·短篇论著·

功能性胃肠病与精神心理因素的关系及其治疗

刘隽*刁磊杨彩虹王俊先李诚

安徽省第二人民医院消化内科(230041)

背景：功能性胃肠病(FGIDs)是消化系统常见病，严重影响患者生活质量。近年来，FGIDs与精神心理因素的关系逐渐受到重视。目的：探讨FGIDs与精神心理因素的关系以及抗抑郁治疗的效果。方法：纳入2013年9月—2014年9月安徽省第二人民医院收治的FGIDs患者270例。采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)对患者的精神心理因素进行评估，并对消化道症状进行评分。对有精神心理异常的FGIDs患者给予常规治疗缓解消化道症状。将常规治疗无效的患者设为难治组，常规治疗有效的患者设为反应组。进一步将难治组患者随机分为常规治疗组和综合治疗组，后者在常规用药的基础上加用帕罗西汀。结果：FGIDs患者焦虑的发生率为61.5%(166/270)，抑郁的发生率为57.0%(154/270)。反应组同时伴有焦虑和抑郁的HAMA、HAMD评分与消化道症状评分呈正相关(r=0.585，P<0.01；r=0.584，P<0.01)。常规治疗后，反应组HAMA、HAMD评分以及消化道症状评分均较治疗前显著下降(P<0.05)。难治组治疗后的HAMA、HAMD评分较反应组治疗前的HAMA、HAMD评分显著升高(P<0.05)。综合治疗组HAMA、HAMD评分以及消化道症状评分较常规治疗组显著下降(P<0.05)。结论：FGIDs与精神心理因素有关，抗抑郁治疗有助于改善FGIDs消化道症状。

关键词功能性胃肠病；焦虑；抑郁；治疗；帕罗西汀

Relationship between Functional Gastrointestinal Disorders and Psychological Factors and Related Treatment

LIUJun,DIAOLei,YANGCaihong,WANGJunxian,LICheng.DepartmentofGastroenterology,AnhuiNo.2ProvincePeople’sHospital,Hefei(230041)

Background: Functional gastrointestinal disorders (FGIDs) is a common disease of digestive system which severely affects the quality of life. Recently, more and more attentions have been paid to the relationship between FGIDs and psychological factors. Aims: To investigate the relationship between FGIDs and psychological factors and related treatment. Methods: A total of 270 patients with FGIDs admitted from Sept. 2013 to Sept. 2014 at Anhui No.2 Province People’s Hospital were enrolled. Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate the mental state of patients, and symptom severity of digestive system was scored. Patients with psychological abnormalities received conventional therapy to relieve digestive symptoms, and those who failed from conventional therapy were assigned into refractory group and others were assigned into response group. Patients in refractory group were further divided into conventional therapy group and combined therapy group for receiving paroxetine in addition to conventional therapy. Results: The rates of anxiety and depression were 61.5%(166/270)and 57.0%(154/270), respectively. The scores of HAMA and HAMD were positively correlated with the score of digestive symptoms (r=0.585，P<0.01；r=0.584，P<0.01) in patients with anxiety and depression in response group. The scores of HAMA, HAMD and digestive symptoms in response group after conventional therapy were significantly decreased (P<0.05), while the scores of HAMA and HAMD in refractory group after therapy were significantly higher than those in response group before therapy (P<0.05). The scores of HAMA, HAMD and digestive symptoms in combined therapy group were significantly lower than those in conventional therapy group (P<0.05). Conclusions: Relationship is found between FGIDs and psychological factors, and antidepressants might contribute to the amelioration of symptoms of FGIDs.

Key wordsFunctional Gastrointestinal Disorders;Anxiety;Depression;Therapy;Paroxetine

功能性胃肠病(functional gastrointestinal disorders, FGIDs)是一类具有慢性、复发性消化道症状而无法以器质性病变或生化指标异常解释的疾病，其发病机制复杂，至今尚未完全明确。FGIDs发病率较高，是消化系统常见疾病，约占就诊患者的40%~50%[1-2]，严重影响患者生活质量。近年来，随着社会发展和生活节奏加快，源于社会、工作和生活的压力增加，精神心理因素与FGIDs的关系逐渐受到重视。本研究应用汉密尔顿焦虑量表(Hamilton Anxiety Scale, HAMA)和汉密尔顿抑郁量表(Hamilton Depression Scale, HAMD)对FGIDs患者进行评分，探讨FGIDs与精神心理因素的关系，并评价抗抑郁药物对伴有精神心理障碍的FGIDs患者的治疗效果。……