精神心理因素对消化不良影响的临床研究

Clinical study on the effects of mental-psychological factors on dyspepsia

【目的】综合分析功能性消化不良(FD)和器质性消化不良(OD)症状特点,以提高消化不良的治疗水平。【方法】连续调查消化不良的患者980例,根据症状、精神心理因素进行评分和分型,并同时选择健康成人980例为对照组进行对照,以期探讨精神心理因素对消化不良影响的病理实质。【结果】980例消化不良的患者中,伴有精神心理因素的FD611例(67.1%),伴有精神心理因素的OD369例(32.2%),与对照组比较高出对照组71.5%。患者SDS、SAS症状积分明显高于对照组(P<0.01),消化不良症状的加重、减轻与精神心理因素的影响相关,胃肠排空率低于对照组(P<0.05)。报警症状FD组与OD组均受精神心理因素的影响有显著差异(P<0.05),OD组高于FD组(P<0.01)。【结论】研究表明,消化不良患者与精神心理因素关系密切,其机制可能为脑—肠轴功能异常的情绪应激变化,即通过大脑边缘系统和下丘脑使植物神经功能发生改变,导致胃肠功能失调,并影响内脏感觉的感知。本研究对提高消化不良治疗用药的准确率和有效率提供了依据。

[Objective] To study the characteristics of the symptoms of functional dyspepsia （FD） and organic dyspepsia （OD）, so as to improve the therapeutic effectiveness. [Methods] A total of 980 cases with dyhspapsia were assessed by symptoms and mental-psychological factors and compared with the control group. [ Results] Among the 980 cases, 611 cases （67.1%） were FD with mental-psychological factors while 369 cases （32.2%） were OD with mental-psychological factors and was 71.5% higher than the control group. The score of SDS and SAS symptoms was distinctively higher than the control group （P〈 0.01）. The aggravation or alleviation of the symptoms was related to the mental-psychological factors. The gastric emptying rate of the dyspepsia group was obviously lower than the control group （P 〈 0.05）. The early warning symptoms of the FD group and OD group were both affected by the mental-psychological factors, and had statistical differences between the two groups （P〈 0.05）, the OD group was higher than the FD group. [Conclusions] Studies show emotional changes of patients can lead to functional changes of the limbic system and the hypothalamus, which lead to the dysfunction of gastrointestinal tract and affect the perception of the organs. So dysfunction of brain-gut-axis plays a very important role with mental-psychological factors. It may be helpful to improve the accuracy and effectivity of drug prescription and treatment for dyspepsia according to this study.