胃食管反流病患者临床症状、心身因素和自主神经功能之间的关系  

Symptoms, psychosomatic factors and autonomic nervous function in patients of gastroesophageal reflux disease

作　　者：王大冰 王世喜 刘安民 韩玉娟 韩芝 刘英 

机构地区：[1]山东省枣庄矿业集团公司中心医院消化内科,277011

出　　处：《中华全科医师杂志》2007年第8期476-478,共3页Chinese Journal of General Practitioners

摘　　要：目的探讨胃食管反流病(GERD)患者临床症状、心身因素、自主神经功能之间的关系。方法 15例对照者与34例经反流性疾病诊断问卷(RDQ)及经过内镜榆查诊断为 GERD 的患者,均填写 Zung 自评量表,评分异常的 GERD 患者为 GERD(+)组,评分正常的 GERD 患者为 GERD(一)组,两组同时记录反流症状积分。全部入选者均进行心率变异性检查。检测频域:24 h 内平均R-R 间期的标准差,5 min 平均窦性心率标准差,相邻 R-R 间期之差的均分根,相邻心博 R-R 间期之差大于50 ms 的心搏占心搏总数的百分比。时域:低频,高频,低频/高频。结果 GERD 组 Zung 焦虑自评量表平均分、Zung 抑郁自评量表平均分明显高于对照组(分别为48±9对38±6,48±1 1对41±6,均 P<0.05)。GERD(+)组 Zung 分数与症状积分呈正相关,相关系数为0.411和0.483。同时发现非糜烂性反流病组 Zung 评分异常分布。GERD 患者迷走神经张力较对照组增高,GERD(+)组增高更明显。结论 GERD 患者尤其是非糜烂性反流病患者反流症状、心身因素、自主神经功能之间互相影响、互为因果,自主神经功能紊乱可能是中间环节。对 GERD 患者需整体治疗。Objective To study the association between clinical symptoms, psychosomatic factors and autonomic nervous function in patients with gastroesophageal reflux disease （GERD）. Methods Thirty-four patients with GERD diagnosed by reflux disease questionnaire （RDQ） and endoscopy and 15 healthy control subjects were enrolled in this study. All the subjects were divided into two groups, one with normal scores of Zung＇ s self-rating anxiety scale （SAS） and Zung＇ s depression scale （SDS） as GERD （ - ） and the other with abnormal scores of SAS and SDS as GERD （ ＋ ）. Reflux symptom score was recorded for both groups at the same time. Autonomic nervous function was assessed by their heart rate variability （HRV） on dynamic electrocardiogram （DCG）. The time domain parameters analyzed included standard deviation （SD） of average R-R interval during 24 hours （SDNN） , SD of average 5-minute sinus heart rate （SDANN）, mean square root of the difference of adjoining two R-R interval （rMSSD） , and proportion of the heart beats with difference of R-R interval more than 50 ms from the total heart beats （ PNN 50） , and the frequency domain parameters analyzed included low-frequency （LF）, high-frequency （HF） and ratio of LF to HF. Results Average scores of SAS and SDS were significantly higher in patients with GERD than those in healthy controls （48 ± 9 vs 38 ± 6 and 48 ±11 vs 41 ±6, respectively, P 〈 0. 05）. Scores of SAS and SDS positively correlated with reflux symptom score in GERD （ ＋ ） group, with coefficients of correlation of 0. 411 and 0. 483, respectively, P 〈0. 05. The study also showed an abnormal distribution of SAS and SDS scores in patients with non-erosive GERD. Tension of the vagus nerve increased more in patients with GERD than in healthy controls, and more significantly in GERD （ ＋ ） group. Conclusions Reflux symptom,psychosomatic factors and autonomic nervous function in patients with GERD impact each other on its pathogenesis. Auto

关 键 词：胃食管反流病 心身因素 自主神经调节 

分 类 号：R571[医药卫生—消化系统]