广东地区难治性肠易激综合征患者抑郁焦虑状况的大样本、多中心调查

A large sample and multi-center survey of the depression and anxiety status of patients with refractory ir-ritable bowel syndrome in Guangdong province

目的探讨广东地区难治性肠易激综合征（IBS）及其各亚型患者的抑郁焦虑状况。方法采用大样本、多中心、前瞻性调查设计（临床试验注册号：ChiCTR—TRC-12001969），对象取自2012年6～9月广东地区3家三甲医院消化内科门诊就诊，并经罗马Ⅲ标准确诊的IBS患者和100例同期医院健康体检者，分别采用17项汉密尔顿抑郁量表（HAMD）、14项汉密尔顿焦虑量表（HAMA）评估抑郁和焦虑状况。结果9802例消化内科门诊患者中诊断IBS1128例（11．5％）。在601例完成问卷调查的IBS患者中，难治性IBS组和非难治性IBS组各有142例（23．6％）和459例（76．4％）。难治性IBS组的抑郁症状、焦虑症状、抑郁合并焦虑症状发生率以及HAMD和HAMA评分均高于非难治性IBS组和健康对照组，分别为[（66．2％，23．3％，9．0％），P〈0．05；（65．5％，28．5％，10．O％），P〈0．05；（58．5％，17．9％，5．0％），P〈0．05；（9．77±5．16）分，（5．48±4．03）分，（1．66±2．50）分，P〈0．05；（9．75±5．08）分，（5．91±3．80）分，（2．26±2．68）分，P〈0．05]，其中难治性IBS组的中重度抑郁、中重度焦虑发生率高于非难治性IBS组和健康对照组[（8．5％，1．3％，0），P〈0．05；（15．5％，3．7％，0），P〈0．05]。难治性IBS组的IBS-D、IBS—C、IBS-M、IBS—U4个亚型间的抑郁症状、焦虑症状、抑郁合并焦虑症状发生率和HAMD评分均差异无统计学意义（P〉0．05），但难治性IBS组中IBS—D、IBS—M的HAMA评分均高于1BS—U[（10．10±5．03）分，（7．55±3．22）分，P〈0．05；（12．08±6．89）分，（7．55±3．22）分，P〈0．05]。结论难治性IBS患者的抑郁症状、焦虑症状和抑郁合并焦虑症状伴发率高，且抑郁、焦虑程度严重，为患者临床难治的重要原因。

Objective To explore the depression and anxiety status of patients with refractory irritable bowel syndrome （IBS）and its subtypes. Methods In this large sample, muhi-center, prospective survey （Registra-tion number in Chinese Clinical Trial Registry ：ChiCTR-TRC-12001969） ,the patients who conformed to the Rome III criteria for 1BS were recruited from the department of gastroenterology of three hospitals in Guangdong province from June 2012 to September 2012. And 100 healthy subjects from the examination center of hospitals were recrui-ted at the same time. The 17-item Hamilton Depression Rating Scale（HAMD） and the 14-item Hamilton Anxiety Rating Scale（HAMA） were used to analyze the depression and anxiety, respectively. Results 9802 patients were collected from department of gastroenterology, and a total of 1128 （ 11.5 % ） patients were diagnosed as IBS. 601 of questionnaires were collected,including 142 （23.6%）of refractory IBS and 459 （76.4%） of non-refractory IBS. The incidences of depression, anxiety, depression and anxiety and the HAMD, HAMA scores were higher in refrac- tory IBS group than those in the non-refractory IBS and control group, （ （66.2% vs 23.3% vs 9.0% ）, P〈0.05 ; （65.5% vs 28.5% vs 10.0%）, P〈0.05;（58.5% vs 17.9% vs 5.0%）, P〈0.05;（9.77 ±5.16）vs（5.48 ± 4.03）vs（ 1.66 ±2.50）, P〈0.05;（9.75 ±5.08）vs（5.91± 3.80）vs（2.26 ±2.68）, P〈0.05）. And the inci- dences of moderate-severe depression and moderate -severe anxiety were higher in refractory IBS group than those in the non-refractory IBS and control group （ （8.5% vs 1.3% vs 0） , P 〈0.05 ; （ 15.5% vs 3.7% vs 0） , P 〈 0.05 ）. The incidences of depression, anxiety, depression and anxiety and the HAMD scores were not obviously dif-ferent among IBS-D,IBS-C,IBS-M and IBS-U subtypes of refractory IBS （P 〉 0.05）. However, the HAMA scores of IBS-D and IBS-M were higher than that of IBS-U （ （ 10.10 ± 5.03 ） vs （7.55 ± 3.22）, P 〈 0. 05 ; （ 12.08 ± 6.89 ） vs （7.55 ±3.22）, P 〈 0. 05）. Conclusion The high incidences of depression, anxiety and depression and anxiety, and the serious degrees of depression and anxiety existed in the patients with refractory IBS. And these are the important causes for refractoriness in these patients.