功能性消化不良就诊患者的人格特征研究

Personality traits in patients referred for functional dyspepsia

目的 使用通用、可靠的评估工具了解功能性消化不良（FD）就诊患者的人格偏离的类型和患病率,分析相互之间的联系.方法 246例FD患者纳入本研究,根据消化道症状的类型将患者分为4组,即单纯FD组、FD重叠反流样症状组（FD＋RS组）、FD重叠肠易激综合征组（FD＋IBS组）,以及FD重叠反流样症状及肠易激综合征组（FD＋RS＋IBS组）.使用人格诊断问卷4（PDQ-4）进行人格偏离筛查.结果 患者中160例（65%）被检出1种或1种以上的人格偏离,无明显性别差异,以焦虑和回避类为特征的C组人格（焦虑-抑制类）最为常见（142例,57.7%）.FD＋IBS组及FD＋RS＋IBS组患者的PDQ-4积分显著高于单纯FD组患者（23.39±8.77和24.22±10.97比18.98±11.88,P值均＜0.05）,提示人格偏离程度较重患者的消化道症状倾向于涉及食管、胃、肠道等多器官.伴有反流样症状（而无病理性酸反流证据）对A组人格（奇特及怪僻类）有一定提示作用.结论 就诊的FD患者人格偏离较多见.较多负性情感、较低的应对压力能力、较少的社会支持等因素可能在FD患者的就医行为中起了重要作用.存在人格偏离的FD患者,消化道症状倾向于涉及食管、胃、肠道等多器官,而不是局限于消化道的某一部分.

Objective To assess the prevalence of Personality Diagnostic Questionnaire （PDQ）personality deviations in patients referred for functional dyspepsia （FD） with reliable and universal psychological measures, and to explore the relationship between co-occurring PDQ-personality deviations and functional dyspepsia. Methods The sample comprised 246 patients referred for functional dyspepsia. Four groups were divided according to their patterns of gastrointestinal symptoms： the FD group, FD with refluxlike symptom group（FD ＋ RS group）, FD with irritable bowel syndrome group（ FD ＋ IBS group）, and FD with reflux-like symptom and irritable bowel syndrome group （ FD ＋ RS ＋ IBS group）. Participants were assessed with the Personality Diagnostic Questionnaire for DSM-Ⅳ （ PDQ-4 ） to evaluate the presence of personality deviations. Results Overall 65% patients scored positive for any personality deviation, male and female alike. Cluster C （anxious/fearful） personality was most commonly found in FD patients （142 patients, 57.7% ）. The FD ＋ IBS group and the FD ＋ RS ＋IBS group had significantly higher total PDQ scores than the FD group （23.39 ± 8. 77 and 24. 22 ± 10. 97 vs 18.98 ± 11.88, P 〈 0. 05, respectively）,indicating that FD patients with greater level of personality deviations tend to report other symptoms involving the esophagus and lower gastrointestinal tract. Reflux-like symptom without actual pathological acid regurgitation indicated cluster A （odd/eccentric） personality deviations. Conclusions The current study shows personality deviations are common in patients referred for functional dyspepsia. Negative emotions,maladaptive coping, and lack of social support, may strongly influence their healthcare-seeking behavior.There is no single personality type specific for some kind of gastrointestinal symptom. But FD patients with personality deviations tend to report other symptoms involving the esophagus and lower gastrointestinal tract.