功能性便秘患者的精神心理状况及生活质量评估

Assessment of psychological status and quality of life in patients with functional constipation

目的通过比较和分析功能性便秘（FC）患者与健康对照者的精神心理和生活质量状况，揭示FC患者的生活质量状况及其临床意义。方法应用普适量表（SCL-90）和疾病特殊量表（PAC-QOL）对60例FC患者和性别、年龄相匹配的30例健康对照者进行问卷调查，并详细记录每天排便情况。对两者之间的一般资料、精神心理评分、生活质量评分进行比较，同时对FC患者的精神心理评分、便秘症状程度与生活质量评分进行相关性分析。结果（1）FC患者与健康对照者在年龄、BMI、性别比例之间差异无统计学意义；而两组在大便性状评分、日均排便次数之间差异有统计学意义。（2）FC患者SCL-90评分的总分、总症状指数、阳性项目数、阳性症状痛苦水平、9个因子分除恐怖外的躯体化、强迫、焦虑、抑郁和精神病性等因子分显著高于健康对照组（P〈0．05）。（3）FC患者PAC-QOL的4个部分得分及总平均分分别为：躯体不适（3．06±0.75）、心理社会不适（2．34±0．79）、担心焦虑（2．99±0．81）、满意度（3．22±0．40）、总平均分（2．85±0、50），均较基线水平明显升高。（4）SCL-90中的总分、总症状指数、阳性项目数、阳性症状痛苦水平、9个因子分中的躯体化、强迫、抑郁、焦虑、敌对等与PAC-QOL评分有显著相关性，尤其表现在焦虑和抑郁两方面。（5）FC患者腹胀、排便费力等症状程度与PAC-QOL总平均分及SCL-90评分有显著相关性。结论FC患者存在明显的精神心理异常，便秘严重降低了患者的生活质量。生活质量评分的高低比实验室指标和便秘的严重程度更能反映患者的健康状况。

Objective To investigate the states of psychological condition and the quality of life in patients with functional constipation （FC） by comparing with those of healthy controls. Methods Symptom Checklist-90 （SCL-90） and Patient Assessment Constipation-Quality of Life （PAC-QOL） were tested by self-report questionnaire in sixty patients with FC and thirty healthy controls with corresponding age and gender. Results （1） There was no difference in age, body mass index and sex ratio between the FC patients and healthy controls, but the scores of stool form and frequency of defecation were significantly different between the two groups. （2） The following items of SCL-90 i.e. total scores, total symptomatic index, the number of positive items and positive symptom distress level were obviously higher in the FC patients than in controls（ P 〈 0.05 ）. The scores of the nine factors of SCL-90 except terror were also higher in the FC patients than in controls. （ 3 ） The average total score and scores of four sections （ physical discomfort, psychological discomfort, anxiety, satisfaction） of PAC-QOL in FC patients were higher than those in basal level. （4） The average score of PAC-QOL was significantly correlated with the scores of SCL-90,especially in anxiety and depression. （5） The severity of symptoms in the FC patients was significantly correlated with the average score of PAC-QOL and the total score of SCL-90. Conclusions FC patients have obviously psychological abnormality, which affects the quality of life significantly. The scores of quality of life is a better parameter to reflect the healthy status of the FC patients than the laboratory tests and the clinical symptoms.