IBS重叠FD的中医证候分型特点以及根除Hp对IBS重叠FD的影响

发布时间：2018-06-17 13:23

本文选题：肠易激综合征 + 功能性消化不良　；参考：《北京中医药大学》2016年硕士论文

【摘要】：背景：肠易激综合征(irritable bowel syndrome,IBS)与功能性消化不良(functional dyspepsia,FD)重叠的情况在临床上日见增多；并且重叠患者比单病患者具有更严重的临床症状,消耗更多的的医疗资源,所以临床对其的研究需要更加的重视。IBS重叠FD的病因病机尚未完全明确,但可能涉及精神心理因素、脑-肠轴及脑肠肽、内脏高敏感性以及胃肠运动障碍等,临床有许多的证据证明,并且与其对应的治疗措施也列入了治疗方案。比如心理疗法、抗抑郁药物,胃肠动力调节药物的治疗等。然而幽门螺杆菌(Helicobacter pylori, Hp)感染作为可能引起IBS重叠FD的因素之一,临床研究相对较少。临床研究发现FD及IBS的Hp感染率都比常人要高；关于FD的Hp感染率,以及根除Hp对FD的影响,临床研究大部分都已经确认,而对于IBS与Hp感染的关系,临床研究极少,有文献报道IBS的Hp感染率较常人高：除此之外,并无其他相关报道。关于IBS重叠FD患者的Hp感染率,根除Hp对于IBS重叠FD是否具有治疗意义等,都未见相关报道。临床上IBS重叠FD的中医研究相对较少,多处于病因病机层次;临床也大都支持IBS重叠FD的基本病机在于肝郁脾虚。对于其后的研究,包括证候分型,以及治疗都尚未进展太深。目的：在中医理论指导下,对IBS重叠FD的进行中医证候分型,并探查各证型的所占比率,以指导临床治疗。探查根除Hp治疗对于IBS重叠FD患者是否具有治疗意义,进一步研究Hp感染与IBS重叠FD的关系。方法：对于符合纳入标准的患者,在患者入组时,分别采取肠易激综合征症状量表(IBS-SSS)、功能性消化不良生活质量量表(FD-QOL)、医院焦虑抑郁自评量表(HAD)以及胃肠疾病中医证候评分表对患者进行问卷调查；而在患者根除Hp治疗后,予IBS-SSS 及 FD-QOL对根除治疗过后的患者再次进行问卷调查；采用统计学方法,对治疗前后进行比较,根除Hp治疗结束后1个月,嘱患者采用复查Hp,记录Hp根除情况。结果：(1)Hp在IBS重叠FD患者中的感染率高达89.13%;比临床对于单纯IBS患者以及单纯FD患者的感染率高。经根除Hp治疗后,排除未治疗或未复查患者,治疗成功率占总治疗数的86.49%。(2)IBS重叠FD患者中,腹痛患者占74.60%；腹胀患者占76.19%。腹痛腹胀同时存在的情况占50.79%。根除Hp治疗后,腹痛症状、腹胀症状、排便情况以及对生活的影响情况都得到改善,根据统计学结果,具有治疗意义。(3)IBS重叠FD患者中,腹泻占总数的30.16%;便秘占19.05%。排便伴腹痛占76.19%；腹痛时大便次数增多且大便更稀,且排便后腹痛症状减轻。大便不成形占77.78%；根据布里斯托尔大便分类方法,4型正常大便占12.70%,根除治疗后,占68.75%。(4)IBS重叠FD患者的生活质量情况中,压力的影响严重程度最高。结合统计学研究结果,根除Hp治疗在各领域都具有统计学差异。其中,根除Hp治疗对于患者在焦虑、不适症状、应对疾病、压力对疾病的影响以及总体方面都具有显著治疗意义。(5)IBS重叠FD患者中,处于焦虑状态的患者占22.22%,处于抑郁状态的患者占26.98%。(6)IBS重叠FD患者中,脾虚湿阻证占15.87%；肝郁脾虚证占12.70%；肝脾(胃)不和证占19.05%；脾胃(肠)湿热证占19.05%；胃肠燥热证占11.11%；脾肾(胃)阳虚证所占比例数为4.76%,为所有证型中最少的证型。寒热错杂证占17.46%。
[Abstract]:BACKGROUND : The overlap between irritable bowel syndrome ( IBS ) and functional dyspepsia ( FD ) is increasing in clinic .
The pathogenesis of IBS overlapping FD has not been completely clear , but it may involve psychological factors , brain - intestinal axes and intestinal peptide , visceral hypersensitivity and gastrointestinal motility disorders .
Objective : To study the relationship between Hp infection rate and Hp infection rate in patients with IBS and Hp infection .
After eradication of Hp in patients , IBS - SSS and FD - QOL were investigated again after eradication therapy .
Results : ( 1 ) The infection rate of Hp in patients with IBS overlapping FD was 89.13 % . Results : ( 1 ) The infection rate of Hp in patients with IBS overlapping FD was 89.13 % .
After eradication of Hp , the symptoms of abdominal pain , symptoms of abdominal distension , defecation and the influence on life were improved . According to the statistical results , the symptoms of abdominal pain , symptoms of abdominal distension , defecation and the influence on life were improved . According to the statistical results , the diarrhea accounted for 30.16 % of the total .
When abdominal pain , the stool frequency is increased and stool is thinner , and the symptoms of abdominal pain after defecation are relieved , and the stool is not formed to occupy 77.78 % ;
( 4 ) In patients with IBS overlapping FD patients , 22 . 22 % of patients who were in the state of anxiety and 26 . 98 % of the patients who were in the state of depression . ( 6 ) Of the patients with IBS overlap FD , the spleen deficiency wet resistance was 15.87 % .
Liver depression and spleen deficiency accounted for 12.70 % ;
Liver and spleen ( stomach ) were not confirmed to be 19.05 % ;
The damp - heat syndrome of spleen and stomach ( intestine ) accounted for 19.05 % ;
gastrointestinal dryness and heat syndrome accounted for 11 . 11 % ;
The proportion of yang deficiency of spleen and kidney ( stomach ) was 4.76 % , which was the least of all types . The cold and heat syndrome accounted for 17.46 % .
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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