老年结肠慢传输型便秘患者肠道神经递质变化及精神心理状态

Intestinal neurotransmitters and mental and psychological state of elderly patients with slow-transit constipation

目的调查老年结肠慢传输型便秘(STC)患者的肠道神经递质变化、精神心理状态及生活质量。方法将四川大学华西医院广安医院肛肠科2020年12月至2022年12月间收治的115例老年结肠STC患者纳为观察组,同期健康体检部接收的90名无胃肠道疾病的同龄老年人作为对照组。采集受试者外周静脉血,检测血清P物质(SP)、一氧化氮(NO)及5-羟色氨酸(5-HT)等肠道神经递质水平。采用90项症状自评量表(SCL-90)评估受试者精神心理状态,简明健康状况调查问卷(SF-36)评估受试者生活质量。对观察组患者进行为期6个月的精神心理干预,评估干预前后患者血清肠道神经递质水平、SCL-90及SF-36得分情况。采用SPSS 20.0统计软件进行数据分析。采用Pearson相关系数分析老年结肠STC患者血清神经递质水平与SCL-90各因子之间的相关性。结果观察组患者血清SP及5-HT水平显著低于对照组,NO水平显著高于对照组,差异均有统计学意义(均P<0.05)。观察组患者SCL-90中躯体化、人际关系敏感、抑郁、焦虑因子得分以及量表总平均分均显著高于对照组,SF-36中RP、GH、VT、MH维度得分以及问卷总得分均显著低于对照组,差异均有统计学意义(均P<0.05)。Pearson相关性分析提示,观察组患者血清SP与SCL-90中躯体化、人际关系敏感以及焦虑因子得分呈负相关(r=-0.243,-0.276,-0.311;P<0.05),血清NO水平与躯体化及焦虑因子得分呈正相关(r=0.247,0.283;P<0.05),血清5-HT水平与人际关系敏感及焦虑因子得分呈负相关(r=-0.369,-0.363;P<0.05)。经精神心理干预后,观察组患者血清神经递质SP及5-HT水平显著上升,血清NO水平显著下降,精神心理状况SCL-90量表总平均分显著下降,生活质量SF-36问卷总得分显著上升,差异均有统计学意义(均P<0.05)。结论老年结肠STC患者生活质量与同龄无胃肠道疾病的对照组相比明显下降,精神心理障碍更严重,且存在肠道兴奋性递质分泌减少、抑制性递质分泌增多表现。老年结肠STC患者血清神经递质水平与其精神心理障碍之间具有相关性,调节患者精神心理状态可在一定程度上改善其肠道神经递质水平异常,提高患者生活质量。

Objective To investigate the changes in the intestinal neurotransmitters,mental and psychological state,and quality of life in the elderly patients with slow-transit constipation(STC).Methods A total of 115 elderly STC patients in the Department of Anorectal Surgery of Guang′an Hospital of West China Hospital affiliated to Sichuan University from December 2020 to December 2022 were included in the observation group,and 90 age-matched elderly individuals without gastrointestinal diseases in the Physical Examination Department during the same period were enrolled as the control group.Peripheral venous blood was collected from the subjects to detect the levels of intestinal neurotransmitters including serum substance P(SP),nitric oxide(NO),and 5-hydroxytryptophan(5-HT).The symptom check-list 90(SCL-90)was used to assess the mental and psychological status of the subjects,and MOS short-form-36 health survey(SF-36)was used to assess their quality of life.The patients in the observation group were given mental and psychological intervention for 6 months,and the serum intestinal neurotransmitters,SCL-90 scores and SF-36 scores were evaluated before and after the intervention.SPSS 20.0 was used for data processing and analysis.Pearson correlation coefficient was used to analyze the correlation between levels of serum neurotransmitters and SCL-90 dimensions in the elderly STC patients.Results The levels of serum SP and 5-HT in the observation group were significantly lower than those in the control group,the NO level was significantly higher than that in the control group,and the differences were statistically significant(P<0.05).The scores for somatization,interpersonal sensitivity,depression and anxiety and total score on SCL-90 in the observation group were significantly higher than the control group,the scores for RP,GH,VT and MH and total score on SF-36 were significantly lower than those in the control group,and the diffe-rences were statistically significant(P<0.05).Pearson correlation analysis indicated that serum SP in the observation group was negatively correlated with scores for somatization,interpersonal sensitivity,and anxiety of SCL-90(r=-0.243,-0.276,-0.311;P<0.05),that serum NO level was positively correlated with scores for somatization and anxiety(r=0.247,0.283;P<0.05),and that serum 5-HT level was negatively correlated with interpersonal sensitivity and anxiety(r=-0.369,-0.363;P<0.05).After mental and psychological intervention,the levels of serum SP and 5-HT in the observation group increased significantly,the serum NO level decreased significantly,and the average SCL-90 score decreased significantly,and the total SF-36 score increased significantly(P<0.05 for all).Conclusion The quality of life in the elderly STC patients declined significantly compared with that of the control group without gastrointestinal diseases,and the mental and psychological disorders worsen,featuring decreased secretions of intestinal excitatory transmitters and increased secretion of inhibitory transmitters.There is a correlation between serum neurotransmitters levels and mental and psychological disorders in the elderly STC patients.Adjusting the patient′s mental and psychological status can improve the abnormal levels of intestinal neurotransmitters and improve the quality of life of the patient.