餐后不适综合征型功能性消化不良患者胃排空及心理状态研究

发布时间：2018-05-30 01:19

本文选题：功能性消化不良 + 胃排空　；参考：《河北医科大学》2008年硕士论文

【摘要】： 目的:功能性消化不良(functional dyspepsia, FD)是临床常见病,其发病机制至今尚不完全明确。目前国内外多数学者倾向于认为胃动力障碍是FD发生的主要机制,并被认为是引起餐后饱胀感、早饱、餐后恶心、嗳气等上消化道症状的主要原因。随着对FD认识的不断深入,罗马Ⅲ学术委员会对FD的诊断提出新的标准,并根据不同的病理生理学异常为基础又将FD分为两种亚型,即上腹痛综合征(epigastric pain syndrome, EPS)和餐后不适综合征(post-prandial distress syndrome, PDS)。因罗马Ⅲ标准认为PDS型FD患者以餐后饱胀感、早饱、餐后恶心、嗳气等为主要临床症状,且症状与进餐相关,故本研究应用核素法对PDS型FD患者和健康人进行胃排空检测,比较二者胃排空情况,从而明确PDS型FD患者是否存在胃动力障碍,探讨其发病相关的病理生理机制,为临床治疗PDS型FD患者是否应用促动力药物提供依据。同时通过对PDS型FD患者的各种临床症状及其严重程度与胃排空进行相关性研究,分析临床症状与胃排空的关系。近年来,亦有许多学者提出重视心理因素在FD发生中的作用。本研究通过对PDS型FD患者和健康人进行焦虑、抑郁量表调查,明确PDS型FD患者是否较健康人易存在焦虑、抑郁状态,同时对PDS型FD患者临床症状的严重程度与焦虑、抑郁状态进行相关性研究,明确二者相关性,探讨PDS型FD的发病机制,为临床对PDS型FD患者进行心理治疗提供依据。方法:采用德国西门子公司双探头1英寸晶体e.camduet型PET/SPECT仪,对PDS型FD患者和健康人进行胃排空检测。34例PDS型FD患者中男性14例,女性20例,平均年龄(岁) 45.94±13.19,平均体重指数(kg/m~2) 23.04±3.32;21例健康人中男性9例,女性12例,平均年龄(岁) 42.47±14.52,平均体重指数(kg/m~2) 22.50±2.25。观察PDS型FD患者和健康人在进餐后即刻、30分钟、60分钟、90分钟、120分钟时胃内放射性计数,依此计算出胃半排空时间(gastric emptying half-time, GET(1/2))及120min胃排空率(gastric emptying rate at 120 minutes, GE_(120))。应用LDQ对PDS组进行临床症状评分,并计算症状总积分。应用焦虑自评量表(self-rating anxiety scale , SAS)、抑郁自评量表(self-rating depression scale, SDS)分别对PDS型FD患者和健康人进行评分。20例PDS型FD患者中男性4例,女性16例,平均年龄(岁)38.00±10.09;30例健康人中男性8例,女性22例,平均年龄(岁)37.17±11.08。同样应用LDQ对PDS组进行临床症状评分,并计算症状总积分。所有数据均应用SPSS 10.0统计软件进行分析。在胃排空研究试验中,应用两独立样本t检验方法对PDS组和健康对照组的年龄、体重指数、GET_(1/2)、GE_(120)结果进行分析。在心理状态研究试验中同样应用两独立样本t检验方法对两组的年龄、焦虑标准总分、抑郁标准总分及各评价抑郁状态的4个因子总分结果进行分析。应用Spearman相关分析方法对PDS型FD患者的临床症状与胃排空及心理状态进行相关性研究。结果:1在胃排空研究中,发现PDS型FD患者GET_(1/2) (min)为105.54±25.66,健康人GET_(1/2) (min)为78.19±14.33,两组间差异具有统计学意义(t=5.066, P=0.000)。PDS型FD患者GE120(%)为56.32±12.91 ,健康人GE_(120)(%)为70.71±11.18 ,两组间差异具有统计学意义(t=-4.221, P=0.000)。 34例PDS型FD患者餐后饱胀感与GET_(1/2)的Spearman相关分析结果为r_s=0.086,P=0.627,无统计学意义;早饱与GET_(1/2)的Spearman相关分析结果为r_s=-0.058,P=0.745,无统计学意义。上腹痛、上腹烧灼感、餐后恶心、嗳气症状与GET_(1/2)的Spearman相关分析结果均无统计学意义。34例PDS型FD患者餐后饱胀感与GE_(120)的Spearman相关分析结果为r_s=-0.025,P=0.888,无统计学意义。早饱与GE120的Spearman相关分析结果为r_s=0.013,P=0.944,无统计学意义。上腹痛、上腹烧灼感、餐后恶心、嗳气症状与GE120的Spearman相关分析结果均无统计学意义。 2在评价PDS型FD患者心理状态研究中,发现PDS型FD患者SAS平均总粗分为39.90±6.45分,平均标准总分为49.90±8.07分;健康人SAS平均总粗分为29.73±8.35分,平均标准总分为36.73±10.45分。两组SAS标准总分间的差异具有统计学意义(t=4.761, P =0.000)。PDS型FD患者SDS平均总粗分为40.50±8.38分,平均标准总分为50.3±10.50分;健康人SDS平均总粗分为30.31±5.79分,平均标准总分为38.03±8.59分。两组SDS平均标准总分间的差异具有统计学意义(t=4.524, p=0.000)。在SDS评分中,将抑郁状态分为4个因子,即躯体症状和焦虑因子、乐观情绪因子、生理状态因子及恶劣心境因子。PDS型FD患者与健康人在上述4个因子之间的差异均具有统计学意义(t=3.344, P=0.002; t=2.680, P=0.011; t=5.488, P=0.000; t=2.472, P =0.017)。 PDS型FD患者临床症状总积分与SAS、SDS评分之间均呈正相关关系,具有统计学意义(r_s=0.502, P=0.024; r_s=0.911, P=0.000)。结论:1 PDS型FD患者的GET_(1/2)较健康人明显延迟, GE_(120)则明显低于健康人,说明PDS型FD患者较健康人存在明显胃动力障碍。 2 PDS型FD患者各种临床症状评分及症状总积分与GET_(1/2)和GE_(120)之间无相关性。说明不能用PDS型FD患者临床症状的严重程度来评价其胃动力情况。 3 PDS型FD患者的SAS、SDS评分明显高于健康人,说明PDS型FD患者比健康人易存在心理障碍。 4 PDS型FD患者的SAS、SDS评分与其临床症状之间呈正相关,说明PDS型FD患者的心理障碍程度越严重,其临床症状越严重。
[Abstract]:Objective : Functional dyspepsia ( FD ) is a common disease in clinic , and the pathogenesis of FD is not completely clear . At present , most scholars tend to think that gastric motility disorder is the main mechanism of FD , and it is considered to be the main cause of upper gastrointestinal symptoms such as post - meal fullness sensation , early saturation , post - meal nausea , belch and other upper gastrointestinal symptoms . According to the different pathological physiology abnormalities , the FD is divided into two subtypes , namely upper abdominal pain syndrome ( EPS ) and post - postprandial discomfort syndrome ( PDS ) . Objective To investigate the relationship between clinical symptoms and gastric emptying in patients with PDS type FD patients .

In recent years , many scholars have put forward the role of psychological factors in the development of FD . By investigating the anxiety and depression scale of PDS type FD patients and healthy people , it is clear whether or not PDS type FD patients are more likely to have anxiety and depression status than healthy people .

Methods : The gastric emptying of PDS type FD patients and healthy persons was detected by using the double probe 1 inch crystal e.camduet type PET / SPECT instrument of Siemens AG . The average body mass index ( kg / m ~ 2 ) 23.04 卤 3.32 , the average body mass index ( kg / m ~ 2 ) 23.04 卤 3.32 , the average body mass index ( kg / m ~ 2 ) 22.50 卤 2.25 . The gastric emptying time ( gastric emptying half - time , GET ( 1 / 2 )) and gastric emptying rate ( 120 minutes , GE _ ( 120 )) were calculated .

The self - rating anxiety scale ( SAS ) , self - rating depression scale ( SDS ) and self - rating depression scale ( SDS ) were used to evaluate the patients with PDS type FD and healthy persons . Among 20 patients with PDS type FD , 4 were male , 16 were female , average age ( years ) was 38.00 卤 10.09 ; 30 healthy persons were male 8 , female 22 , mean age ( years ) 37.17 卤 11.08 . The clinical symptom score of PDS group was also applied with LDQ and the total score of symptoms was calculated .

The age , body mass index , GET _ ( 1 / 2 ) and GE _ ( 120 ) of PDS group and healthy control group were analyzed by using two independent sample t - test methods .

Results : In the study of gastric emptying , it was found that the GET _ ( 1 / 2 ) ( min ) was 105.54 卤 25.66 in patients with PDS type FD , 78.19 卤 14.33 for healthy persons ( 1 / 2 ) ( min ) and 78.19 卤 14.33 for healthy persons ( t = 5.066 , P = 0.000 ) . GE120 ( % ) of PDS type FD was 56.32 卤 12.91 , GE _ ( 120 ) ( % ) was 70.71 卤 11.18 , there was significant difference between the two groups ( t = - 4.221 , P = 0.000 ) .

In 34 patients with PDS type FD , the results were r _ s = - 0.058 , P = 0.745 , and no statistical significance . The results were r _ s = - 0.025 , P = 0 .

2 In the study of PDS type FD patients , the mean total score of SAS in patients with PDS was 39.90 卤 6.45 , the mean standard was 49.90 卤 8.07 , the average total score of SAS was 29.73 卤 8.35 , the mean standard was 36.73 卤 10.45 , the difference between the two groups was statistically significant ( t = 4.761 , P = 0.000 ) . The mean total score of SDS in patients with PDS was 40.50 卤 8.38 , the mean total score was 50.3 卤 10.50 , the mean total score of SDS was 30.31 卤 5.79 , the mean standard was 38.03 卤 8.59 . The difference between the two groups was statistically significant ( t = 4.524 , p = 0.000 ) .

In the SDS score , the depressive state was divided into 4 factors , somatic symptoms and anxiety factors , optimistic mood factors , physiological status factors and bad mood factors . The difference between PDS type FD patients and healthy persons was statistically significant ( t = 3.344 , P = 0.002 ; t = 2.680 , P = 0 . 011 ; t = 5.488 , P = 0.000 ; t = 2.472 , P = 0 . 017 ) .

There was a positive correlation between the total score of clinical symptoms and SAS and SDS scores in patients with PDS type FD , with statistical significance ( r _ s = 0.502 , P = 0 . 024 ; r _ s = 0.911 , P = 0.000 ) .

Conclusion : The GET _ ( 1 / 2 ) of patients with PDS type FD was significantly delayed than that in healthy individuals , and GE _ ( 120 ) was significantly lower than that of healthy persons , indicating that there were significant gastric motility disorders in patients with PDS type FD .

There was no correlation between the scores of clinical symptoms and the total score of symptoms and GET _ ( 1 / 2 ) and GE _ ( 120 ) in patients with PDS type FD .

The SAS and SDS scores of patients with PDS type FD were significantly higher than those of healthy persons , indicating that PDS type FD patients were more susceptible to psychological disorders than healthy persons .

There was a positive correlation between SAS and SDS scores of PDS type FD patients and their clinical symptoms . The more serious the degree of mental disorder in PDS type FD patients , the more serious the clinical symptoms were .
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R57;R395

【参考文献】