上海市崇明区中学生功能性便秘筛查状况

庄羽骁; 许俊; 周红艳; 徐慧鲜; 王志勇; 胡颖

doi:10.16835/j.cnki.1000-9817.2022.09.027

上海市崇明区中学生功能性便秘筛查状况

doi: 10.16835/j.cnki.1000-9817.2022.09.027

1.
上海中医药大学附属曙光医院, 上海 200021
2.
上海交通大学医学院附属新华医院崇明分院

基金项目:

上海交通大学医学院附属新华医院崇明分院2017年度院级科研基金项目 YL201705

上海中医药大学附属曙光医院2020年度四明基金 SKKJ-202021

详细信息

作者简介:
庄羽骁(1993-)，男，江苏苏州人，硕士，主治医师，主要研究方向为功能性胃肠病的诊治

通讯作者:
胡颖，E-mail：no531208922@sina.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R181.3 G478 R179 R725.7
计量
- 文章访问数: 349
- HTML全文浏览量: 168
- PDF下载量: 28
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-09
- 修回日期: 2022-05-18
- 网络出版日期: 2022-09-23
- 刊出日期: 2022-09-25

Screening of functional constipation among adolescents in Chongming District, Shanghai

1.
Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai (200021), China

摘要

摘要: 目的了解上海市崇明区中学生功能性便秘(functional constipation, FC)的流行病学特征及相关因素。方法采用多级分层整群随机抽样法, 于2019年3-6月对上海市崇明区18周岁以下的4 969名在读初、高中生进行问卷调查。结果上海市崇明区中学生FC患病率为13.95%, 不同性别、学段、城乡之间患病率差异均无统计学意义(P值均>0.05)。在高中组中, 临毕业年级组FC的患病率(17.36%, 130/749)高于非临毕业年级组(13.77%, 201/1 460)(χ²=5.01, P=0.03), 市示范性高中组FC的患病率(18.23%, 115/631)高于普通高中组(13.07%, 49/375)和区示范性高中组(13.88%, 167/1 203)(χ²=7.43, P=0.02)。多因素Logistic回归分析显示, 体育锻炼频率、食用辛辣食品频率高、饮食中辛辣食品占比、食用蔬菜频率、饮食中蔬菜占比、每日饮水量、是否纳差、睡眠质量、是否就读于示范型学校与中学生FC有关(OR=0.11~7.71, P值均 < 0.05)。结论 FC为上海市崇明区中学生的常见病, 好发于高中临毕业年级组, 且危险因素较多。
- 便秘 /
- 流行病学研究 /
- 患病率 /
- 回归分析 /
- 学生
Abstract: Objective To understand the prevalence and risk factors for functional constipation (FC) among high school students in Chongming District of Shanghai. Methods A cross-sectional study was conducted in Chongming District of Shanghai from March-June 2019.A total of 4 969 adolescents under the age of 18 were recruited high schools, using a stratified random sampling technique.A validated self-administered questionnaire on Rome Ⅳ criteria for diagnosing FC and predisposing factors was filled by each student in a classroom setting. Results The prevalence of FC among middle school students in Chongming District of Shanghai was 13.95%.There were no significant differences in the prevalence between males and females, middle and high school groups, and urban and rural areas (P>0.05).In senior high schools, students in the graduation year were more likely to suffer from FC (17.36%, 130/749) than other students (13.77%, 201/1 460)(χ²=5.01, P=0.03).The prevalence of FC in the key senior high schools (18.23%, 115/631) was significantly higher than that in ordinary high schools (13.07%, 49/375)(χ²=7.43, P=0.02).Multivariate Logistic regression analysis showed that frequency of physical exercise, and consumption of spicy foods, proportion of spicy foods in the diet, consumption of vegetables, a lower proportion of vegetables in the diet, drinking water, anorexia, quality of sleep and school type were associated with FC in high school students (OR=0.11-7.71, P < 0.05). Conclusion FC is prevalent among high school students on Chongming District of Shanghai, especially among middle school graduates, and many risk factors were significantly associated with the occurrence of FC.
- Constipation /
- Epidemiologic studies /
- Prevalence /
- Regression analysis /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 上海市崇明区中学生FC影响因素的单因素Logistic回归分析(n=4 969)

Table 1. Single-factor Logistic regression analysis on the influencing factors of FC among middle school students in Chongming District(n=4 969)

自变量	选项	β值	标准误	Wald χ²值	OR值(OR值95%CI)	P值
性别	女	0.10	0.08	1.44	1.10(0.94~1.30)	0.23
学段	六年级	-0.53	0.16	11.83	0.59(0.43~0.80)	＜0.01
	七年级	-0.32	0.15	4.68	0.73(0.54~0.97)	0.03
	八年级	-0.28	0.15	3.58	0.76(0.57~1.01)	0.06
	九年级	-0.21	0.15	2.03	0.81(0.61~1.08)	0.15
	高一	-0.28	0.14	3.85	0.75(0.57~1.00)	0.05
	高二	-0.27	0.15	3.37	0.77(0.58~1.02)	0.06
体育锻炼频率/(次·周^-1)	每天	-1.80	0.29	39.91	0.17(0.09~0.29)	＜0.01
	3~6	-1.92	0.28	45.85	0.15(0.08~0.26)	＜0.01
	1~2	-1.59	0.29	29.67	0.21(0.12~0.36)	＜0.01
高强度运动占总锻炼时间	＞80%~100%	-0.14	0.30	0.21	0.87(0.49~1.56)	0.64
	＞50%~80%	-0.34	0.26	1.69	0.71(0.43~1.19)	0.19
	＞30%~50%	0.01	0.21	0.01	1.01(0.66~1.53)	0.97
	＞0~30%	0.02	0.21	0.01	1.02(0.67~1.56)	0.91
食用辛辣食品频率/(次·周^-1)	0	-2.01	0.16	167.98	0.13(0.10~0.18)	＜0.01
	1~2	-1.20	0.13	81.77	0.30(0.23~0.39)	＜0.01
	3~6	0.05	0.15	0.12	1.05(0.79~1.40)	0.73
饮食中辛辣食品占比	0	-0.55	0.36	2.38	0.58(0.29~1.16)	0.12
	＞0~30%	-0.90	0.35	6.76	0.41(0.21~0.80)	0.01
	＞30%~50%	-0.55	0.35	2.50	0.58(0.29~1.14)	0.11
	＞50%~80%	1.32	0.37	13.00	3.73(1.82~7.62)	＜0.01
食用蔬菜频率/(次·周^-1)	每天	-2.52	0.23	124.26	0.08(0.05~0.13)	＜0.01
	3~6	-1.41	0.22	42.43	0.24(0.16~0.37)	＜0.01
	1~2	-0.36	0.22	3.27	0.70(0.46~1.07)	0.10
饮食中蔬菜占比	＞80%~100%	-0.59	0.34	2.99	0.55(0.28~1.08)	0.08
	＞50%~80%	-0.64	0.32	4.03	0.53(0.28~0.99)	0.05
	＞30%~50%	1.01	0.32	10.25	2.75(1.48~5.11)	＜0.01
	＞0~30%	1.44	0.32	20.62	4.22(2.27~7.84)	＜0.01
食用水果频率/(次·周^-1)	每天	-0.51	0.33	2.36	0.60(0.31~1.15)	0.33
	3~6	-0.23	0.25	0.85	0.79(0.49~1.30)	0.36
	1~2	-0.14	0.20	0.47	0.87(0.59~1.29)	0.50
饮食中水果食品占比	＞80%~100%	-0.15	0.33	0.21	0.86(0.46~1.63)	0.65
	＞50%~80%	-0.07	0.32	0.05	0.93(0.50~1.73)	0.83
	＞30%~50%	-0.04	0.12	0.09	0.97(0.76~1.22)	0.77
	＞0~30%	0.10	0.12	0.55	1.10(0.86~1.40)	0.46
每日饮水量/mL	＞1 600	-0.57	0.17	12.12	0.56(0.41~0.78)	＜0.01
	＞1 200~1 600	-1.39	0.17	69.28	0.25(0.18~0.35)	＜0.01
	＞600~1 200	0.72	0.16	20.28	2.06(1.50~2.81)	＜0.01
学习紧张、神经压抑、学业压力大	几乎不	-1.80	0.22	70.27	0.17(0.11~0.25)	＜0.01
	偶尔	-1.54	0.22	49.65	0.21(0.14~0.33)	＜0.01
	经常	-0.25	0.29	0.79	0.78(0.44~1.36)	0.38
睡眠质量	睡眠时间充足、睡眠质量好	-1.32	0.29	21.04	0.27(0.15~0.47)	＜0.01
	不容易入睡	0.23	0.29	0.61	1.25(0.71~2.20)	0.43
	睡眠质量差、易醒	-0.49	0.34	2.09	0.61(0.32~1.19)	0.15
家人有无排便困难	没有	-0.39	0.42	8.65	0.68(0.30~1.54)	0.03
	部分	0.11	0.42	0.07	1.11(0.49~2.53)	0.80
烧心/胸骨后不适		0.09	0.13	0.46	1.09(0.85~1.41)	0.50
纳差		0.81	0.09	87.98	2.24(1.89~2.65)	＜0.01
恶心/呕吐		0.23	0.12	3.72	1.25(1.00~1.58)	0.05
反酸、嗳气		0.01	0.09	0.01	1.01(0.84~1.21)	0.95
临近毕业		0.24	0.09	7.27	0.79(0.67~0.94)	＜0.01
示范性学校	普通高中	-0.39	0.19	4.55	0.67(0.47~0.97)	0.03
	区示范性高中	-0.32	0.13	5.97	0.72(0.56~0.94)	0.02

下载: 导出CSV

表 2 上海市崇明区中学生FC影响因素的多因素Logistic回归分析(n=4 969)

Table 2. Multivariate Logistic regression analysis on the influencing factors of FC among middle school students in Chongming District(n=4 969)

自变量	选项	β值	标准误	Wald χ²值	OR值(OR值95%CI)	P值
体育锻炼频率/(次·周^-1)	每天	-1.99	0.54	13.76	0.14(0.05~0.39)	＜0.01
	≥3	-2.07	0.53	15.04	0.13(0.05~0.36)	＜0.01
	1~2	-1.64	0.55	9.01	0.19(0.07~0.57)	＜0.01
食用辛辣食品频率/(次·周^-1)	0	-0.61	0.32	3.57	0.55(0.30~1.02)	0.06
	1~2	0.59	0.28	4.45	1.80(1.04~3.10)	0.03
	≥3	0.91	0.28	10.29	2.49(1.43~4.34)	＜0.01
饮食中辛辣食品占比	0	0.87	0.70	1.55	2.39(0.61~9.44)	0.21
	＞0~30%	0.80	0.70	1.34	2.22(0.58~8.57)	0.25
	＞30%~50%	1.27	0.70	3.34	3.57(0.91~14.00)	0.07
	＞50%~80%	2.04	0.72	8.07	7.71(1.89~31.54)	＜0.01
食用蔬菜频率/(次·周^-1)	每天	-2.18	0.36	36.12	0.11(0.06~0.23)	＜0.01
	3~6	-0.68	0.36	3.58	0.51(0.25~1.03)	0.06
	1~2	-0.17	0.36	0.21	0.85(0.42~1.71)	0.64
饮食中蔬菜占比	＞80%~100%	-0.24	0.47	0.26	0.79(0.32~1.97)	0.79
	＞50%~80%	0.57	0.42	1.85	1.77(0.78~4.04)	0.17
	＞30%~50%	1.07	0.42	6.64	2.92(1.29~6.60)	0.01
	＞0~30%	0.80	0.42	3.53	2.22(0.97~5.08)	0.06
每日饮水量/mL	＞1 600	0.56	0.33	2.94	1.75(0.92~3.30)	0.09
	＞1 200~1 600	-0.40	0.33	1.47	0.67(0.35~1.28)	0.23
	＞600~1 200	1.32	0.31	18.09	3.74(2.04~6.86)	＜0.01
纳差		0.38	0.17	4.96	1.46(1.05~2.04)	0.03
睡眠质量	睡眠时间充足、睡眠质量好	-0.90	0.52	3.03	0.41(0.15~1.12)	0.03
	不容易入睡	0.01	0.52	0.01	1.01(0.37~2.78)	0.98
	睡眠质量差、易醒	-0.84	0.60	1.93	0.43(0.13~1.41)	0.17
示范性学校	普通高中	-0.57	0.43	1.74	0.57(0.25~1.32)	0.19
	区示范性高中	-1.03	0.43	5.70	0.36(0.16~0.83)	0.02

下载: 导出CSV

参考文献(28)

[1]	DROSSMAN D A, HASLER W L. Rome Ⅳ-Functional GI Disorders: Disorders of gut-brain interaction[J]. Gastroenterology, 2016, 150(6): 1257-1261. doi: 10.1053/j.gastro.2016.03.035
[2]	LACY B E, MEARIN F, CHANG L, et al. Bowel disorders[J]. Gastroenterology, 2016, 150(6): 1393-1407. doi: 10.1053/j.gastro.2016.02.031
[3]	DENNISON C, PRASAD M, LLOYD A, et al. The health-related quality of life and economic burden of constipation[J]. Pharmacoeconomics, 2005, 23(5): 461-476. doi: 10.2165/00019053-200523050-00006
[4]	HYAMS J S, DI L C, SAPS M, et al. Functional disorders: children and adolescents[J]. Gastroenterology, 2016, 150: 1456-1468. doi: 10.1053/j.gastro.2016.02.015
[5]	LEE Y J, PARK K S. Understanding the changes in diagnostic criteria for functional constipation in pediatric patients: from Rome Ⅲ to Rome Ⅳ[J]. J Neurogastroenterol Motil, 2019, 25(1): 3-5. doi: 10.5056/jnm18199
[6]	KEARNEY R, EDWARDS T, BRADFORD M, et al. Emergency provider use of plain radiographs in the evaluation of pediatric constipation[J]. Pediatr Emerg Care, 2019, 35(9): 624-629.
[7]	LEWIS M L, PALSSON O S, WHITEHEAD W E, et al. Prevalence of functional gastrointestinal disorders in children and adolescents[J]. J Pediatr, 2016, 177: 39-43. doi: 10.1016/j.jpeds.2016.04.008
[8]	KOPPEN I J, VELASCO-BENITEZ C A, BENNINGA M A, et al. Is there an association between functional constipation and excessive bodyweight in children?[J]. J Pediatr, 2016, 171: 178-182. doi: 10.1016/j.jpeds.2015.12.033
[9]	RAJINDRAJITH S, DEVANARAYANA N M, ADHIKARI C, et al. Constipation in children: an epidemiological study in Sri Lanka using Rome Ⅲ criteria[J]. Arch Dis Child, 2012, 97(1): 43-45. doi: 10.1136/adc.2009.173716
[10]	MIELE E, SIMEONE D, MARINO A, et al. Functional gastrointestinal disorders in children: an Italian prospective survey[J]. Pediatrics, 2004, 114(1): 73-78. doi: 10.1542/peds.114.1.73
[11]	ZABLAH R, VELASCO-BENITEZ C A, MERLOS I, et al. Prevalence of functional gastrointestinal disorders in school-aged children in El Salvador[J]. Rev Gastroenterol Mex, 2015, 80(3): 186-191.
[12]	UDOH E E, RAJINDRAJITH S, DEVANARAYANA N M, et al. Prevalence and risk factors for functional constipation in adolescent Nigerians[J]. Arch Dis Child, 2017, 102(9): 841-844. doi: 10.1136/archdischild-2016-311908
[13]	TAM Y H, LI A M, SO H K, et al. Socioenvironmental factors associated with constipation in Hong Kong children and Rome Ⅲ criteria[J]. J Pediatr Gastroenterol Nutr, 2012, 55(1): 56-61. doi: 10.1097/MPG.0b013e31824741ce
[14]	闫宁, 沈蕙, 徐勇. 苏州市中学生功能性便秘危险因素分析[J]. 中国学校卫生, 2014, 35(8): 1249-1250. http://www.cjsh.org.cn/article/id/zgxxws201408047 YAN N, SHEN H, XU Y. Analysis of risk factors for functional constipation among middle school students in Suzhou[J]. Chin J Sch Health, 2014, 35(8): 1249-1250. http://www.cjsh.org.cn/article/id/zgxxws201408047
[15]	周立平, 邓凌, 黄格丽, 等. 青少年功能性便秘的流行病学调查[J]. 中国儿童保健杂志, 2010, 18(7): 566-568. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201007013.htm ZHOU L P, DENG L, HUANG G L, et al. Epidemiologic study on functional constipation in adolescents[J]. Chin J Child Health Care, 2010, 18(7): 566-568. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201007013.htm
[16]	吕峻峰, 熊勇, 刘玉玲, 等. 儿童及青少年功能性便秘流行病学调查及危险因素分析[J]. 中国妇幼保健, 2012, 27(21): 3301-3303. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201221033.htm LYU J F, XIONG Y, LIU Y L, et al. Epidemiological investigation and analysis of risk factors of functional constipation in children and adolescents[J]. Matern Child Health Care Chin, 2012, 27(21): 3301-3303. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201221033.htm
[17]	周惠清, 李定国, 宋艳艳, 等. 全国城市中小学生功能性便秘危险因素研究[J]. 临床儿科杂志, 2008, 26(2): 113-115. https://www.cnki.com.cn/Article/CJFDTOTAL-LCAK200802014.htm ZHOU H Q, LI D G, SONG Y Y, et al. Risk factors of functional constipation in adolescents in China[J]. J Clin Pediatr, 2008, 26(2): 113-115. https://www.cnki.com.cn/Article/CJFDTOTAL-LCAK200802014.htm
[18]	WU T C, CHEN L K, PAN W H, et al. Constipation in Taiwan elementary school students: a nationwide survey[J]. J Chin Med Assoc, 2011, 74(2): 57-61. doi: 10.1016/j.jcma.2011.01.012
[19]	ZHOU H, YAO M, CHENG G Y, et al. Prevalence and associated factors of functional gastrointestinal disorders and bowel habits in Chinese adolescents: a school-based study[J]. J Pediatr Gastroenterol Nutr, 2011, 53(2): 168-173. doi: 10.1097/MPG.0b013e3182125388
[20]	ASAKURA K, MASAYASU S, SASAKI S. Dietary intake, physical activity, and time management are associated with constipation in preschool children in Japan[J]. Asia Pac J Clin Nutr, 2017, 26(1): 118-129.
[21]	俞汀, 姜柳琴, 林琳. 功能性便秘的新认识: 罗马Ⅳ标准更新点解读[J]. 中华胃肠外科杂志, 2017, 20(12): 1334-1338. YU T, JIANG L Q, LIN L. Update of the Rome criteria for functional constipation[J]. Chin J Gastrointest Surgery, 2017, 20(12): 1334-1338.
[22]	MUGIE S M, BENNINGA M A, DI LORENZO C. Epidemiology of constipation in children and adults: a systematic review[J]. Best Pract Res Clin Gastroenterol, 2011, 25(1): 3-18. doi: 10.1016/j.bpg.2010.12.010
[23]	VAN DEN BERG M M, BENNINGA M A, DI LORENZO C. Epidemiology of childhood constipation: a systematic review[J]. Am J Gastroenterol, 2006, 101(10): 2401-2409. doi: 10.1111/j.1572-0241.2006.00771.x
[24]	叶飞, 王巧民. 慢性便秘的流行病学研究进展[J]. 中国临床保健杂志, 2010, 13(6): 665-667. https://www.cnki.com.cn/Article/CJFDTOTAL-LZBJ201006051.htm YE F, WANG Q M. Epidemiological research progress of chronic constipation[J]. Chin J Clin Health, 2010, 13(6): 665-667. https://www.cnki.com.cn/Article/CJFDTOTAL-LZBJ201006051.htm
[25]	KOLOSKI N A, JONES M, WAI R, et al. Impact of persistent constipation on health-related quality of life and mortality in older community-dwelling women[J]. Am J Gastroenterol, 2013, 108(7): 1152-1158. doi: 10.1038/ajg.2013.137
[26]	FATTAHI M R, ALORIZI S M E, NIMROUZI M, et al. A randomized clinical trial on treatment of chronic constipation by traditional Persian medicine recommendations compared to allopathic medicine: a pilot study[J]. Int J Prev Med, 2017, 8(1): 50.
[27]	NELLESEN D, CHAWLA A, OH D L, et al. Comorbidities in patients with irritable bowel syndrome with constipation or chronic idiopathic constipation: a review of the literature from the past decade[J]. Postgrad Med, 2013, 125(2): 40-50. doi: 10.3810/pgm.2013.03.2640
[28]	MASON H J, SERRANO-IKKOS E, KAMM M A. Psychological morbidity in women with idiopathic constipation[J]. Am J Gastroenterol, 2000, 95(10): 2852-2857.