Giordano痔病症状严重程度评分评价痔病严重程度的有效性和指导治疗的价值研究

doi:10.12114/j.issn.1007-9572.2025.0280

摘要/Abstract

摘要： 背景 Giordano痔病症状严重程度评分（GSQ评分）作为评价痔病严重程度的特异性量表，近年来在临床实践中屡次被应用于评价痔病，但目前GSQ评分尚未经过有效性验证，因此有必要开展研究以评估其指导临床的价值。目的本研究旨在验证GSQ评分评估痔病严重程度的有效性，探讨其在手术治疗患者与非手术治疗患者之间的区分能力，并评估其在指导临床治疗痔病方面的价值。方法选取2021年11月—2022年11月在北京中医药大学东直门医院、北京市肛肠医院、中国科学技术大学附属第一医院、太原市中医医院、广东医科大学附属东莞第一医院和云南中医药大学第三附属医院6家医院肛肠科被诊断为痔病的患者开展问卷调查。通过标准化问卷收集患者的人口学资料、GSQ评分、Goligher分级、痔严重程度视觉模拟（VAS）评分、中文版痔和肛裂患者生命质量量表（HF-QoL-C）、痔症状评分（HDSS评分）等信息。比较不同Goligher分级和不同治疗方案（药物治疗或手术治疗）患者的GSQ评分，探讨GSQ评分与痔严重程度VAS评分、HDSS评分的相关性。绘制受试者工作特征（ROC）曲线分析GSQ评分预测手术治疗需求的效能，并确定最佳截断值。根据该截断值将患者分为低分组和高分组，比较两组患者HF-QoL-C评分的差异。结果本研究共发放问卷707份，回收671份有效问卷（有效回收率为94.9%）。不同Goligher分级患者GSQ评分比较，差异有统计学意义（P<0.001）。接受手术治疗患者的GSQ评分高于接受药物治疗患者（P<0.001）。GSQ评分与痔严重程度VAS评分、HDSS评分均呈正相关（rs=0.599、0.801，P<0.001）。ROC曲线显示，GSQ评分预测手术治疗的ROC曲线下面积为0.760（95%CI=0.722~0.799），最佳截断值为12.5分，灵敏度为62.3%，特异度为79.5%。根据GSQ评分将患者分为低分组（GSQ评分≤12分，n=366）和高分组（GSQ评分≥13分，n=306），高分组患者HF-QoL-C总分及各维度评分均高于低分组（P<0.05）。结论 GSQ评分能够有效反映痔病的严重程度，并为临床治疗方案的制定提供参考依据。当GSQ评分≥13分时，可优先考虑手术治疗。

关键词: 痔, 疾病严重程度, 疾病评估, 临床治疗, Giordano痔病症状严重程度评分

Abstract:

Background

As a specific scale to evaluate the severity of hemorrhoids, Giordano severity of hemorrhoidal symptom questionnaire (GSQ) has been used to evaluate hemorrhoids in clinical practice many times in recent years. However, the effectiveness of GSQ score has not been verified yet, so it is necessary to carry out research to evaluate its clinical value.

Objective

The purpose of this study is to verify the validity of GSQ in evaluating the severity of hemorrhoids, and explore its ability to distinguish between surgical patients and non-surgical patients, and evaluate its value in guiding clinical treatment of hemorrhoids.

Methods

From November 2021 to November 2022, patients who were diagnosed with hemorrhoid in anorectal departments of six hospitals, including Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing Anorectal Hospital, the First Affiliated Hospital of China University of Science and Technology, Taiyuan Hospital of Traditional Chinese Medicine, Dongguan First Affiliated Hospital of Guangdong Medical University and the Third Affiliated Hospital of Yunnan University of Chinese Medicine, were investigated by questionnaire. The demographic data, GSQ score, Goligher grade, Visual analogue scale (VAS) score of hemorrhoid severity, Chinese version of HF-QoL (HF-QoL-C), Hemorrhoidal disease symptom score (HDSS) and other information were collected through standardized questionnaires. Then compared the GSQ scores of patients with different Goligher grades and different treatment schemes (drug treatment or surgical treatment), and explored the correlation between GSQ score and VAS score of hemorrhoid severity and HDSS score. The receiver's operating characteristic (ROC) curve was drawn to analyze the effectiveness of GSQ score in predicting the surgical treatment demand, and determine the best cutoff value. According to the cut-off value, patients were divided into low group and high group, and the differences of quality of life scores between the two groups were compared.

Results

A total of 707 questionnaires were distributed and 671 valid questionnaires were recovered (the effective recovery rate was 94.9%). The GSQ scores of patients with different Goligher grades were significantly different (P<0.001). The GSQ score of patients receiving surgery was higher than that of patients receiving medication (P<0.001). GSQ score was positively correlated with VAS score of hemorrhoid severity and HDSS score (r_s=0.599, 0.801, P<0.001). ROC curve showed that the area under the curve predicted by GSQ score was 0.760 (95%CI=0.722-0.799), the best cutoff value was 12.5 points, the sensitivity was 62.3%, and the specificity was 79.5%. According to GSQ score, patients were divided into low group (GSQ score≤12, n=366) and high group (GSQ score ≥13, n=306). The total score of HF-QoL-C in high group was higher than that in low group (P<0.05).

Conclusion

GSQ can effectively reflect the severity of hemorrhoid disease and provide reference for the formulation of clinical treatment plan. When GSQ score is≥13 points, surgical treatment can be given priority.

Key words: Hemorrhoids, Severity of the disease, Disease assessment, Clinical treatment, GSQ score

褚洪川,孙松朋,龙俊红,等. Giordano痔病症状严重程度评分评价痔病严重程度的有效性和指导治疗的价值研究[J]. 中国全科医学, 2026, 29(11): 1405-1410. DOI: 10.12114/j.issn.1007-9572.2025.0280.
CHU Hongchuan,SUN Songpeng,LONG Junhong, et al. Evaluating the Effectiveness of GSQ Score for the Severity of Hemorrhoids and the Value of Guiding Treatment[J]. Chinese General Practice, 2026, 29(11): 1405-1410. DOI: 10.12114/j.issn.1007-9572.2025.0280.

图/表 3

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临床指标	0分	1分	2分	3分	4分
便血	从不□	每年至少1次□	每月至少1次□	每周至少1次（<6次/周） □	每次排便时都有□
痔脱垂	从不□	每年至少1次□	每月至少1次□	每周至少1次（<6次/周） □	每次排便时都有□
手法辅助回纳	从不□	每年至少1次□	每月至少1次□	每周至少1次（<6次/周） □	每次排便时都有□
不适/疼痛	从不□	每年至少1次□	每月至少1次□	每周至少1次（<6次/周） □	每次排便时都有□
对生命质量的影响	根本没有□	很小□	中等□	严重□	非常严重□

临床指标	0分	1分	2分	3分	4分
便血	从不□	每年至少1次□	每月至少1次□	每周至少1次（<6次/周） □	每次排便时都有□
痔脱垂	从不□	每年至少1次□	每月至少1次□	每周至少1次（<6次/周） □	每次排便时都有□
手法辅助回纳	从不□	每年至少1次□	每月至少1次□	每周至少1次（<6次/周） □	每次排便时都有□
不适/疼痛	从不□	每年至少1次□	每月至少1次□	每周至少1次（<6次/周） □	每次排便时都有□
对生命质量的影响	根本没有□	很小□	中等□	严重□	非常严重□

组别	例数	HF-QoL-C	生理功能	心理功能	排便	性生活
低分组	366	25.0（7.6，37.1）	25.0（6.8，39.0）	20.8（3.6，32.1）	33.3（16.7，50.0）	12.5（0，25.0）
高分组	306	39.8（29.4，50.0）	38.6（27.3，50.0）	35.7（25.0，50.0）	50.0（41.7，66.7）	25.0（0，50.0）
Z值		-10.120	-9.007	-9.470	-10.767	-6.762
P值		<0.001	<0.001	<0.001	<0.001	<0.001

组别	例数	HF-QoL-C	生理功能	心理功能	排便	性生活
低分组	366	25.0（7.6，37.1）	25.0（6.8，39.0）	20.8（3.6，32.1）	33.3（16.7，50.0）	12.5（0，25.0）
高分组	306	39.8（29.4，50.0）	38.6（27.3，50.0）	35.7（25.0，50.0）	50.0（41.7，66.7）	25.0（0，50.0）
Z值		-10.120	-9.007	-9.470	-10.767	-6.762
P值		<0.001	<0.001	<0.001	<0.001	<0.001