功能性消化不良患者重叠下消化道症状的临床特征和胃电图分析

Clinical characteristics and electrogastrogram analysis of patients with functional dyspepsia overlapping lower gastrointestinal symptoms

目的分析功能性消化不良(FD)患者重叠下消化道症状(LGS)的表现和胃电图特征。方法回顾性分析2018年1月至2020年12月南京医科大学第一附属医院61例FD患者的临床资料。其中,FD重叠LGS 33例(FD重叠LGS组),单纯FD 28例(单纯FD组)。记录FD患者重叠LGS的表现;采用罗马Ⅳ标准评估消化不良症状评分;采用医院焦虑抑郁量表(HADS)评估焦虑和抑郁状态,匹兹堡睡眠质量指数(PSQI)量表评估睡眠障碍情况;进行胃电图检查,记录正常慢波百分比(N%)、胃动过缓百分比(B%)、胃动过速百分比(T%)、胃节律紊乱百分比(A%)、主频率、主功率和餐后与餐前功率比(PR)。结果FD患者重叠LGS的最常见症状是下腹胀[84.85%(28/33)]。FD重叠LGS组上腹胀气评分明显高于单纯FD组[7.00(6.50,7.00)分比分5.00(0.50,7.00)分],差异有统计学意义(P<0.01);两组其他各消化不良症状评分及总评分比较差异无统计学意义(P>0.05)。FD重叠LGS组抑郁和睡眠障碍发生率明显高于单纯FD组[42.42%(14/33)比14.29%(4/28)和69.70%(23/33)比39.29%(11/28)],差异有统计学意义(χ^(2)=5.77和5.68,P<0.05);两组焦虑发生率比较差异无统计学意义(P>0.05)。FD重叠LGS组,胃底区餐后T%和胃体区餐后A%明显低于餐前[13.79%(6.79%,21.46%)比20.69%(12.45%,27.59%)和3.45%(0,6.90%)比6.90%(3.45%,13.79%)],差异有统计学意义(P<0.01);单纯FD组,胃底区餐后N%明显低于餐前[55.92%(43.71%,70.02%)比69.27%(48.07%,78.45%)],差异有统计学意义(P<0.05)。胃底区,FD重叠LGS组餐前N%明显低于单纯FD组,餐前B%和T%明显高于单纯FD组,差异有统计学意义(P<0.01或<0.05);胃体区,FD重叠LGS组餐前N%明显低于单纯FD组,差异有统计学意义(P<0.05);幽门区,FD重叠LGS组PR明显低于单纯FD组,差异有统计学意义(P<0.05);整体胃,FD重叠LGS组餐前N%明显低于单纯FD组,餐前B%和T%明显高于单纯FD组,差异有统计学意义(P<0.01或<0.05)。Spearman相关分析结果显示,FD重叠LGS患者病程与胃电参数无相关性(P>0.05);消化不良症状总评分与整体胃餐后A%呈正相关(r=0.345,P<0.05),与整体胃及幽门区餐后主频率呈负相关(r=-0.357和-0.473,P<0.05或<0.01)。结论FD患者可重叠多种LGS。FD重叠LGS患者消化不良症状更严重;伴抑郁和睡眠障碍的比例更高;空腹时近端胃电节律异常和排空功能受损更严重。FD重叠LGS患者消化不良症状程度与餐后胃电节律异常相关。

Objective To analyze the characteristics and electrogastrogram features of patients with functional dyspepsia(FD)overlapping lower gastrointestinal symptoms(LGS).Methods The clinical data of 61 patients with FD from January 2018 to December 2020 in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed.Among them,FD overlapping LGS was in 33 cases(FD overlapping LGS group),and simple FD in 28 cases(simple FD group).The manifestations of patients with FD overlapping LGS were recorded.The dyspeptic symptom score was assessed using the RomeⅣcriteria.Anxiety and depression status were evaluated using the hospital anxiety and depression scale(HADS),and sleep disorder was assessed using the Pittsburgh sleep quality index(PSQI).The electrogastrogram was performed,and the normal slow wave percentage(N%),bradygastria percentage(B%),tachygastria percentage(T%),arrhythmia percentage(A%),dominant frequency,dominant power and postprandial-to-fasting power ratio(PR)were recorded.Results The most common symptom in FD patients overlapping LGS was lower abdomen distention,the incidence was 84.85%(28/33).The upper abdominal bloating score in FD overlapping LGS group was significantly higher than that in simple FD group:7.00(6.50,7.00)scores vs.5.00(0.50,7.00)scores,and there was statistical difference(P<0.01);there were no statistical differences in other dyspeptic symptoms scores and total score between the two groups(P>0.05).The incidences of depression and sleep disorder in FD overlapping LGS group were significantly higher than those in simple FD group:42.42%(14/33)vs.14.29%(4/28)and 69.70%(23/33)vs.39.29%(11/28),and there were statistical differences(χ^(2)=5.77 and 5.68,P<0.05);there was no statistical difference in the incidence of anxiety between the two groups(P>0.05).In FD overlapping LGS group,the postprandial T%in the gastric fundus and postprandial A%in the gastric body were significantly lower than those before meal:13.79%(6.79%,21.46%)vs.20.69%(12.45%,27.59%)and 3.45%(0,6.90%)vs.6.90%(3.45%,13.79%),and there were statistical differences(P<0.01).In simple FD group,the postprandial N%in the gastric fundus was significantly lower than that before meal:55.92%(43.71%,70.02%)vs.69.27%(48.07%,78.45%),and there was statistical difference(P<0.05).In the gastric fundus,the preprandial N%in FD overlapping LGS group was significantly lower than that in simple FD group,preprandial B%and T%were significantly higher than those in simple FD group,and there were statistical differences(P<0.01 or<0.05).In the gastric body,the preprandial N%in FD overlapping LGS group was significantly lower than that in simple FD group,and there was statistical difference(P<0.05).In the pyloric region,the PR in FD overlapping LGS group was significantly lower than that in simple FD group,and there was statistical difference(P<0.05).In the overall stomach,the preprandial N%in FD overlapping LGS group was significantly lower than that in simple FD group,the preprandial B%and T%were significantly higher than those in simple FD group,and there were statistical differences(P<0.01 or<0.05).Spearman correlation analysis result showed that the disease course was not correlated with electrogastrogram parameters in patients with FD overlapping LGS(P>0.05);the total score of dyspeptic symptoms was positively correlated with postprandial A%in the overall stomach(r=0.345,P<0.05),and negatively correlated with postprandial dominant frequency in the overall stomach and pyloric region(r=-0.357 and-0.473,P<0.05 or<0.01).Conclusions FD patients can overlap with various LGS.The patients with FD overlapping LGS have more severe dyspepsia symptoms,higher proportions of comorbid depression and sleep disorders,and more severe abnormalities in fasting proximal gastric electrical rhythm and emptying function.The severity of dyspeptic symptoms in patients with FD overlapping LGS is correlated with postprandial gastric electrical rhythm abnormalities.