复合自主神经症状评分-31在老年糖尿病性胃肠病患者中的应用

Application of Complex Autonomic Symptom Score-31 in Elderly Diabetic Gastrointestinal Patients

摘要: 目的：通过复合自主神经症状评分-31 (COMPASS-31)调查老年2型糖尿病患者胃肠病症状发生情况，并分析探讨COMPASS-31量表在老年2型糖尿病性胃肠病患者中的评估和诊断价值。方法：采用胃肠道分级评估量表(GSRS)和COMPASS-31量表于2022年8月~2023年5月调查评估入住延安大学附属医院、吴起县人民医院内分泌科和普外科301例老年2型糖尿病患者，根据GSRS评估患者有无胃肠相关症状并将其分为两组(NGSRS组和GSRS组)，单因素分析比较两组患者一般资料和疾病相关资料及COMPASS-31得分，采用二元Logistic回归分析筛选GSRS发生的危险因素，受试者操作特征曲线(ROC)评价COMPASS-31对患者胃肠病的筛查能力，采用Spearman相关性分析COMPASS-31总得分与GSRS量表的相关度，并进行一致性检验。结果：本研究共纳入301例老年2型糖尿病患者，其中174 (57.80%)例患者COMPASS-31量表得分 ≥ 1分，平均得分为7.00 (4.75, 9.00)，其中43.19% (130/301)患者存在便秘情况，占比最高，80.00% (104/130)的患者便秘严重情况在中重度水平，其次(85/301) 28.24%的患者存在早饱感。本研究中该量表的Cronbach’s alpha为0.743，两种量表的一致性Kappa系数为0.856 (P < 0.001)，Spearman相关系数为0.806 (P < 0.001)。ROC的曲线下面积AUC值为0.956 (95% CI 0.932, 0.980)，最佳评估诊断切点为1分，灵敏度为91.2%，特异度为95.0%。结论：COMPASS-31评分与经典的GSRS量表一致性和相关性较好，对老年2型糖尿病胃肠病也具有较高的诊断价值，且COMPASS-31评分对于老年患者来说12项问题通俗易懂，选项独立清楚，应用简便、快速、临床操作性强，更适合用于老年2型糖尿病患者胃肠病的评估与诊断。

Abstract: Objective: The occurrence of gastrointestinal symptoms in elderly patients with type 2 diabetes was investigated by complex autonomic symptom Score-31 (COMPASS-31), and the evaluation and di-agnostic value of COMPASS-31 scale in elderly patients with type 2 diabetes gastrointestinal disease was analyzed. Methods A total of 301 elderly patients with type 2 diabetes admitted to the Depart-ment of Endocrinology and General Surgery of the Affiliated Hospital of Yan’an University and Wuqi County People’s Hospital from August 2022 to May 2023 were investigated and evaluated by using the Gastrointestinal Grading Assessment Scale (GSRS) and COMPASS-31. According to GSRS, the pa-tients were evaluated for gastrointestinal related symptoms and divided into two groups (NGSRS group and GSRS group). Univariate analysis was performed to compare the general data, dis-ease-related data and COMPASS-31 scores of the two groups, and binary Logistic regression analysis was used to screen the risk factors of GSRS. Receiver operating characteristic curve (ROC) was used to evaluate the screening ability of COMPASS-31 in patients with gastrointestinal disease, and Spearman correlation analysis was used to analyze the correlation between COMPASS-31 total score and GSRS scale, and the consistency test was conducted. Results: A total of 301 elderly patients with type 2 diabetes were included in this study, among which 174 (57.80%) patients scored ≥ 1 point on the Compas-31 scale, with an average score of 7.00 (4.75, 9.00). Among them, 43.19% (130/301) patients had constipation, accounting for the highest proportion. 80.00% (104/130) of patients had moderate to severe constipation, followed by 85/301 (28.24%) of patients with early satiation. In this study, the Cronbach’s alpha of this scale was 0.743, the consistency Kappa coefficient of the two scales was 0.856 (P < 0.001), and the Spearman correlation coefficient was 0.806 (P < 0.001). The area AUC value under ROC curve was 0.956 (95% CI 0.932, 0.980), the optimal diagnostic cut-off point was 1 point, the sensitivity was 91.2%, and the specificity was 95.0%. Conclusion: COMPASS-31 score is in good consistency and correlation with classical GSRS scale, and has high di-agnostic value for senile type 2 diabetes gastrointestinal disease. Moreover, COMPASS-31 score is easy to understand for elderly patients with 12 questions, independent and clear options, simple, rapid application and strong clinical operation. It is more suitable for the assessment and diagnosis of gastrointestinal disease in elderly patients with type 2 diabetes.