慢性胃炎患者300例的精神心理特征分析

Psychoanalysis of 300 patients with chronic gastritis

目的分析慢性胃炎患者的精神心理特征差异。方法连续纳入2018年6至12月于西京医院就诊的300例慢性胃炎患者,分为慢性非萎缩性胃炎(CNAG)组、慢性萎缩性胃炎(CAG)组和CAG伴肠化生组,每组100例。采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、生活事件量表(LES)和艾森克人格问卷(EPQ)进行评估分析。采用卡方检验、方差分析、非参数秩和检验和Kruskal-Wallis H检验进行统计学分析。结果CAG组和CAG伴肠化生组焦虑发生率均高于CNAG组[分别为64.0%(64/100)、53.0%(53/100)、34.0%(34/100)],差异均有统计学意义(χ^2=0.007、0.001,P均<0.05);CAG伴肠化生组抑郁发生率高于CNAG组和CAG组[分别为24.0%(24/100)、15.0%(15/100)、13.0%(13/100)],差异均有统计学意义(χ2=0.108、0.045,P均<0.05)。CAG伴肠化生组LES负性事件评分高于CNAG组和CAG组[分别为0分(0分,6.75分)、0分(0分,1.00分)、0分(0分,0.75分)],差异均有统计学意义(Z=-2.619、-3.022,P均<0.05)。CNAG组、CAG组和CAG伴肠化生组LES评分≥20分(精神压力大)的患者比例[分别为8.0%(8/100)、9.0%(9/100)、18.0%(18/100)]逐渐升高,差异有统计学意义(χ^2=0.036,P<0.05);男性和<50岁患者中,CAG伴肠化生组的抑郁发生率和LES评分≥20分的患者比例均高于CNAG组[22.5%(9/40)比9.6%(5/52)和47.5%(19/40)比16.2%(11/68);22.5%(9/40)比7.7%(4/52)和20.0%(8/40)比4.4%(3/68)],差异均有统计学意义(χ^2=0.015、0.001、0.043、0.013,P均<0.05)。CNAG组和CAG伴肠化生组EPQ评分中精神质、内外向、稳定性和掩饰性分量表评分均以正常(43.3~56.7分)居多,分别占62.0%(62/100)和45.0%(45/100)、56.0%(56/100)和44.0%(44/100)、54.0%(54/100)和44.0%(44/100)、59.0%(59/100)和45.0%(45/100);CAG组、CAG伴肠化生组内外向和掩饰性量表评分偏高(>56.7分)患者比例均高于CNAG组[分别为48.0%(48/100)、23.0%(23/100)、4.0%(4/100)和46.0%(46/100)、21.0%(21/100)、7.0%(7/100)],差异均有统计学意义(χ^2=0.001、0.001、0.001、0.004,P均<0.01)。结论焦虑与CAG和肠化生密切相关,而抑郁与肠化生相关。男性和<50岁的患者中,抑郁、负性事件和精神压力大与肠化生的关系更显著。精神质、外向型、情绪不稳定、掩饰倾向的精神特征与CAG密切相关。

Objective To analyze the difference of psychosocial characteristics in patients with chronic gastritis.Methods From June to December 2018,a total of 300 patients with chronic gastritis visited Xijing Hospital were consecutively enrolled.The patients were divided into chronic non-atrophic gastritis(CNAG)group,chronic atrophic gastritis(CAG)group and CAG with intestinal metaplasia group,with 100 cases in each group.Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),living events scale(LES)and Eysenck personality questionnaire(EPQ)were used for evaluation and analysis.Chi square test,analysis of variance,nonparametric rank sum test and Kruskal Wallis H test were used for statistical analysis.Results The incidences of anxiety of the CAG group and the CAG with intestinal metaplasia group were both significantly higher than that of the CNAG group(64.0%,64/100;53.0%,53/100;and 34.0%,34/100;respectively),and the differences were statistically significant(χ^2=0.007 and 0.001,both P<0.05).The incidence of depression of the CAG with intestinal metaplasia group was significantly higher than those of CNAG group and the CAG group(24.0%,24/100;15.0%,15/100 and 13.0%,13/100;respectively),and the differences were statistically significant(χ2=0.108 and 0.045,both P<0.05).The negative event score of LES of CAG with intestinal metaplasia group was higher than those of CNAG group and CAG group(0(0,6.75),0(0,1.00),0(0,0.75)respectively),and the differences were statistically significant(Z=-2.619 and-3.022,both P<0.05).The proportion of patients with LES score≥20 points(high mental stress)of CNAG group,CAG group and CAG with intestinal metaplasia group gradually increased(8.0%,8/100;9.0%,9/100 and 18.0%,18/100;respectively),and the difference was statistically significant(χ^2=0.036,P<0.05).In male patients and patients under 50 years old,the incidence of depression and the proportions of patients with LES score≥20 points of CAG with intestinal metaplasia group were higher than those of CNAG group(22.5%,9/40 vs.9.6%,5/52;47.5%,19/40 vs.16.2%,11/68;22.5%,9/40 vs.7.7%,4/52;and 20.0%,8/40 vs.4.4%,3/68),and the differences were statistically significant(χ^2=0.015,0.001,0.043 and 0.013,all P<0.05).The results of EPQ showed that the psychoticism,extraversion or introversion,stability and concealment of CNAG group and CAG with intestinal metaplasia group,were mostly normal(43.3 to 56.7),accounting for 62.0%(62/100)and 45.0%(45/100),56.0%(56/100)and 44.0%(44/100),54.0%(54/100)and 44.0%(44/100),59.0%(59/100)and 45.0%(45/100),respectively.The percentage of patients with high score(>56.7)of etraversion or introversion and concealment in CAG group and the CAG with intestinal metaplasia group were higher than those in the CNAG group(48.0%,48/100;23.0%,23/100;4.0%,4/100 and 46.0%,46/100;21.0%,21/100 and 7.0%,7/100,respectively),and the differences were statistically significant(χ^2=0.001,0.001,0.001 and 0.004,all P<0.01).Conclusions Anxiety is associated with CAG and intestinal metaplasia,while depression is associated with intestinal metaplasia.In male patients and patients under 50 years old,depression,negative event and high psychiatric stress are more significantly related to intestinal metaplasia.The mental characteristics of extroversion,emotional instability,psychoticism and concealment are closely associated with CAG.