肠易激综合征患者肠外症状评价

The evaluation for gastrointestinal symptom and psychosocial parameters in irritable bowel syndrome

目的评析肠易激综合征患者(irritable bowel syndrome,IBS)结肠外症状,特别是精神症状及其不同亚型表现的差异以及精神症状和消化道症状的关系。方法对71例IBS患者采用Rome官方网站调查表进行症状问卷。采用精神心理自评表(SCL-90)进行心理因素测评,对结果进行统计学分析。结果71例患者除结肠症状外较易合并腰痛(74.6%),对异性兴趣减退(50.7%)、睡眠不好(62%)、头痛(40.8%)、头昏(38%),食欲不振(32.4%),肌肉酸痛(62%)。与腹泻型IBS患者相比较,胃排空障碍在便秘型IBS较为常见(P<0.05)。IBS患者SCL-90各因子评分均高于中国常模组(P<0.05),其中焦虑和精神因子差异非常显著(P<0.01)。女性患者较男性患者在人际关系敏感、焦虑和抑郁等方面表现差异显著(P<0.05),其中焦虑非常显著(P<0.01),SCL-90各因子积分在便秘型IBS与腹泻型IBS之间无明显差异。将SCL-90各因子与消化道症状严重性进行相关性分析,其中躯体化(R:0.303,P=0.04),焦虑(R:0.56,P=0.008)及睡眠饮食(R:0.275,P=0.02)有明显相关性,其余因子无明显统计学意义。结论IBS患者除结肠症状外易合并结肠外症状。便秘型IBS患者较腹泻型患者易并发上消化道症状,以胃排空障碍为主。精神心理因素与IBS患者的症状关系密切,精神症状方面女性患者较男性更易表现为焦虑,抑郁及人际关系敏感。消化道症状的严重性与心理因素有关,其中焦虑呈明显相关。

Objective To determine if irritable bowel syndrome（IBS）patients with different bowel predominance differ in self-reported viscerosensory symptoms related to the upper gastrointestinal tract.Also,we sough to evaluate the relationship between psychosocial parameters and outcome in the patients.Methods Seventy-one Rome Ⅱ-positive IBS patients completed a bowel symptom questionnaire（BSO）and psychological symptom checklist（SCL-90）which contained 90 questions.The data were collected and analyzed by the SPSS 11.0.The prevalence of symptoms was expressed in percentage.Comparison among groups wase performed using Pearson X2 test for categorical data and t test for continuous data.Results Symptoms referred to the upper GI were more prevalent in IBS-C than IBS-D.Compared with IBS-D,IBS-C patients reported higher prevalence of early satiety（P 〈 0.05）,fullness（P 〈 0.05）,and a trend to upper GI bloating（P 〈 0.05）,but there was no difference about the symptom of nausea and heartburn（5.3% vs.6.7%,P 〉 0.05）.In addition,when patients with severe illness reported more pain,there were higher scores of anxiety（R：0.56,P = 0.008）.Conclusion IBS-C patients showed greater prevalence of a wide range of symptoms related to the upper GI（early satiety,fullness,bloating）than IBS-D.IBS patients were more likely to have the presence of psychiatric disorders.There was closely relationship between the psychiatric disorders and the symptom severity,especially anxiety.