精神心理因素对非糜烂性反流病的作用探讨

The study of the psychophysiological effect on non-erosive reflux disease

目的从胃肠激素-胃动素角度探讨心理精神因素对非糜烂性反流病(NERD)发病的影响。方法无反流症状并经内镜和24小时食管pH动态监测确认的对照组14例,经症状评估和内镜诊断、并结合24小时食管pH动态监测或质子泵抑制(PPI)试验诊断的非糜烂性反流病患者30例。放射免疫方法检测血浆胃动素(MTL)水平。采用症状自评量表(SCL-90)和综合医院焦虑/抑郁(HAD)情绪测定表对入选者进行精神心理状态评估。结果非糜烂性反流病患者有23例的胃动素(76.7%)不在正常范围,对照组3例(21.4%),两组异常率比较差异有显著性(P<0.01),且非糜烂性反流病患者胃动素水平低于对照组(P<0.05);SCL-90评分NERD组各参数总分或均分大多数高于对照组,但各项得分高低与对照组胃动素水平高低无相关性(P>0.05)。非糜烂性反流病患者HAD情绪测定阳性率(13/30,43.3%)与对照组(1/14,7.1%)比较,差异有显著性(P<0.05)。结论非糜烂性反流病患者存在不同程度的精神心理障碍,可能通过影响胃肠激素的分泌而成为非糜烂性反流病发病的一个危险因素。

Objective To explore the effect of psychophysiology on non-erosive reflux disease by the means of evaluating the gut hormon-motilin. Methods Fourteen normal controls without typical reflux symptom comfirmed by endoscopy and ambulatory 24h pH monitoring and thirty NERD patients diagnosed by symptom evaluation, combined endoscopy and ambulatory 24h pH monitoring or proton pump inhibitor treatment trial were enrolled in this study. The blood plasma level of motilin（MTL） was examined by radioimmunity（RI） method,The anxiety and （or） depression score of all subjects with Symptom Checklist 90 （SCL-90） and Hospital Anxiety and Depression Scale （HAD） were evaluated. Results Twenty-three of all NERD patients had abnormal motilin plasma level, accounted 76.7%, but only three of the normal controls had the latter accounted 21.4% （P 〈0.01 ） with SCL-90 score：The score of most items in each mental scale were significantly higher in the NERD patients than in the normal controls, but there was no correlation between the mental score degree and the motilin level. HAD evaluation：Thirteen-one of NERD patients suffered from different degree of anxiety and（or） depression, accounted 43.3%, In the normal controls, only one has mild depression, accounted 7.1% （ P 〈 0.05 ）. The difference of abnormal rate between motilin and the HAD evaluation existed statistical significance （ P 〈 0.01 ）. Conclusion Our find- ings suggest that different degree of psychophysiological factors may lead to symptomatic presentation in part of the NERD patients,which may be a risk factor of NERD by affecting the secretion of gut hormone through the brain-gut reflection way.