【作者】 杨彬；

【导师】 吴扬；

【作者基本信息】 吉林大学 ， 临床医学， 2010， 硕士

【摘要】 肠易激综合征(IBS)是常见的一种慢性功能性胃肠病,以腹痛或腹部不适伴排便习惯改变为特征。其发病率高,并严重影响生活质量。目前对该病在遗传、免疫、生化、神经、微生物等方面进行了大量、广泛的研究,取得了重大进展。随着人们对IBS的认识从单一生物模式向生物-心理-社会模式转变,越来越多的研究显示精神心理因素在IBS的发病中起着非常重要的作用。IBS罗马III诊断标准及分型的推出,需要对IBS四种亚型的临床特点及患者的焦虑、抑郁等精神心理因素及亚型间性别、年龄是否存在差异性进行研究。对此,本文对2009年3月至2010年1月间在我院消化科就诊,且符合2006年RomanIII最新诊断标准的IBS患者116例进行调查分析,探讨IBS临床各型的性别、年龄、精神心理因素差异性、临床症状等问题,为临床医生评估IBS患者的病情,进行个体化治疗提供更准确的信息,指导临床医生采取科学、综合的治疗方法。本研究结果显示:(1)IBS患者中SAS\SDS标准分及症状积分在两性间无显著性差异(P>0.05);(2)四种亚型之间性别、年龄、焦虑、抑郁、临床症状无显著性差异(P>0.05);(3)IBS患者临床症状积分与焦虑、抑郁程度呈正相关性(P<0.05);(4)IBS患者均伴随多种胃肠外症状,最多见如睡眠障碍、胸闷、气短、乏力、易过敏等,个体差异较大。更多还原

【Abstract】 Irritable bowel syndrome is a common functional gastrointestinal disease, although not life threatening, but the quality of life in patients with severe lower, while the clinical effect is not ideal. Although through the gastrointestinal tract emptying rate, intestinal manometry evaluation of gastrointestinal motility and other methods, but by patients with limited disease, and will bring pain patients, there may aggravate symptoms. IBS study in early gastrointestinal motility, abnormal visceral sensitivity more, But only through routine clinical regulate gastrointestinal motility drugs, efficacy is not satisfactory. IBS has been defined as a psychosomatic illness, psychological factors have an important role in the pathogenesis of IBS. Domestic and foreign scholars through a large number of clinical control study, showed that IBS patients with anxiety / depression and other higher risk of psychological abnormality. And genetic, immune, endocrine, brain imaging, and even psychiatric research, further psychological factors in IBS incidence and the correlation between the strong support provided. Most IBS disease models also stress method used to establish, in some ways to help the pathogenesis of IBS. New Rome III diagnostic criteria for IBS disease characteristics based primarily on the development of foreign, domestic need for epidemiological investigation verified. The division of IBS clinical subtype to the existing method of abnormal psychological stress led to the establishment of disease models and challenges, psychological factors associated with IBS has been recognized, but whether there were differences between the various subtypes remains to be discussion. In addition, IBS symptoms with gastrointestinal symptoms and characteristics also need attention. This article will IBS subtypes of sex, age, psychological factors, clinical symptoms of gastrointestinal symptoms and other related indicators associated with statistical research, With a view to the IBS disease modeling and clinical physicians in the treatment of IBS was helpful to improve the efficacy and reduce patient suffering.Objective:This study gastroenterology outpatients and inpatients were found in patients with IBS Rome III diagnostic criteria for clinical investigation, observation of age, sex, occupation, clinical symptoms, anxiety, depression and associated symptoms and other indicators, statistical analysis of these indicators for improving IBS disease individualized treatment model and provide more accurate information, improve IBS treatment.Materials and Methods:Inclusion criteria: March 2009 to January 2010 Department of Gastroenterology, in our hospital outpatients and inpatients, according to Rome III diagnostic criteria in 2006 were diagnosed as irritable bowel syndrome in 116 patients. Among them, the number of male was 45, while female was 71, The youngest age was 19, the eldest age was 70. All of 116 cases will be divided as (32) IBS with diarrhea (IBS-D), (39) as IBS with constipation (IBS-C), (17) as mixed IBS (IBS-M) and (28) as unsubtyped IBS (IBS-U) based on Rome III diagnostic criteria.。Exclusion criteria: suffering from erosion, ulcers, tumors and other organic diseases, and the existence of the disease history; laboratory, X ray, B ultrasonic check for the presence of liver, gallbladder, pancreas and gastrointestinal organic diseases; HbsAg, anti-HCV, anti-HIV test positive; intestinal endoscopy anomaly; diabetes, hyperthyroidism, connective tissue disease and mental illness and other systemic diseases; pregnant and lactating women. Records of all patients by sex, age, occupation, anxiety, depression score, clinical symptom score, with the symptoms. Observation: IBS patients between the four subtypes of sex, age, on whether there were different; IBS group between the various subtypes of anxiety, depression, standard score, symptom score, whether the difference; IBS symptoms and anxiety, whether the degree of depression Correlation; IBS symptoms associated with statistical analysis.Results:(1) IBS patients with a total of 116 cases, male 45 cases, female 71 cases, male to female ratio is about 1:1.58. Patients with anxiety, depression and clinical symptoms of records in table. IBS patients, men and women of anxiety, depression and clinical symptom score was not significant (P>0.05).(2) The four subtypes of IBS patients, constipation-39, male 14, female 25 cases, mean age 43.05±10.82 years; Diarrhea 32 cases, 13 males, 19 females, mean age 43.56±10.60 years; mixed 17 cases, 5 males and 12 females, mean age 41.41±8.99 years; atypical in 28 cases, 13 males, 15 females, mean age 37.79±9.25 years. The four subtypes of gender, age was no significant difference (P>0.05).(3) IBS subtype number of cases of four patients, anxiety and depression scores in Table 4.3. IBS patients with anxiety and depression in the four subtypes showed no significant difference between (P>0.05).(4) IBS type and a negative correlation between gender and symptom scores, anxiety, depression, a positive correlation between the relationship, but the correlation did not reach statistical significance level; symptom score and gender, anxiety and depression are among the positively correlated, and gender, depression correlated to the 0.05 significance level, and anxiety correlated to the 0.01 significance level, indicating that symptom scores to some extent by the impact of gender, while symptom score was also affected by the degree of anxiety and depression, anxiety and depression levels would make the increase of disease symptoms become more pronounced.Conclusions:(1) IBS patients with anxiety, depression and other psychological abnormalities and clinical symptoms of the occurrence of no significant relationship with sex.(2) IBS patients with clinical symptoms and the severity of anxiety, depression and other psychological factors were positively correlated, and correlation with anxiety than depression. Anxiety / depression and other mental and psychological evaluation of the IBS condition assessment and guide clinical treatment.(3) IBS division of the four subtypes of anxiety / depression and other psychological factors no significant correlation, simply through the mental - physical concept model of the establishment of IBS appears increasingly inadequate.(4) IBS patients had varying degrees of parenteral symptoms, and there are individual differences, need to emphasize individualized treatment.更多还原