肠易激综合征合并抑郁的症状特征

Symptom features of irritable bowel syndrome complicated with depression

目的通过分析合并抑郁的 IBS 患者的消化道和躯体症状特点，拟提高早期识别 IBS 患者存在精神心理异常的能力。方法纳入2014年5月至10月就诊的102例 IBS 患者，对其进行问卷调查和跟踪随访。另选取102名同期性别、年龄结构相仿并接受问卷调查的体检者作为健康对照组。收集、整理所有 IBS 患者的门诊详细资料，对其进行汉密尔顿量抑郁量表（HAMD）、消化道症状调查表、自制躯体症状调查表和肠易激综合征‐症状严重度评分（IBS‐SSS）。对健康对照者进行 HAMD 评分。统计学处理采用 t 检验或卡方检验。结果 IBS 组的 HAMD 评分为（19．1±17．0）分，高于健康对照组的（3．2±2．9）分（t＝8．966，P＜0．05）。102例 IBS 患者中，合并抑郁58例（56．9％），未合并抑郁44例（43．1％）。合并抑郁的 IBS 患者有消化道重叠症状占75．9％（44／58），高于未合并抑郁的34．1％（15／44），差异有统计学意义（χ^2＝17．902， P ＜0．01）。合并抑郁的 IBS 患者突出的躯体症状为头痛，头昏或头晕，失眠，心慌和心悸，胸痛、胸闷。 IBS‐SSS 显示，合并抑郁的 IBS 患者的腹痛时间、腹胀程度和对生命质量影响程度评分分别为78．1±28．7，53．7±17．9和69．4±19．7，分别高于未合并抑郁的34．7±16．6，37．7±12．5和32．4±12．7，合并抑郁的 IBS 患者的排便满意度评分为43．7±16．4，低于未合并抑郁的55．0±20．3，差异均有统计学意义（t＝－8．930、－2．326、－8．913、－2．344，P均＜0．05）。结论合并抑郁的 IBS 患者的消化道重叠症状和躯体化症状非常明显且复杂。对于描述 IBS 外症状明显的患者，提示其存在心理障碍，需要在治疗 IBS 症状的基础上进行心理障碍治疗。

Objective To improve the ability of early recognition of psychological disorders in irritable bowel syndrome （IBS） patients by analyzing somatic and digestive tract symptoms of IBS patients complicated with depression .Methods From May to October 2014 ,102 out‐patients with IBS were enrolled who completed the questionnaire and were followed‐up .Another 102 gender and age matched individual who received check‐up were set as healthy controls .The detailed clinical data of all IBS patients were collected .The scores of Hamilton depression scale （HAMD ） ,digestive symptom questionnaire , somatic symptom questionnaire and irritable bowel syndrome symptom severity score （IBS‐SSS ） were evaluated in the IBS patients ,and HAMD was evaluated in healthy controls .The t test or chi‐square test was performed for statistical analysis .Results HAMD score of the IBS group was 19 .1 ± 17 .0 ,which was higher than that of control group （3 .2 ± 2 .9 ;t = 8 .966 ,P 〈 0 .05） .Among the 102 IBS patients , 58 were complicated with depression （56 .9% ） and 44 （43 .1% ） without depression . Among the IBS patients complicated with depression ,75 .9% （44/58） were overlapped with gastrointestinal symptoms , which was higher than that of patients without depression （34 .1% ,15/44 ） ,and the difference was statistically significant （χ^2 = 17 .902 ,P〈 0 .01） .The typical somatic symptoms of IBS patients complicated with depression were headaches ,dizziness ,insomnia ,palpitations ,chest pain ,and chest tightness .The results of IBS‐SSS indicated that scores of duration of abdominal pain ,bloating degree and the impacts on quality of life in IBS patients complicated with depression were 78 .1 ± 28 .7 ,53 .7 ± 17 .9 and 69 .4 ± 19 .7 , which were significantly higher than those of IBS patients without depression （34 .7 ± 16 .6 ,37 .7 ± 12 .5 and 32 .4 ± 12 .7） .The score of defecation satisfaction of IBS patients complicated with depression was 43 .7 ± 16 .4 ,which was lower than that of patients without depression （55 .0 ± 20 .3） ,and all the differences were statistically significant （t = -8 .930 ,- 2 .326 ,- 8 .913 and - 2 .344 ,all P 〈 0 .05） .Conclusions The somatic and overlapped digestive symptoms of IBS patients complicated with depression are obvious and complicated .For IBS patients with obvious extra symptoms ,mental disorders should be taken into consideration . On the basis of the treatment of IBS symptoms ,the treatment of psychological disorders are also needed .