rome Ⅲ criteria,and 23.26％ (50/215) who had bothersome postprandial fullness,early satiation,epigastic pain or epigastric burning did not meet Rome Ⅲ criteria.About 61.45 ％ (153/249) of the FD patients diagnosed according to Rome Ⅲ criteria were also in accordance with Rome Ⅱ criteria,and the courses of disease of 28.92％(72/249) patients didn't met Rome Ⅱ criteria.According to RomeⅡ,51 (23.72％) patients were ulcer-like type,103 (47.91％)patients were dysmotility-like type,and 61 (28.37％) patients were non-idiotype.According to Rome Ⅲ criteria,76.31％ (190/249) patients were consistent with postprandial distress syndrome (PDS),52.61％ (131/249) patients were consistent with epigastric pain syndrome (EPS),and 28.92％ (72/249) patients met both PDS and EPS.The percentage of the FD patients with anxiety and depression was 16.83％ and 47.52％respectively.Of the FD patients in accordance with Rome Ⅲ criteria who were with both anxiety and depression,the total symptom scores of bothersome postprandial fullness,early satiation,epigastic pain or epigastic burning were the highest (x2 =49.637,P＜0.05).Conclusions Rome Ⅲ criteria is easier to understand and more practical.FD patients always have psychosocial disorders,which may worsen the clinical symptoms.