中老年餐后不适综合征患者的临床症状和脑肠肽水平分析

Clinical symptoms and brain-gut peptide level in middle-aged and elderly patients with postprandial distress syndrome

目的探讨中老年与青年餐后不适综合征(PDS)患者在中医证候、临床症状和脑肠肽方面的差异。方法选取2018年3月至2018年10月在北京中医药大学东方医院针灸科就诊的PDS患者65例,将患者分为中老年组(>45岁)和青年组(≤45岁),对2组患者进行中医辨证分型,并分别采用消化不良症状指数(SID)、尼平消化不良指数(NDI)及医院焦虑抑郁量表(HADS)依次评估其消化不良严重程度、生活质量受影响严重程度及焦虑抑郁状态。采用酶联免疫吸附法检测患者血浆中降钙素基因相关肽(CGRP)、血管活性肠肽(VIP)、胃饥饿激素(ghrelin)和P物质(SP)的浓度。采用SPSS20.0统计软件对数据进行分析。根据数据类型,组间比较采用独立样本t检验、Mann-WhitneyU检验或卡方检验。结果2组患者肝胃不和证、脾胃气滞证、脾胃湿热证构成比比较差异无统计学意义(χ^2=4.787,P=0.091)。与青年组比较,中老年组患者上腹烧灼感症状评分[1(0,1)]显著高于青年组[0(0,1)],差异有统计学意义(P<0.05),但其他症状及量表评分在2组患者间比较差异无统计学意义(P>0.05)。中老年组血浆中CGRP浓度[(1.06±0.24)ng/ml]显著高于青年组[(0.93±0.25)ng/ml],差异有统计学意义(P<0.05),但VIP、SP及ghrelin浓度在2组患者间比较差异均无统计学意义(P>0.05)。结论中老年PDS患者存在较严重的上腹烧心感症状,且血浆中CGRP水平明显升高,这可能与年老导致的胃肠道运动降低及胃肠排空延迟有关。

Objective To explore the differences of traditional Chinese medicine (TCM) syndromes,clinical symptoms and brain-gut peptide level between middle-aged and elderly patients with young patients with postprandial distress syndrome (PDS). Methods A total of 65 PDS patients admitted to our Acupuncture Department from March to October 2018 were enrolled in this study,and divided into the middle-aged and elderly group (>45 years old) and the young group (≤45 years old). The 2 groups of patients were classified according to TCM syndrome differentiation. The severities of dyspepsia,quality of life,anxiety and depression were evaluated by symptom index of dyspepsia (SID),Nepean dyspepsia index (NDI) and hospital anxiety and depression scale (HADS),respectively. The plasma levels of calcitonin gene-related peptide (CGRP),vasoactive intestinal peptide (VIP),ghrelin and substance P (SP) were measured by enzyme-linked immunosorbent assay (ELISA). The data was analyzed using SPSS statistics 20.0. Depending on the types of data,independent sample t test,Mann- Whitney U test,or Chi-square test was used for comparison between 2 groups. Results There was no significant differences in the compositions of liver-stomach disharmony syndrome,spleen-stomach weakness syndrome and spleen-stomach dampness-heat syndrome between the 2 groups (Chi- square=4.787,P =0.091). The score of epigatric burning symptom was significantly higher in the middle-aged and elderly group than the young group [1(0,1) vs 0(0,1),P <0.05 ],but no such differences were seen in the other symptoms,and scores of NDI and HADS between them ( P >0.05). The plasma level of CGRP was significantly higher in the middle-aged and elderly group than the young group [(1.06±0.24) vs (0.93±0.25)ng/ml,P <0.05 ],but there was no significant differences in the levels of VIP,SP and ghrelin between the 2 groups ( P >0.05). Conclusion The middle-aged and elderly PDS patients experience severe epigastric burning symptom,and have significantly increased plasma CGRP level,which may be associated with ageing-related decreased gastrointestinal motility and delayed gastrointestinal emptying.