焦虑抑郁对腹泻型肠易激综合征直肠肛门运动及直肠感觉功能影响的研究

Effects of depression and/or anxiety on the changes of anorectal motility and rectal sensation in patients with diarrhea-predominant irritable bowel syndrome

目的研究焦虑和(或)抑郁对腹泻型肠易激综合征(IBS-D)患者直肠肛门运动及直肠感觉功能的影响。方法采用汉密尔顿焦虑量表和汉密尔顿抑郁量表对2008年1月至2009年6月广州医学院第二附属医院就诊的58例IBS-D患者进行评定,按是否伴有焦虑和(或)抑郁状态进行分组,采用高分辨多道胃肠功能消化道检测仪检测IBS-D患者肛门直肠运动功能及直肠感觉,以同期25名健康者作对照。结果 (1)增加腹压时,伴有焦虑和(或)抑郁状态组与不伴焦虑和(或)抑郁状态组肛门括约肌净增压分别为(3.0±0.9)kPa和(3.0±1.0)kPa,低于正常对照组[(3.6±1.6)kPa,P<0.05];直肠对容量刺激的最低敏感量、最大耐受性、顺应性则分别为(57.2±38.4)mL、(149±50.8)mL、(20.1±12.6)mL/kPa和(67.3±39.3)mL、(170.6±49.3)mL、(26.3±10.1)mL/kPa,前组低于后组(P<0.05),两组均低于正常对照组[(80±38)mL、(190±50)mL、(30.8±15.2)mL/kPa,P<0.01及P<0.05]。(2)两组直肠静息压、肛门括约肌压力、最大缩窄压、模拟大便时括约肌净减压,差异无统计学意义(P>0.05)。结论 (1)IBS-D直肠对容量刺激存在高敏感、低耐受、低顺应性和肛门自控能力减弱。(2)焦虑和(或)抑郁对IBS-D患者肛门直肠动力无影响,这可能需要扩大样本进一步证实,焦虑和(或)抑郁影响IBS-D患者直肠感知功能。

Objective To study the effects of depression and/or anxiety on the changes of anorectal motility and rectal sensation in patients with diarrhea-predominant irritable bowel syndrome（IBS-D）.Methods 58 patients with IBS-D registered to Second Affiliated Hospital of Guangzhou Medical College between January 2008 and June 2009 were evaluated by Hamilton Anxiety Scale（HAMA） and Hamilton depression scale（HAMD）.They were randomly divided into two groups according to investigated results（with and without depression and/or anxiety status）.Anorectal motility and rectal sensation in these two groups were determined by Medtronic PC-Polygraf HR and compared with results from 25 healthy subjects（HS） as the control group.Results（1）When elevated abdominal pressure,the net increase in pressure of anal sphincter was（3.0±0.9）kPa in the patients with depression and/or anxiety status group and（3.0±1.0）kPa in those without depression and/or anxiety status group,compared with HS[（3.6±1.6）kPa,P〈0.05].The rectal lowest volume of sensory threshold,maximal volume of tolerance and maximal compliance were respectively（57.2±38.4）mL,（149±50.8）mL,（20.1±12.6）mL/kPa in the patients with depression and/or anxiety status group,（67.3±39.3）mL,（170.6±49.3）mL,（26.3±10.1）mL/kPa in the patients without depression and/or anxiety status group,which were much lower when compared with HS[（80± 38）mL,（190±50）mL,（30.8±15.2）mL/kPa,P〈0.01 and P〈0.05].（2）The static rectal pressure,pressure of anal sphincter,maximal squeeze pressure of anal sphincter,net decrease in pressure of anal sphincter at imitated defecation showed no significant statistical differences between the two groups（P〈0.05）.Conclusion（1）Higher sensitivity,lower tolerance,lower compliance of rectum and weakened autonomous anal control in IBS-D may be associated with diarrhea and frequent defecation.（2）There was no association between depression and/or anxiety status and anorectal motility in patients with IBS-D.Further studies in larger patient groups may be needed to confirm the effects of depression and/or anxiety status on rectal sensations in the patients with IBS-D.