焦虑及其结构因子与腹泻型肠易激综合征患者症状的相关性  

Correlation of Anxiety and Structural Factors With Symptoms in Patients With Irritable Bowel Syndrome With Diarrhea

作　　者：陆佳[1] 史丽丽 朱丽明[1] 樊文娟[1] 杨爱明[1] 方秀才[1] LU Jia;SHI Lili;ZHU Liming;FAN Wenjuan;YANG Aiming;FANG Xiucai(Department of Gastroenterology;Department of Psychological Medicine,Peking Union Medical College Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing,100730)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院消化内科,100730 [2]中国医学科学院北京协和医学院北京协和医院心理医学科,100730

出　　处：《胃肠病学》2019年第12期734-740,共7页Chinese Journal of Gastroenterology

基　　金：国家国际科技合作专项项目(2014DFA31850)

摘　　要：背景:肠易激综合征(IBS)患者常合并焦虑,焦虑可影响IBS症状的严重程度和治疗效果。目的:了解腹泻型IBS(IBS-D)患者的临床总体症状、精神心理状况,并探讨焦虑及其结构因子与患者症状的关系。方法:连续纳入符合罗马Ⅲ标准的IBS-D患者,以面对面问卷调查的方式评估患者症状,并进行汉密尔顿焦虑量表(HAMA)测评。分析HAMA及其结构因子与IBS-D患者肠道主要症状、排便症状、重叠上消化道症状、胃肠道外症状的相关性。结果:共纳入410例IBS-D患者,264例(64.4%)患者合并焦虑。与无焦虑患者比,合并焦虑的患者肠道主要症状评分、排便后腹痛/腹部不适评分明显升高,腹胀、排便费力、排黏液便、重叠胃食管反流病和胃肠道外症状的比例均显著升高(P<0.05)。精神性焦虑与肠道症状评分、排便后腹痛/腹部不适改善程度存在相关性(P<0.05);躯体性焦虑与排便前腹痛/腹部不适程度相关性较强(P<0.05);HAMA各结构因子与患者平时(非发作期)和IBS发作时排便次数和粪便性状变化无明显相关性。腹胀、排黏液便、重叠胃食管反流病、重叠胃肠道外症状者的HAMA总分、精神性焦虑和躯体性焦虑因子评分显著高于无相应症状者(P<0.05)。结论:焦虑及其结构因子主要与IBS-D患者腹痛/腹部不适严重程度有关,与排便次数和粪便性状无关。Background:Patients with irritable bowel syndrome(IBS)have comorbid anxiety,which influences the severity of IBS symptoms and therapeutic efficacy.Aims:To investigate the intestinal and extra-gastrointestinal symptoms and psychological status of patients with IBS with diarrhea(IBS-D),and to identify the correlation of comorbid anxiety and structural factors with symptoms.Methods:Consecutive patients met the RomeⅢcriteria for IBS-D were enrolled in this study.The IBS symptom questionnaire and Hamilton anxiety scale(HAMA)were completed in a face-to-face manner.Correlations of HAMA and its structural factors with main bowel symptom,defecation symptom,overlapping with gastroesophageal reflux disease and extra-gastrointestinal symptoms were analyzed.Results:A total of 410 IBS-D patients were enrolled,264(64.4%)had comorbid anxiety.Compared with patients without anxiety,score of the main bowel symptom and abdominal pain/discomfort after defecation were significantly increased in patients with anxiety,proportions of abdominal bloating,difficulty in stool passage,mucous stool,overlapping with gastroesophageal reflux disease and extra-gastrointestinal symptoms were significantly increased(P<0.05).Psychic anxiety was significantly correlated with main bowel symptom score and degree of improvement of abdominal pain/discomfort after defecation(P<0.05).Somatic anxiety was significantly correlated with degree of pre-defecation abdominal pain/discomfort(P<0.05).No structural factor had significant correlation with bowel movements or stool form either in the symptom episode or in the non-symptom period.HAMA score,psychic anxiety score,somatic anxiety score in patients with abdominal bloating,mucous stool,overlapping with gastroesophageal reflux disease and extra-gastrointestinal symptoms were significantly higher than those in patients without the corresponding symptoms(P<0.05).Conclusions:The comorbid anxiety and structural factors are mainly correlated with degree of abdominal pain/discomfort in IBS-D patients,but not with b

关 键 词：腹泻型肠易激综合征 焦虑 结构因子 问卷调查 

分 类 号：R47[医药卫生—护理学]