肠易激综合征患者心理状态与自主神经功能异常

Mental status and dysautonomia in patients with irritable bowel syndrome

目的:了解心理因素和自主神经功能失调在肠易激综合征发病中所起的作用。方法:选择2003-06/2004-05郑州大学第一附属医院消化内科门诊就诊的女性肠易激综合征患者30例,对照组为同期在本院的实习学生、职工及患者家属20人,均为健康女性,两组受试对象对本次测查知情,并同意参与。对两组受试者独立进行汉密顿抑郁量表和汉密顿焦虑量表的心理测评,并在4℃的冷水浸手及7.89kPa的压力下直肠扩张,扩张前后进行心率变异率(低频功率/高频功率)的短程频域分析,评价交感和迷走神经的张力。结果:两组受试对象的量表评定及各实验检查结果均纳入分析。①心理测评:肠易激综合征组有77%(23/30)表现为焦虑,73%(22/30)表现为抑郁;对照组10%(2/20)表现为焦虑,15%(3/20)表现为抑郁。肠易激综合征组在抑郁、焦虑心理状态的异常率均高于对照组(χ2=18.75,17.88;P均<0.01)。②自主神经功能测定:肠易激综合征患者在冷水刺激后(3.10±1.33)、直肠扩张前(5.57±1.74)、直肠扩张时(4.42±2.00)心率变异率的短程频域高于对照组(0.98±0.28,1.76±0.54,1.24±0.31),差异有显著性(t=4.283,6.386,4.625;P<0.01)。结论:肠易激综合征女性患者伴有心理障碍和自主神经功能失调,在内脏刺激及心理应激时表现为交感神经张力增高而迷走神经的活性降低。

AIM： To investigate the roles of psychological factors and automatic dysfunction in the attack of irritable bowel syndrome.METHODS： Thirty female patients with irritable bowel syndrome, who were treated in the Department of Gastroenterology,First Affiliated Hospital of Zhengzhou University from June 2003 to May 2004,and 20 healthy females （control group）, who were the student practicers, employees and patients＇ relatives in this hospital at the same period, were voluntarily involved in this study. All the subjects in both groups received psychological tests with Hamilton depression scale and Hamilton anxiety scale,proctectasis was undertaken with hands dipped into the 4 ℃ cold water under the pressure of 7.89 kpa; The short-time frequency range of heart rate variability （low frequency power/high frequency power） was analyzed before and after proctectasis, and the tensions of sympathetic nerve and vagus nerve were assessed.RESULTS： The results of each scale assessment and examination in both groups were involved in the analysis.① Psychological tests： In the irritable bowel syndrome group, 77% （23/30） of the patients had anxiety, and 73%（22/30） had depression; In the control group, 10% （2/20） of the cases had anxiety, and 15% （3/20） had depression. The abnormal rates of depression and anxiety were higher in the irritable bowel syndrome group and control group （x^2 =18.75, 17.88; P 〈 0.01）.②Determination of autonomic nerve function： The short-time frequency ranges of heart rate variability after stimulation of cold water, before and during proctectasis were significantly higher in the irritable bowel syndrome group （3.10±1.33, 5.57±1,74,4.42±2.00） than in the control group （0.98±0.28, 1.76±0.54, 1.24±0.31）（t=4.283, 6.386, 4.625; P 〈 0.01）.CONCLUSION： Female patients with irritable bowel syndrome are accompanied with psychological obstacles and automatic nerve functional disorders, which are manifested by the increased tension of sympathetic nerve and decreased activity of vagus nerve under stimulation at internal organ and psychological stress.