胃食管反流病重叠消化不良的临床及精神心理特征研究  

Clinical and psychological characteristics of overlapping dyspepsia in patients with gastroesophageal reflux disease

作　　者：胡祥鹏[1] 张深深 王乔[1] 曹鸿霞[1] 刘珺[2] HU Xiang-peng;ZHANG Shen-shen;WANG Qiao(Digestive Department,the Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230601,China)

机构地区：[1]安徽医科大学第二附属医院消化内科,安徽合肥230601 [2]安徽医科大学基础医学院,安徽合肥230032

出　　处：《中华全科医学》2019年第9期1447-1449,1550,共4页Chinese Journal of General Practice

基　　金：国家自然科学基金项目(81602120);安徽省自然科学基金项目(1708085QH176);安徽医科大学第二附属医院博士科研启动基金(2018BSJJ054)

摘　　要：目的重叠消化不良常导致胃食管反流病(gastroesophageal reflux disease,GERD)疗效不佳,目前尚不明确是否与精神心理因素有关,拟研究GERD重叠消化不良患者的临床和精神心理特征,为临床治疗提供一定依据。方法收集2018年1-11月在安徽医科大学第二附属医院就诊的100例以典型反酸、烧心症状就诊的GERD患者,根据有无重叠消化不良症状分为GERD组和GERD重叠消化不良组,采用反流性疾病问卷(RDQ)、病人健康问卷抑郁量表(PHQ-9)、广泛性焦虑障碍量表(GAD-7)、匹兹堡睡眠质量指数量表(PSQI)进行评估。对合并上腹痛、餐后饱胀、上腹部烧灼感、早饱、嗳气、恶心等消化不良症状进行评分,采用SPSS 17.0统计学软件进行分析。结果 100例GERD患者中,重叠消化不良症状的患者37例(37.0%)。与GERD组患者相比,GERD重叠消化不良组患者的RDQ程度评分、GAD-7、PHQ-9、PSQI评分均显著升高,差异有统计学意义(均P<0.05)。在GERD重叠消化不良患者中,消化不良症状总积分与RDQ、GAD-7、PHQ-9、PSQI评分呈正相关(均P<0.05);单个消化不良症状中,相关分析显示上腹痛、恶心症状与GAD-7评分呈正相关,恶心、早饱症状与PHQ-9、PSQI评分呈正相关(均P<0.05),多元线性回归分析显示恶心、早饱症状严重程度与PHQ-9、PSQI评分相关。结论重叠消化不良症状的GERD患者胃食管反流症状更加明显,焦虑、抑郁表现更为突出,睡眠质量更差。上腹痛、恶心、早饱可能是提示GERD患者存在精神心理异常的重要症状。Objective Overlap of dyspeptic symptoms often leads to poor response to therapy in gastroesophageal reflux disease(GERD) patients, which may be associated with psychological factors. This study is to study the clinical and psychological characteristics of overlapping dyspepsia in patients with GERD. Methods One hundred GERD patients with typical acid reflux and heartburn symptoms were collected from the second affiliated hospital of Anhui Medical University from January to November 2018. All participants were evaluated with Reflux Disease Questionnaire(RDQ) score, Patient Health Questionnaire-9(PHQ-9), The Generalized Anxiety Disorder 7-item scale(GAD-7) and Pittsburgh Sleep Quality Index Scale(PSQI). The scores of overlapping dyspeptic symptoms including epigastric pain, post-prandial fullness, epigastric burning, early satiation, belching and nausea were recorded. All statistical analyses were performed using SPSS software(version 17.0). Results Among the 100 GERD patients, the prevalence of GERD overlapping dyspepsia was 37%. Patients with GERD overlapping dyspepsia had higher score of RDQ, GAD-7, PHQ-9 and PSQI than GERD alone and the difference was statistically significant(all P<0.05). In patients with GERD overlapping dyspepsia, the dyspeptic symptom score was positively correlated with the severity of RDQ score and the score of GAD-7, PHQ-9 and PSQI(all P<0.05). Among dyspepsia symptoms, epigastric pain and nausea were significantly related to the score of GAD-7, early satiation and nausea were significantly related to the score of PHQ-9 and PSQI(all P<0.05). Multivariate linear regression analysis also showed that early satiation and nausea were significantly related to the score of PHQ-9 and PSQI. Conclusions Patients with GERD overlapping dyspepsia have more obvious clinical symptoms, more anxiety and depression, and worse sleep quality. Epigastric pain, early satiation and nausea may be important symptoms of mental and psychological abnormalities in patients with GERD.

关 键 词：胃食管反流病 消化不良 焦虑 抑郁 睡眠质量 

分 类 号：R571[医药卫生—消化系统] R573[医药卫生—内科学]