陆军某部官兵创伤后应激障碍患病情况及其与功能性胃肠病的关系  

The prevalence of post traumatic stress disorder in an army unit and its relationship with functional gastrointestinal disorders

作　　者：王倩 姚欣 靳海峰[3] 孙蓉[3] 于佳[3] 智佳[3] 王春华[3] 郭丽丽[3] 

机构地区：[1]承德医学院研究生学院,河北承德067000 [2]首都医科大学附属北京友谊医院新华医院消化内科,北京101100 [3]解放军白求恩国际和平医院消化内科,石家庄050082

出　　处：《解放军医学杂志》2018年第2期172-180,共9页Medical Journal of Chinese People's Liberation Army

基　　金：河北省科技计划项目(17277767D)~~

摘　　要：目的探讨陆军某部官兵创伤后应激障碍(PTSD)患病情况及其与功能性胃肠病(FGIDs)的关系。方法应用创伤后应激障碍症状自评量表(PCL-C)诊断PTSD,应用罗马ⅢFGIDs调查问卷进行FGIDs的分类和诊断。采用创伤史筛查问卷及压力性事件调查问卷研究PTSD与创伤性及压力性事件的关系。分析PTSD与FGIDs的重叠情况及二者的相关性。结果 927例调查对象中,诊断为PTSD者33例,总体患病率3.56%;诊断为FGIDs者435例,总体患病率为46.93%。诊断为PTSD的33例中28例合并FGIDs,FGIDs患病率为84.85%(28/33),明显高于非PTSD组(45.53%,P<0.05)。同时,FGIDs组PTSD患病率高于非FGIDs组(6.43%vs.1.02%,P<0.05)。PTSD官兵最常见的FGIDs是周期性呕吐综合征(CVS,33.33%)、非特异性功能性肠病(24.24%)、功能性腹胀(18.18%)和功能性直肠肛门痛(18.18%)。多因素分析发现,PTSD是CVS(OR=9.118)、功能性直肠肛门痛(OR=3.373)、功能性腹胀(OR=4.772)、肠易激综合征(OR=3.438)、反刍综合征(OR=16.033)、功能性呕吐(OR=10.329)和功能性吞咽困难(OR=9.891)的危险因素(P<0.05)。多因素logistic回归分析显示,CVS(OR=4.063)、创伤性事件个数(OR=1.159)和压力性事件个数(OR=1.401)是军人PTSD患病的危险因素(P<0.05)。结论 PTSD与FGIDs互为患病的危险因素,PTSD在多种FGIDs中的患病率存在较大差异。CVS是PTSD官兵最常见的FGIDs,也是PTSD患病的危险因素,其原因及机制值得深入研究。Objective To determine the prevalence of post traumatic stress disorder （PTSD） in the army officers and soldiers （AOSs）, and identify its relationship with functional gastrointestinal disorders （FGIDs）. Methods PTSD and FGIDs were diagnosed based on the PTSD checklist--civilian （PCL-C） and Rome III Modular Questionnaire respectively, the overlaps of PTSD and FGIDs and their correlation were diagnosed. The correlation of PTSD with traumatic and stressful events was investigated using Trauma History and Stressful Event Screening Questionnaire. The coexistence and relationship of PTSD and FGIDs were analyzed. Results Of 927 AOSs, 33 were diagnosed with PTSD. The prevalence of PTSD was 3.56%. FGIDs were identified in 435 subjects and the incidence of FGIDs was 46.93%. Among. 33 AOSs with PTSD, 28 were diagnosed as having FGIDs and the prevalence of FGIDs was 84.85%, which was significantly higher than that of non-PTSD group （45.53%, P〈0.05）. Moreover, the FGIDs group had a higher prevalence of PTSD, compared with the non-FGID group （6.43% vs. 1.02%, P〈0.05）. Cyclic vomiting syndrome （CVS, 33.33%）, unspecified functional bowel disorder （24.24%）, functional bloating （18.18%） and functional anorectal pain （18.18%） were the four most frequent FGIDs in PTSD AOSs. Multiple regression analysis showed PTSD was the risk factor for CVS （OR=9.118）, functional anorectal pain （0R=3.373）, functional bloating （0R=4.772）, irritable bowel syndrome （OR=3.438）, rumination syndrome （0R=16.033）, functional vomiting （0R=10.329）, functional dysphagia （OR=9.891）（P〈0.05）. CVS （0R=4.063）, the number of traumatic （OR=1.159） and stress events （OR=1.401） were the risk factors for PTSD in AOSs （P〈0.05）. Conclusions PTSD and FGID interact as risk factor each other. The prevalence of PTSD differs significantly in different FGIDs. CVS is the most frequent FGID in PTSD AOSs and risk factor for PTSD, which deserves more concerns.

关 键 词：创伤后应激障碍 功能性胃肠病 军人 创伤性事件 压力性事件 

分 类 号：R57[医药卫生—消化系统] R749.5[医药卫生—内科学]