摘要
目的比较反流性食管炎(RE)及非糜烂性反流病(NERD)不同亚组之间焦虑和抑郁心理量表评分方面的差异,探讨精神心理因素对胃食管反流病(GERD)症状发生的影响。方法具有典型反酸、烧心等症状的206例GERD患者,根据胃镜检查及胃食管24hpH监测是否存在RE及病理酸反流将其分为4个亚组:REpH监测阳性组(RE+组,35例,70.0%),REpH监测阴性组(RE-组,15例,30.0%),NERDpH监测阳性组(NERD+组,77例,49.4%),NERDpH监测阴性组(NERD-组,79例,50.6%);最后一组又根据监测症状指数(SI)分为症状指数阳性组(NERD-SI+组,18例,22.8%)和阴性组(NERD-SI-组,61例,77.2%)。比较各组间的酸反流特点、精神心理评估[使用症状自评量表和综合医院焦虑/抑郁情绪测定(HAD量表)]、人口学特征及体重指数等。结果(1)RE组男性比例较高,而NERD组则以女性为主;RE组和RE+组患者的体重指数分别高于NERD组和NERD+组,差异均有统计学意义。(2)RE组pH监测阳性率显著高于NERD组(70.0%比49.4%),且在DeMeester积分等多个指标上差异均有统计学意义[39.3(96.5)比13.9(33.6)];进一步比较RE+组与NERD+组,结果亦显示RE+组在DeMeester积分等多个指标上明显高于NERD+组[68.1(95.2)比40.1(64.4)]。(3)受试患者中完成HAD量表者中44.6%(29/65)存在抑郁,36.9%(24/65)存在焦虑,大多数均为轻中度抑郁/焦虑。NERD-组在各量表参数上的得分或指数均高于NERD+组,且在大多数参数上的差异具有统计学意义。其中NERD-SI-组在各量表参数上的得分或指数均高于总体水平。结论NERD+与RE可能为同一发病机制下程度递增的病变。NERD组(尤其NERDSI组)患者的心理评估指标高于其他组患者,提示精神心理应激在该组患者反流症状的发生中起重要作用。
Objective To compare the differences in the psychological scale scoring among different subgroups reflux esophagitis （ RE ） and non-erosive reflux disease （ NERD ） and to explore the influence of mental factors on the pathogenesis of RE and NERD. Methods Two hundred and six patients with typical heartburn and acid regurgitation underwent endoscopy and esophageal pH monitoring and then were divided into 4 groups ： RE ＋ group （ n =35, 24.3% ） with RE and positive pH monitoring results, RH - group （ n = 15, 30.0% ） with RE and negative pH monitoring results, NERD ＋ group （ n = 77, 40% ）, with NERD and positive pH monitoring results, and NERD - group （ n = 79, 50.6% ） with NERD and negative pH monitoring results that was re-divided into 2 subgroups according to the symptom index （SI） ： NERD-SI ＋ group （ n = 18,22.8% ） with positive symptom index and NERD - SI - group （ n = 61,77. 2% ） with negative SI. The demographic data and body mass index （BMI） were investigated. The psychological questionnaires： Symptom Checklist 90 （SCL-90） , and Hospital Anxiety and Depression Scale （HAD） were used. Results （1） Male patients were dominant in the RE group and RE ＋ subgroup, while female patients were dominant in the NERD group and NERD ＋ subgroup. The values of BMI of the RE group and RE ＋ subgroup were significantly higher than those of the NERD group and NERD ＋ subgroup. （2） The abnormal pH monitoring rate of the RE group was 70.0% , significantly higher than that of the NERD group （49.4%） The average DeMeester＇s score of the RE group was 39.3 （ 96.5 ）, significantly higher than that of the NERD group 13.8 （33.6）. The average DeMeester＇s score of the RE ＋ group was 68. 1 （95.2）, significantly higher than that of the NERD ＋ group 40. 1 （64.4）. （3） 44.6% （29/65） of the patients presented depression and 36.9% （24/65） had anxiety, most of them were in mild or moderate degree. The scores of most items of each mental scale were significantly higher in the NERD - patients than in the NERD ＋ patients, especially in the NERD - SI - subgroup. Conclusion The symptoms of RE ＋ and NERD ＋ patients are associated with esophageal acid exposure and the acid reflux in the RE patients is much severer than that in the NERD patients. Anxiety and depression are related to the symptoms of patients without objective evidence of esophageal mucosal injury and acid reflux （ NERD - ） , especially in the symptom index negative subgroup. Visceral hypersensitivity and stress play an important role in the pathogenesis of gastroesophageal reflux.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2005年第45期3210-3215,共6页
National Medical Journal of China
关键词
胃食管反流
焦虑
抑郁症
Gastroesophageal reflux
Anxiety
Depression
