Harrell Steven P, Studts Jamie L, Dryden Gerald W, Eversmann Jennifer, Cai Luwa, Wo John M
Division of Gastroenterology/Hepatology, University of Louisville School of Medicine, Louisville, KY 40202, USA.
J Clin Gastroenterol. 2008 May-Jun;42(5):455-9. doi: 10.1097/MCG.0b013e31815ed084.
Symptoms of gastroparesis are very diverse. Classifying patients by predominant symptom may improve management strategy.
To validate a new symptom-predominant classification for gastroparesis using symptom severity and quality-of-life measures.
Subjects with gastroparesis for >2 months were prospectively enrolled. A physician classified each subject into one of the following: vomiting-predominant, dyspepsia-predominant, or regurgitation-predominant gastroparesis. Subjects also classified themselves independently from the physician. Each subject completed a Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) and SF-12v2 Health-Related Quality-Of-Life survey. Receiver operating characteristic curves were constructed with sensitivity and specificity of each PAGI-SYM subscale to differentiate subjects into symptom-predominant subgroups. Area under the curve (AUC) was used to compare the receiver operating characteristic curves. Analysis of variance, Cohen's kappa (kappa) statistic, student t test, and Pearson correlation (r) were used.
One hundred subjects (87 females, mean 48 y) were enrolled. There was a 78% concordance between physician and subject's classification of gastroparesis with substantial correlation (kappa=0.64). PAGI-SYM nausea/vomiting subscale (AUC=0.79) and PAGI-SYM heartburn/regurgitation subscale (AUC=0.73) were the best in differentiating subjects into vomiting-predominant and regurgitation-predominant gastroparesis, respectively. No subscale was adequate to differentiate dyspepsia-predominant gastroparesis. SF-12v2 total scores significantly correlated with worsening of the total PAGI-SYM scores (r=-0.339 to -0.600, all P<0.001).
There was a substantial agreement between physician and patient using a symptom-predominant gastroparesis classification. Results suggest that a predominant-symptom classification is a valid means to categorize subjects with vomiting-predominant and regurgitation-predominant gastroparesis. Patients with dyspepsia and delayed gastric emptying need further research.
胃轻瘫的症状非常多样。根据主要症状对患者进行分类可能会改善管理策略。
使用症状严重程度和生活质量指标来验证一种新的胃轻瘫症状为主的分类方法。
前瞻性纳入胃轻瘫病程超过2个月的受试者。医生将每个受试者分为以下类别之一：呕吐为主型、消化不良为主型或反流为主型胃轻瘫。受试者也独立于医生进行自我分类。每个受试者完成一份胃肠道疾病患者评估-症状严重程度指数（PAGI-SYM）和SF-12v2健康相关生活质量调查。构建受试者工作特征曲线，利用每个PAGI-SYM子量表的敏感性和特异性将受试者分为症状为主的亚组。曲线下面积（AUC）用于比较受试者工作特征曲线。采用方差分析、科恩kappa（kappa）统计量、学生t检验和皮尔逊相关系数（r）。
纳入100名受试者（87名女性，平均年龄48岁）。医生和受试者对胃轻瘫的分类之间有78%的一致性，相关性显著（kappa = 0.64）。PAGI-SYM恶心/呕吐子量表（AUC = 0.79）和PAGI-SYM烧心/反流子量表（AUC = 0.73）分别在将受试者分为呕吐为主型和反流为主型胃轻瘫方面表现最佳。没有子量表足以区分消化不良为主型胃轻瘫。SF-12v2总分与PAGI-SYM总分的恶化显著相关（r = -0.339至-0.600，所有P < 0.001）。
医生和患者在使用症状为主的胃轻瘫分类方面有很大的一致性。结果表明，主要症状分类是对呕吐为主型和反流为主型胃轻瘫患者进行分类的有效方法。消化不良和胃排空延迟的患者需要进一步研究。
