肠易激综合征的社会心理因素调查及危险因素分析

  本文关键词：肠易激综合征的社会心理因素调查及危险因素分析，由笔耕文化传播整理发布。

        目的肠易激综合征(Irritable Bowel Syndrome, IBS)是一种以腹痛或腹部不适伴排便习惯改变和(或)粪便性状改变的功能性肠病,该病缺乏可解释症状的形态学改变和生化异常。有研究认为,很多肠易激综合征患者都存在一定的心理功能异常,为进一步了解肠易激综合征患者的社会心理特征,课题组对云南省第二人民医院消化科的126例患者进行了情绪特点、人格特征、述情障碍、疾病观念、家庭环境、家庭动力学等社会心理特征调查,探讨这些社会心理特征与肠易激综合征发病的关系。方法2010年至2011年对云南省第二人民医院消化科门诊的126名肠易激综合征患者和126名无重大躯体疾病的正常对照进行抑郁量表、焦虑量表、家庭环境量表、系统家庭动力学自评量表、艾森克人格量表、疾病观念与求医行为量表以及多伦多述情障碍量表等的问卷调查。结果肠易激综合征患者存在一定的社会心理问题,如：①IBS组与对照组在抑郁自评量表方面存在显著差异(F=4.634；P=0.032)；女性IBS组患者与女性对照者抑郁量表得分有显著差异(F=9.784；P=0.002)。②IBS组与对照组在焦虑自评量表方面存在显著差异(F=31.716;P<0.001)；IBS组男性患者与女性患者焦虑评分有显著性差异(女性均值为40.44±7.386；男性均值为36.85±7.197；T=-2.758；P<0.05)；女性患者与女性对照者焦虑评分有显著性差异(F=39.442;P<0.001)。③IBS组与对照组在家庭环境量表的因子V成功性上存在显著差异(F＝11.492；P<0.001)；女性IBS组患者与女性对照者之间家庭环境量表在因子Ⅳ独立性(F=6.870;P=0.010)和因子V成功性(F=9.196：P<0.003)方面有显著性差异。④IBS组与对照组在系统家庭动力学自评量表间差异不明显。⑤男性IBS患者与男性对照者的疾病观念与求医行为问卷量表在求医方式与行为上有显著差异(F=4.463;P=0.037)。⑥IBS组与对照组在艾森克量表因子N：神经质(F=15.528;P<0.001)和艾森克量表因子总分(F=8.241；P=0.004)上存在显著差异；IBS组男女患者之间EPQ量表在因子L被试者的掩饰度上存在显著差异(T=-3.095；P=0.002)；女性IBS患者与女性对照者在艾森克因子N：神经质(F=12.623;P=<0.001)及因子总分(F=6.386;P=0.013)方面存在显著差异。⑦IBS组与对照组在多伦多述情障碍因子Ⅱ缺乏认识和区别情感和躯体感受的能力(F=8.613;P<0.05)和因子Ⅲ少幻想(F=6.796；P<0.05)方面存在显著差异；男性IBS组患者与男性对照者在因子Ⅱ(F=7.908;P<0.05)和因子Ⅲ(F=5.198：P<0.05)方面存在显著性差异。⑧IBS患者腹部症状与SDS总分、与SAS总分、系统家庭动力学自评量表在因子Ⅲ系统逻辑、疾病观念与求医行为问卷在因子Ⅱ成年时期对疾病与健康的观念、态度呈正相关(R=0.198,P<0.05；R=0.217；P<0.05；R=0.189,P<0.05；R=0.178,P<0.05)； IBS患者腹部症状与家庭环境量表在因子Ⅰ亲密度(R=-0.186；P<0.05)和因子Ⅸ组织性(R=-0.198；P<0.05)上存在负相关。⑨抑郁、家庭环境量表中因子V成功性即喜欢将一般性活动变为成就性或竞争性活动、年龄及TAS因子Ⅱ即缺乏认识和区别情感和躯体感受的能力为IBS患者发病的危险因素；焦虑、艾森克因子N为IBS患者抑郁发生的危险因素；抑郁、艾森克因子N、家庭环境量表因子总和、疾病观念与求医行为问卷因子总和为IBS患者焦虑发生的危险因素。结论肠易激综合征患者存在一定的社会心理问题,他们主诉的腹痛、腹胀、腹泻、便秘等情况可能跟患者的抑郁、焦虑情绪、喜欢把一般性活动变为竞争性活动、自己及家庭成员间不够自信、容易紧张、担忧、情绪起伏较大、缺乏区分情感和躯体感受能力及爱幻想等有关,建议这部分患者的治疗中可以结合新的治疗方式,如抗抑郁药治疗或心理治疗等。

    Objective Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorders with abdominal pain and abdominal discomfort. It has a change with bowl evacuation habit and feces traits. This disease is lack of the change with morphology and biochemistry to explain the symptom. Many researches showed that the patients with IBS had certain social psychological problems. In order to further understand the social psychological factors about IBS patients, our research group make an investigation in emotional character, personality character, alexithymia character, disease concept,healthy seeking behaviors, family environment and family dynamics to IBS patients and control in gastroenterology department of the second people’s hospital in Yunnan province.Methods We make an investigation to IBS patients and control in gastroenterology department of the second people’s hospital in Yunnan province with questionnaires of SAS, SDS, FES-CV, SSFD, EPQ, ICHSB, TAS.Results The irritable bowel syndrome patients have the following social psychological problems.①The scores of depression were significantly higher in IBS patients than those in healthy subjects (F=4.634; P=0.032). The scores of depression were significantly higher in the female patients of IBS group than those in the female of control group (F=9.784; P=0.002)②The scores of anxiety were significantly higher in IBS patients than those in healthy subjects (F=31.716; P<0.001). The scores of anxiety were significantly higher in the female patients of IBS group than those in the male patients of IBS group (the mean of female is40.44±7.386; the mean of male is36.85±7.197; T=-2.758; P<0.05). The scores of anxiety were significantly higher in the female patients of IBS group than those in the female of control group (F=39.442; P<0.001)③The scores of achievement orientation in FES were significantly higher in IBS patients than those in healthy subjects (F=11.492; P<0.001). The scores of independence (F=6.870; P=0.010) and achievement orientation (F=9.196; P<0.003) in FES were significantly higher in the female patients of IBS group than the female of control group.④The scores of SSFD were no diferent between IBS patients and healthy subjects.⑤The scores of health seeking behavior of ICHSB were significantly higher in male patients of IBS group than those in male healthy subjects (F=4.463; P=0.037).⑥The scores of nervosity (F=15.528; P<0.001) and the total points (F=8.241; P=0.004) of EPQ were significantly higher in IBS patients than those in healthy subjects. The scores of hide degrees in EPQ were significantly higher in the female patients of IBS group than those in the male patients of IBS group (T=-3.095; P=0.002). The scores of nervosity (F=12.623; P=<0.001) and the total points (F=6.386; P=0.013) of EPQ were significantly higher in the female patients of IBS group than those in the female of control group.⑦The scores of factor II (F=8.613; P<0.05) and factor III (F=6.796; P<0.05) in TAS were significantly higher in IBS patients than those in healthy subjects. The scores of factor II (F=7.908; P<0.05) and factor III (F=5.198; P<0.05) in TAS were significantly higher in the male patients of IBS group than those in the male of control group.⑧The symptom of IBS patients is positively correlated to the severity of depression R=0.198; P<0.05). anxiety(R=0.217; P<0.05),. system logic in SSFD (R=0.189; P<0.05) and factor II in ICHSB (R=0.178; P<0.05) The symptom of IBS patients is negatively correlated to the severity of intimacy (R=-0.186; P<0.05) and the sense of organization (R=-0.198; P<0.05) in FES.⑨The risk factors of IBS are depression, achievement orientation, age, the factor II of TAS. The risk factors to depression of IBS are anxiety and the factor N of EPQ. The risk factors to anxiety of IBS are depression, the factor N of EPQ, the total points of FES and the total points of ICHSB.Conclusion The irritable bowel syndrome patients have certain social psychological problems such as depression, anxiety, competitiveness, lacking self-confident, tension, alexithymia, lacking of the ablity to distinguish between emotion and physical feelings and loving fantasy.

          肠易激综合征的社会心理因素调查及危险因素分析

摘要5-7Abstract7-9英文缩略词表10-11前言11-19研究对象与方法19-23结果23-48讨论48-54结论54-55参考文献55-61综述61-72    参考文献68-72攻读学位期间发表文章情况72-73致谢73

  本文关键词：肠易激综合征的社会心理因素调查及危险因素分析，，由笔耕文化传播整理发布。