Ihana-Sugiyama Noriko, Nagata Naoyoshi, Yamamoto-Honda Ritsuko, Izawa Eiko, Kajio Hiroshi, Shimbo Takuro, Kakei Masafumi, Uemura Naomi, Akiyama Junichi, Noda Mitsuhiko
Noriko Ihana-Sugiyama, Ritsuko Yamamoto-Honda, Hiroshi Kajio, Mitsuhiko Noda, Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
World J Gastroenterol. 2016 Mar 21;22(11):3252-60. doi: 10.3748/wjg.v22.i11.3252.
AIM: To determine the bowel symptoms associated with diabetes and diabetes-related factors after excluding gastrointestinal (GI) organic diseases. METHODS: Participants were 4738 (603 diabetic and 4135 non-diabetic) patients who underwent colonoscopy and completed a questionnaire. On the day of pre-colonoscopy, 9 symptoms (borborygmus, abdominal distension, increased flatus, constipation, diarrhea, loose stools, hard stools, fecal urgency, and incomplete evacuation) were prospectively evaluated on a 7-point Likert scale. The test-retest reliability of the bowel symptom scores from the baseline and second questionnaires was analyzed using kappa statistics. Associations between bowel symptom scores and diabetes or diabetes-related factors were analyzed by a rank-ordered logistic model adjusted for related confounders, and odds ratios (ORs) were estimated. RESULTS: In multivariate analysis, constipation [adjusted odds ratio (AOR) = 1.57, CI: 1.33-1.85, P < 0.01] and hard stools (AOR = 1.56, CI: 1.33-1.84, P < 0.01) were associated with diabetes, and fecal urgency (AOR = 1.16, CI: 0.99-1.37, P = 0.07) and incomplete evacuation (AOR = 1.16, CI: 1.00-1.36, P = 0.06) were marginally associated with diabetes. These symptoms remained associated even after excluding organic GI diseases on colonoscopy. Test-retest reliability of symptom score with a mean duration of 3.2 mo was good (mean kappa, 0.69). Associations of symptoms with diabetes-related factors were found; constipation with HbA1c ≥ 8.0% (AOR = 2.11, CI: 1.19-3.73), body mass index (BMI) < 25 (AOR = 2.11, CI: 1.22-3.66), and insulin use (AOR = 1.90, CI: 1.08-3.36); hard stools with diabetes duration (AOR = 1.03, CI: 1.00-1.07); fecal urgency with BMI < 25 (AOR = 1.73, CI: 1.00-2.98); and incomplete evacuation with BMI < 25 (AOR = 2.60, CI: 1.52-4.43), serum creatinine level (AOR = 1.27, CI: 1.10-1.47), and insulin use (AOR = 1.92, CI: 1.09-3.38). CONCLUSION: Diabetes is associated with constipation, hard stools, fecal urgency, and incomplete evacuation, and poor glycemic control, duration, leanness, and nephropathy affect the risk of these symptoms.
目的：在排除胃肠道（GI）器质性疾病后，确定与糖尿病及糖尿病相关因素有关的肠道症状。 方法：研究对象为4738例患者（603例糖尿病患者和4135例非糖尿病患者），这些患者接受了结肠镜检查并完成了一份问卷。在结肠镜检查前一天，对9种症状（肠鸣音、腹胀、排气增多、便秘、腹泻、稀便、硬便、便急和排便不尽）采用7分李克特量表进行前瞻性评估。使用kappa统计分析基线问卷和第二次问卷中肠道症状评分的重测信度。通过调整相关混杂因素的有序逻辑模型分析肠道症状评分与糖尿病或糖尿病相关因素之间的关联，并估计优势比（OR）。 结果：在多变量分析中，便秘[调整后优势比（AOR）=1.57，置信区间（CI）：1.33 - 1.85，P<0.01]和硬便（AOR = 1.56，CI：1.33 - 1.84，P<0.01）与糖尿病相关，便急（AOR = 1.16，CI：0.99 - 1.37，P = 0.07）和排便不尽（AOR = 1.16，CI：1.00 - 1.36，P = 0.06）与糖尿病存在边缘关联。即使在结肠镜检查排除器质性GI疾病后，这些症状仍有关联。症状评分平均间隔3.2个月的重测信度良好（平均kappa值为0.69）。发现症状与糖尿病相关因素之间存在关联；便秘与糖化血红蛋白（HbA1c）≥8.0%（AOR = 2.11，CI：1.19 - 3.73）、体重指数（BMI）<25（AOR = 2.11，CI：1.22 - 3.66）以及使用胰岛素（AOR = 1.90，CI：1.08 - 3.36）有关；硬便与糖尿病病程（AOR = 1.03，CI：1.00 - 1.07）有关；便急与BMI<25（AOR = 1.73，CI：1.00 - 2.98）有关；排便不尽与BMI<25（AOR = 2.60，CI：1.52 - 4.43）、血清肌酐水平（AOR = 1.27，CI：1.10 - 1.47）以及使用胰岛素（AOR = 1.92，CI：1.09 - 3.38）有关。 结论：糖尿病与便秘、硬便、便急和排便不尽有关，血糖控制不佳、病程、消瘦和肾病会影响这些症状的发生风险。
J Gastroenterol Hepatol. 2015-8
Am J Gastroenterol. 2014-7-1
Am J Gastroenterol. 2008-3
Am J Gastroenterol. 2011-11-8
Eur J Gastroenterol Hepatol. 2016-5
Scand J Gastroenterol. 2010-5
J Can Assoc Gastroenterol. 2022-12-30
J Clin Biochem Nutr. 2022-9
Clin Exp Nephrol. 2021-11
Diabetes Res Clin Pract. 2013-12-1
Diabetes Care. 2014-1
Diabetes Care. 2012-3-12
Neurogastroenterol Motil. 2010-12-1
J Neurogastroenterol Motil. 2010-1-31
Zotero 插件