基于RDQ量表评估幽门螺杆菌根除治疗对反流症状的影响及预测因素研究

Evaluation of the Impact and Predictive Factors of Helicobacter pylori Eradication Therapy on Reflux Symptoms Based on the RDQ Scale

摘要: 目的：探索患者在接受幽门螺旋杆菌(Helicobacter pylori, H. pylori)根除治疗前后的胃食管反流症状的变化，分析影响症状改善的独立预测因素。方法：本研究采用单中心、前瞻性观察性研究设计。利用反流性消化不良问卷(Reflux Dyspepsia Questionnair, RDQ)和胃食管反流病量表(Gastroesophageal Reflux Disease Questionnaire, GerdQ)收集患者治疗前后的症状数据，采用线性回归和Logistic回归模型分析症状改善的独立预测因素。结果：在111例完成随访的患者中，根除治疗后RDQ总分由5.18 ± 5.82分下降至2.15 ± 3.81分，差异有统计学意义(p < 0.001)。单项症状中，反酸、胸骨后疼痛及上腹部烧灼感评分均显著下降(p < 0.05)，而烧心症状改善不明显(p = 0.446)。多因素回归分析显示，基线RDQ总分(β = 0.89, p < 0.001)和根除成功(β = 4.56, p = 0.006)是症状改善幅度的独立正向预测因子；严重肥胖(BMI ≥ 30 kg/m²)是阻碍症状改善的独立危险因素(OR = 0.011, p = 0.036)｡结论：1) H. pylori根除治疗有助于改善胃食管反流相关症状，基线症状评分RDQ是预测治疗获益程度的最强独立因素；2) 严重肥胖(BMI ≥ 30 kg/m²)是阻碍反流症状缓解的独立危险因素，提示临床在治疗合并反流的H. pylori感染患者时，应重视患者的体重管理。

Abstract: Objective: To investigate changes in gastroesophageal reflux symptoms before and after Helicobacter pylori (H. pylori) eradication therapy, and to identify the independent predictive factors for symptom improvement. Methods: This was a single-center, prospective observational study. Symptom data were collected from patients before and after eradication therapy using the Reflux Disease Questionnaire (RDQ) and the Gastroesophageal Reflux Disease Questionnaire (GerdQ). Linear regression and Logistic regression models were employed to analyze the independent predictors of symptom improvement. Results: Among the 111 patients who completed the follow-up, the total RDQ score significantly decreased from 5.18 ± 5.82 to 2.15 ± 3.81 after eradication therapy (p < 0.001). Regarding individual symptoms, scores for acid regurgitation, retrosternal pain, and epigastric burning showed significant reductions (p < 0.05), whereas the improvement in heartburn symptoms was not statistically significant (p = 0.446). Multivariate regression analysis revealed that the baseline RDQ total score (β = 0.89, p < 0.001) and successful eradication (β = 4.56, p = 0.006) were independent positive predictors for the magnitude of symptom improvement. Conversely, severe obesity (BMI ≥ 30 kg/m²) was an independent risk factor hindering symptom relief (OR = 0.011, p = 0.036). Conclusions: 1) H. pylori eradication therapy effectively alleviates gastroesophageal reflux-related symptoms, with the baseline RDQ score being the strongest independent predictor of clinical benefit. 2) Severe obesity (BMI ≥ 30 kg/m²) is an independent risk factor that hinders the resolution of reflux symptoms, suggesting that clinical management of H. pylori-infected patients with comorbid reflux should emphasize weight control.