Massarrat S, Müller H G, Schmitz-Moormann P
Department of Gastroenterology and Metabolic Disease, Philipps-University, Marburg, Federal Republic of Germany.
Gut. 1988 Mar;29(3):291-7. doi: 10.1136/gut.29.3.291.
In order to identify the risk factors affecting the healing of duodenal ulcer, a clinical trial with effective dose of antacid was carried out in 53 patients. Duration of ulcer history, number of relapses, duration of the last and present relapse, number, duration and severity of pain attacks in the present ulcer relapse, pain radiation to back, vomiting, appetite, smoking habit, intake of analgesics and previous haemorrhage were registered. Number of ulcers, ulcer depth, bublar narrowing, erosions, duodenitis at initial endoscopy and healing of ulcer were assessed by one endoscopist. Basic and peak acid output were measured. The extent of duodenitis on the site opposite the ulcer was determined by histological examination. Sixty per cent of the duodenal ulcers were healed after three weeks. By univariate analysis, the following factors affect the healing; pain radiation to back and pain duration during treatment (p less than 0.001), multiple or deep ulcers, narrowing of duodenal bulb (p less than 0.01), number of pain attacks and poor appetite (p less than 0.05). By the stepwise logistic regression model, the following factors were selected as predictors for healing of duodenal ulcer with 76% correct classification: pain radiation to back (p = 0.002), deep ulcer (p = 0.013), multiple ulcers (p = 0.028). Number of cigarettes/day (p less than 0.007) and male sex (p = 0.036). By this model, the prediction of healing could be accurately assessed in 78% in a new sample. Individual treatment should be carried out on the basis of these factors.
为了确定影响十二指肠溃疡愈合的危险因素，对53例患者进行了使用有效剂量抗酸剂的临床试验。记录溃疡病史的时长、复发次数、上次和本次复发的时长、本次溃疡复发时疼痛发作的次数、时长和严重程度、疼痛向背部放射的情况、呕吐、食欲、吸烟习惯、镇痛药的摄入情况以及既往出血情况。由一名内镜医师评估溃疡数量、溃疡深度、十二指肠球部狭窄、糜烂、初始内镜检查时的十二指肠炎以及溃疡的愈合情况。测量基础胃酸分泌量和高峰胃酸分泌量。通过组织学检查确定溃疡对面部位的十二指肠炎程度。60%的十二指肠溃疡在三周后愈合。通过单因素分析，以下因素影响愈合：疼痛向背部放射以及治疗期间的疼痛时长（p<0.001）、多发或深部溃疡、十二指肠球部狭窄（p<0.01）、疼痛发作次数以及食欲不佳（p<0.05）。通过逐步逻辑回归模型，以下因素被选为十二指肠溃疡愈合的预测因素，分类正确率为76%：疼痛向背部放射（p=0.002）、深部溃疡（p=0.013）、多发溃疡（p=0.028）、每日吸烟量（p<0.007）以及男性（p=0.036）。通过该模型，在一个新样本中，78%的愈合情况能够得到准确评估。应基于这些因素进行个体化治疗。
