腹泻型肠易激综合征合并心理异常对肠道症状的影响

Impact of comorbid psychological disorders on intestinal symptoms in patients with irritable bowel syndrome with diarrhea

目的 调查腹泻型肠易激综合征（IBS）患者的临床症状、精神心理状态,分析腹泻型IBS合并心理异常的特点及其对肠道症状的影响.方法 连续纳入2009年7月至2012年6月在北京协和医院就诊的符合罗马Ⅲ诊断标准的腹泻型IBS患者.采用IBS症状发作规律调查表调查IBS症状,采用汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）评定精神心理状态.比较合并心理异常与无心理异常患者肠道症状的差异,以及HAMA和HAMD评分与肠道症状的相关性.统计学分析采用两独立样本t检验、卡方检验或Fisher确切概率法,相关性分析采用Spearman秩相关分析.结果 共纳入231例腹泻型IBS患者,其中男133例,女98例,年龄为（42.8±11.1）岁,病程为4.5年（8.0年）.H A M A评分为（17.00±7.12）分,H A M D评分为（14.05±6.00）分,72.29％（167/231）的患者合并心理异常,32.90％（76/231）为中重度焦虑和（或）抑郁,以焦虑为主.合并心理异常的患者中,平时腹痛或腹部不适的比例及中重度腹痛或腹部不适的比例均高于无心理异常的患者[53.29％（89/167）比34.37％（22/64）,49.44％（44/89）比18.18％（4/22）],差异均有统计学意义（χ2=6.634、7.002,P=0.010、0.009）;且排便前腹痛或腹部不适每日发作比例高,在排便后难以完全缓解,更常伴发排便相关症状.HAMD评分与IBS发作的频度呈正相关（r=0.172,P=0.009）,HAMA评分与排便前腹痛或腹部不适的程度呈正相关（r=0.134,P=0.042）.HAMA评分、HAMD评分与患者排便后腹痛或腹部不适改善程度均呈负相关（r=-0.215,P=0.001;r=-0.251,P〈0.01）,与改善等待时间均呈正相关（r=0.175,P=0.008;r=0.219,P=0.001）.结论 大多数腹泻型IBS患者合并心理异常,焦虑抑郁广泛影响IBS患者肠道症状.

Objective To investigate the clinical symptoms and mental state of patients with irritable bowel syndrome with diarrhea （IBS-D ） , and to analyze the characteristics of psychological disorders in patients with IBS-D and their impacts on intestinal symptoms .Methods From July 2009 to June 2012 ,patients met Rome Ⅲ criteria of IBS-D were consecutively enrolled at Peking Union Medical College Hospital .The symptoms of IBS were investigated by IBS symptoms questionnaire and mental state were evaluated by Hamilton anxiety scale （HAMA ） and Hamilton depression scale （HAMD ） . The differences in intestinal symptoms between patients with comorbid psychological disorders and without psychological disorders were compared .And the correlation between the scores of HAMA ,HAMD and intestinal symptoms were analyzed . Two independent sample t-tests ,chi square test and Fisher exact probability were performed for statistical analysis .Spearman rank correlation was used for correlation analysis .Results A total of 231 patients with IBS-D were enrolled .There were 133 males and 98 females with an age of （42 .8 ± 11 .1） years old and a disease course of （4 .5 years （8 .0 years）） .The HAMA and HAMD scores were 17 .00 ± 7 .12 and 14 .05 ± 6 .00 ,respectively ,and 72 .29% （167/231） patients had comorbid psychological disorders ,32 .90% （76/231 ） patients had moderate to severe anxiety and/or depression ,mainly had anxiety .The proportion of patients with ordinary abdominal pain or discomfort and the proportion of moderate to severe abdominal pain or discomfort in patients with psychological disorders were higher than those of patients without psychological disorders （53 .29% , 89/167 vs . 34 .37% , 22/64;49 .44% ,44/89 vs .18 .18% ,4/22） ,and the differences were statistically significant （χ2=6 .634 and 7 .002 , P=0 .010 and 0 .009） .In patients with comorbid psychological disorders ,more patients had frequent onset of abdominal pain or discomfort ,less achieved completely improvement after defecation , and often accompanied with defecation related symptoms .The HAMD score was positively correlated with the onset frequency of IBS （r=0 .172 ,P=0 .009） ,and the HAMA score was positively correlated with the degree of abdominal pain or discomfort before defecation （r=0 .134 , P= 0 .042） .The HAMA and HAMD scores were negatively correlated with the improvement degree of abdominal pain or discomfort after defecation （r= -0 .215 , P=0 .001 ;r= -0 .251 , P〈0 .01） ,and were positively correlated with waiting time for symptoms improvement （r=0 .175 , P=0 .008;r=0 .219 , P= 0 .001） .Conclusion Most IBS-D patients have comorbid psychological disorders , anxiety and/or depression greatly impact the intestinal symptoms of patients with IBS .