腹泻型肠易激综合征神经调节剂的选择和疗效  

Selection and efficacy of neuromodulators for patients with irritable bowel syndrome with diarrhea

作　　者：陆佳[1] 史丽丽[2] 方秀才[1] 朱丽明[1] 樊文娟[1] 杨爱明[1] LU Jia;SHI Lili;FANG Xiucai;ZHU Liming;FAN Wenjuan;YANG Aiming(Department of Gastroenterology,2.Department of Psychological Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

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 [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,北京100730

出　　处：《胃肠病学和肝病学杂志》2020年第6期682-687,共6页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家自然科学基金面上项目(81870379);科技部国际科技合作项目(2014DFA31850)。

摘　　要：目的调查腹泻型肠易激综合征(IBS-D)患者的消化道症状、精神心理状况和使用神经调节剂治疗情况,分析、探讨IBS-D患者神经调节剂选择和疗效。方法连续纳入符合罗马Ⅲ诊断和分型标准的IBS-D患者,以面对面方式问卷调查患者消化道症状和诊疗情况,并进行汉密尔顿焦虑量表(HAMA)和抑郁量表(HAMD)测评,临床医师根据患者病情处方神经调节剂,对患者随诊记录的疗效进行评分。采用t检验、非参数检验、χ2检验和Spearman秩相关分析进行统计分析。结果共纳入IBS-D患者410例,其中116例(28.3%)处方了神经调节剂(≥2周),19例(16.4%)未随访。神经调节剂治疗组合并中重度焦虑、抑郁比例高于常规治疗组(P=0.001;P=0.000);排便前腹痛/腹部不适频率更高(P=0.005)、排便后腹痛/腹部不适症状更难以改善(P=0.045)。97.9%(95/97)患者服用神经调节剂后情绪、睡眠、腹痛/腹部不适和腹泻4种症状均有不同程度改善。用药后起效时间为(0.8±0.4)个月,最佳疗程为(3.5±2.8)个月。用药后情绪、腹痛/腹部不适、腹泻改善程度与用药疗程均呈正相关(r=0.344;r=0.322;r=0.381)。最常用药为帕罗西汀和米氮平,共占78.4%(76/97);帕罗西汀治疗后情绪显著改善者基线认知障碍因子评分更低(P=0.036),腹泻显著改善者基线精神性焦虑、迟滞因子评分更高(P=0.034;P=0.028);米氮平治疗后腹痛/腹部不适和腹泻显著改善者基线睡眠障碍因子评分更高(P=0.008;P=0.003)。结论神经调节剂适用于合并中重度焦虑和/或抑郁,或肠道症状重的难治性IBS-D患者;个体化选择神经调节剂、足疗程和维持用药可明显提高整体治疗效果。Objective To investigate the intestinal symptoms,psychological status and treatment with neuromodulators of patients with irritable bowel syndrome with diarrhea(IBS-D),and to identify the optimizing selection and efficacy of neuromodulators for patients with IBS-D.Methods Consecutive patients met the RomeⅢDiagnostic Criteria for IBS-D were enrolled in this study.The IBS symptom questionnaire and Hamilton rating sale for anxiety/depression(HAMA/HAMD)were completed in face-to-face manner.The neuromodulators were prescribed and the efficacies were evaluated according to follow-up records.t-test,nonparametric test,χ^2 test and Spearman rank analysis were used for data analysis.Results A total of 410 IBS-D patients were enrolled,116(28.3%)were prescribed with neuromodulators(≥2 weeks),among them 16.4%(19/116)lost follow-up.The comorbid anxiety with moderate to severe,depression in patients prescribed neuromodulators were higher than that in conventional treated patients(P=0.001;P=0.000).Patients prescribed neuromodulators had higher frequency of abdominal pain/discomfort before defecation(P=0.005),and difficulty in improvement of abdominal pain/discomfort after defecation(P=0.045).After neuromodulator therapy,97.9%(95/97)patients achieved improvement in symptoms of mood,sleep,abdominal pain/discomfort and diarrhea.The treatment course of neuromodulators was in an average of 4(2.0,9.3)months with onset time of(0.8±0.4)months and the best course of(3.5±2.8)months.The improvement of mood,abdominal pain/discomfort and diarrhea after treatment were positively correlated with treatment course(r=0.344;r=0.322;r=0.381).Paroxetine and mirtazapine were most commonly used neuromodulators(78.4%,76/97).Patients with significant improvement of mood after paroxetine had lower score in baseline mental disorders(P=0.036),and those with significant improvement in di-arrhea had higher scores in psychic anxiety and retardation symptoms(P=0.034;P=0.028);while patients with significant improvement in abdominal pain/discomfort and di

关 键 词：腹泻型肠易激综合征 神经调节剂 焦虑 抑郁 结构因子 

分 类 号：R574[医药卫生—消化系统]