原发性胆汁反流性胃炎患者胆囊排空功能与心理精神因素相关性研究

发布时间：2018-05-26 04:56

本文选题：原发性胆汁反流性胃炎 + 胆囊排空功能　；参考：《青岛大学》2017年硕士论文

【摘要】：目的研究原发性胆汁反流性胃炎患者胆囊排空功能与心理精神因素在发病机制中的作用及心理精神因素对胆囊排空功能的影响,为原发性胆汁反流性胃炎临床治疗提供新理论依据,同时探究胆囊排空的特点,探讨幽门螺杆菌感染与胆汁反流关系。方法标本取自来我院内镜室行内镜检查的患者,采用胃镜检查和胃粘膜组织活检共同诊断的方法,选取原发性胆汁反流性胃炎患者31例,和19例慢性非萎缩性胃炎患者作对照。所有受试者均填写一般情况登记表,采用躯体化症状自评量表评估心理精神因素,在B超下分别进行空腹以及脂餐后的胆囊排空试验,记录胆囊最大长径、前后径、横径和胆囊壁变化,统计躯体化症状自评量表得分以及空腹和餐后胆囊体积大小并计算排空率。结果原发性胆汁反流性胃炎患者常见的症状为腹胀(64.5%)、腹痛(64.5%)、嗳气(67.7%)、烧心(61.3%)、反酸(51.6%),同时可伴早饱感(35.5%)、恶心(38.7%)、食欲不振(25.8%)、失眠(41.9%)等症状,与慢性非萎缩性胃炎临床表现差异无统计学意义(P0.05),原发性胆汁反流性胃炎临床症状无特异性;原发性胆汁反流性胃炎组中存在心理精神因素比例(71.8%)明显高于对照组(42.1%),胆囊排空率(35.31±18.53)%也明显低于对照组(51.99±11.80)%(均P0.05),且试验组中存在心理精神因素组的胆囊排空率(29.51±13.65)%,也明显低于不存在心理精神因素组(51.97±21.43)%,P0.05,心理精神因素(SSS评分)与胆囊排空率呈负相关(r=-0.76,p0.05);超声检测下最大长径变化、最大前后径变化和最大横径变化均与胆囊排空率呈负相关(r=-0.746、-0.382、-0.538),且横径变化对胆囊排空率影响(B=-18.77)最为显著,而胆囊壁变化与胆囊排空率之间无相关性(P0.05);反流组HP感染率与非反流组HP感染率差异有统计学意义,反流组HP感染明显低于非反流组(X~2=5.632,P0.05)。结论原发性胆汁反流性胃炎临床症状无特异性,常见的有腹痛、腹胀、反酸、烧心、嗳气,同时可伴有早饱、恶心、食欲不振、失眠等;原发性胆汁反流性胃炎患者存在显著心理精神因素的影响,胆囊排空率显著降低,心理精神因素可显著影响胆囊排空功能,可能是通过中枢神经系统、自主神经系统和各种胃肠肽共同调控造成的,在临床治疗中应适当给予患者心理精神方面的干预,加强调节胃肠道及胆囊功能,有望研制新型药物调节自主神经系统;原发性胆汁反流性胃炎的幽门螺杆菌感染率较低,胆汁反流能够抑制幽门螺杆菌生长繁殖;超声测定胆囊体积变化时最大横径变化对胆囊体积变化影响最显著,而胆囊壁厚度的变化与胆囊体积变化无相关性,可能仅存在动力因素。
[Abstract]:Objective to study the effect of gallbladder emptying and psychological factors on the pathogenesis of primary bile reflux gastritis and the effect of psycho mental factors on the gallbladder emptying function, to provide a new theoretical basis for the clinical treatment of primary bile reflux gastritis, and to explore the characteristics of gallbladder emptying, and to explore the infection of Helicobacter pylori and to explore the infection of Helicobacter pylori. Method specimens were selected from the endoscopy room of our hospital. By gastroscopy and gastric mucosal biopsy, 31 patients with primary bile reflux gastritis were selected and 19 patients with chronic non atrophic gastritis were compared. All subjects filled in the general registration form and used the body. The psychological and mental factors were evaluated by the self rating scale, and the gallbladder emptying test was carried out on the empty stomach and after the fat meal. The maximum length of the gallbladder, the front and back diameter, the transverse diameter and the change of the gallbladder wall were recorded. The scores of the somatic symptom self rating scale, the volume of the gallbladder and the postprandial gallbladder and the rate of emptying were calculated. The result of primary bile reflux was the result. The common symptoms of gastritis were abdominal distention (64.5%), belching (67.7%), heart burning (61.3%), acid reacid (51.6%), accompanied by early satiety (35.5%), nausea (38.7%), anorexia (25.8%), insomnia (41.9%) and other symptoms, with no statistical difference from chronic atrophic gastritis (P0.05), the clinical symptoms of primary bile reflux gastritis. The proportion of mental and mental factors in the primary bile reflux gastritis group (71.8%) was significantly higher than that in the control group (42.1%), and the gallbladder emptying rate (35.31 + 18.53)% was significantly lower than that of the control group (51.99 + 11.80)% (all P0.05), and the gallbladder emptying rate (29.51 + 13.65)% in the group of psycho psychic factors in the experimental group was also significantly lower than that of the non existence heart. The group (51.97 + 21.43)%, P0.05, psycho psychic factor (SSS score) had a negative correlation with the gallbladder emptying rate (r=-0.76, P0.05), and the maximum length and diameter change under ultrasonic examination, the maximum change of front and back diameter and the maximum transverse diameter were all negatively correlated with the gallbladder emptying rate (r= -0.746, -0.382, -0.538), and the change of transverse diameter on the gallbladder emptying rate (B=-18.77). There was no correlation between the gallbladder wall change and the gallbladder emptying rate (P0.05), and the HP infection rate and the HP infection rate in the reflux group were significantly lower than that in the non reflux group, and the HP infection in the reflux group was significantly lower than that of the non reflux group (X~2=5.632, P0.05). It can be accompanied by early satiety, nausea, nausea, loss of appetite, insomnia, and so on. There are significant psychological and mental factors in the patients with primary bile reflux gastritis, the gallbladder emptying rate is significantly reduced, psycho psychic factors can significantly affect the gallbladder emptying function, which may be through the central nervous system, the autonomic nervous system and various gastrointestinal peptides. In clinical treatment, the psychological and mental intervention should be properly given to the patients to regulate the function of the gastrointestinal tract and the gallbladder, and a new drug regulating autonomic nervous system is expected to be developed. The rate of Helicobacter pylori infection in primary bile reflux gastritis is low, and bile reflux can inhibit the growth and reproduction of Helicobacter pylori; The change of the maximum diameter of the gallbladder has the most significant influence on the change of the gallbladder volume, while the change of the thickness of the gallbladder is not related to the change of the gallbladder volume, and there may be only a dynamic factor.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R573.3

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