符合罗马Ⅲ标准FD患者心理测试及自主神经功能观察44例

Psychological states and autonomic nervous system function in 44 patients with functional dyspepsia diagnosed based on the Room Ⅲ criteria

目的:观察功能性消化不良(functional dyspep-sia1,FD)及其不同类型患者的心理状态和自主神经功能,以了解其特点.方法:对符合罗马Ⅲ标准的44例FD患者根据罗马Ⅲ分类标准分为餐后不适综合征(postprandial distress syndrome,PDS)(n=31)和上腹痛综合征(epigastric pain syndrome,EPS)(n=13)两个类型,16例无症状的健康人作为对照组,对所有受试者均进行上胃肠消化不良症状评分、Zung氏量表进行心理测试和自主神经功能检测.结果:FD组抑郁和(或)焦虑状态的比例(24/44),较对照组(1/16)明显多见(P=0.001).FD抑郁评分(49.36±1.71)和焦虑评分(39.83±1.57)均明显高于对照组(34.42±1.98和27.77±0.75,P值均为0.000).餐后不适组抑郁和焦虑评分(51.40±1.80和40.39±2.01)及上腹痛组抑郁和焦虑评分(45.50±3.68和38.52±2.44),均高于对照组(P值分别为0.000、0.000和0.026、0.001).餐后不适组抑郁评分较上腹痛组有增高趋势(P=0.050).FD组自主神经功能检测中深呼吸心率变异(17.61±1.18)较对照组(22.71±2.12)明显减低(P=0.031),上腹痛组深呼吸心率变异(16.17±1.98)亦较对照组明显减低(P=0.038).存在焦虑抑郁状态患者深呼吸心率变异(17.23±1.49)较对照组(22.71±2.12)明显减低(P=0.036);非焦虑抑郁组与对照组及焦虑抑郁组与非焦虑抑郁组自主神经功能检测无明显差异.结论:FD患者焦虑、抑郁状态较明显,餐后不适组抑郁状态更趋严重;FD患者的自主神经功能受损以副交感神经为主;存在抑郁和(或)焦虑状态的FD患者更易出现自主神经功能受损.

AIM： To investigate the psychological states and autonomic nerve function in patients with functional dyspepsia （FD）. METHODS： Forty-four FD patients who were diagnosed according to the Room III criteria and 16 healthy volunteers were enrolled in this study. FD patients were divided into postprandial distress syndrome （PDS） group （n = 31） and epigastric pain syndrome （EPS） group （n = 13）. Sixteen healthy subjects （HS） were used as controls. Epigastric discomfort and Zung Scale scoring was performed for testing psychological states and autonomic nerve function in all participants. RESULTS： The incidence of depression and/or anxiety was significantly higher in FD patients than in HS （24/44 vs 1/16, P = 0.001）. Both the depression score and anxiety score were significantly higher in the FD group than in the HS group （49.36 ± 1.71 vs 34.42 ± 1.98, 39.83 ± 1.57 vs 27.77 ± 0.75, both P = 0.000）, in the PDS group （51.40 ± 1.80, 40.39 ± 2.01） than in the HS group （both P = 0.000）, and in the EPS group （45.50 ± 3.68, 38.52 ± 2.44） than in the HS group （P = 0.026 and 0.001）. The heart rate variability （HRV） with deep breathing was significantly lower in FD patients than in HS （17.61 ± 1.18 vs 22.71 ± 2.12, P = 0.031）, in EPS patients than in HS （16.17 ± 1.98 vs 22.71 ± 2.12, P = 0.038）, and in FD patients with depression and/or anxiety than in HS （17.23 ± 1.49 vs 22.71 ± 2.12, P = 0.036）. However, no significant difference was observed between FD patients without depression or anxiety and HS, and between FD patients with and without depression or anxiety. CONCLUSION： Depression and anxiety are notable in FD patients. PDS patients generally suffer more severe depression than EPS patients. Impaired autonomic nerve function is mainly due to the injury of the parasympathetic nerve. Patients with depression and/or anxiety are more likely to have impaired autonomic nerve function.