胃食管反流病患者精神心理状态及其对质子泵抑制剂治疗的影响
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摘要
目的探讨胃食管反流病(GERD)患者精神心理状态对质子泵抑制剂治疗效果的影响。方法选择2017年3月至2018年3月东莞市桥头医院收治的80例GERD患者作为研究对象(GERD组),其中非糜烂性反流病(NERD)患者56例,反流性食管炎(RE)患者24例,选取同期本院体检中心健康志愿者80例为对照组。采用反流性疾病问卷(RDQ)、匹兹堡睡眠质量指数量表(PSQI)和综合医院焦虑抑郁量表(HADS)评价三组研究对象的精神心理状态,并对影响质子泵抑制剂(PPI)疗效的可能危险因素进行多因素Logistic回归分析。结果 GERD组患者的焦虑、抑郁状态及睡眠障碍发生率分别为47.5%、40.0%及57.5%,均明显高于对照组的7.5%、5.0%及10.0%,差异均有统计学意义(P<0.05);RE患者焦虑、抑郁状态及睡眠障碍发生率分别为41.7%、37.5%及66.7%,与NERD患者的50.0%、41.1%及53.6%比较,差异均无统计学意义(P>0.05);多因素Logistic回归分析结果显示,NERD、焦虑、抑郁和睡眠障碍是影响PPI疗效的独立影响因素(P<0.05)。结论 GERD患者存在不同程度的焦虑、抑郁及睡眠障碍,治疗时考虑精神心理因素的影响可提高GERD患者PPI的治疗效果。
Objective To explore the effect of psychological status of patients with gastroesophageal reflux disease(GERD) on the treatment of proton pump inhibitor. Methods A total of 80 patients with GERD admitted in Dongguan Qiaotou Hospital from March 2017 to March 2018 were selected as research objects, including 24 cases of reflux esophagitis(RE) and 56 cases of non-erosive reflux disease(NERD). During the same period, 80 healthy volunteers in the hospital were selected as the control group. Reflux disease questionnaire(RDQ), Pittsburgh sleep quality index(PSQI), and Hospital Anxiety and Depression Scale(HADS) were used to evaluate the mental state of the three groups,and multiple Logistic regression analysis was performed to analyze the possible risk factors influencing the efficacy of proton pump inhibitor(PPI). Results The incidence of anxiety and depression in GERD patients was 47.5%, 40.0%,and 57.5%, significantly higher than 7.5%, 5.0%, and 10.0% in the control group(P<0.05). There were no statistically significant difference between RE(41.7%, 37.5% and 66.7%) and NERD(50.0%, 41.1% and 53.6%) with anxiety depression and sleep disorders(P>0.05). Multiple logistic regression analysis showed NERD, anxiety, depression and sleep disorders were independent predictors of therapeutic effect of PPI(P<0.05). Conclusion Varying degrees of depression, anxiety and sleep disorders can exist in GERD patients, and considering the role of psychological factors in the treatment of GERD patients with PPI drug can improve the clinical efficacy.
Objective To explore the effect of psychological status of patients with gastroesophageal reflux disease(GERD) on the treatment of proton pump inhibitor. Methods A total of 80 patients with GERD admitted in Dongguan Qiaotou Hospital from March 2017 to March 2018 were selected as research objects, including 24 cases of reflux esophagitis(RE) and 56 cases of non-erosive reflux disease(NERD). During the same period, 80 healthy volunteers in the hospital were selected as the control group. Reflux disease questionnaire(RDQ), Pittsburgh sleep quality index(PSQI), and Hospital Anxiety and Depression Scale(HADS) were used to evaluate the mental state of the three groups,and multiple Logistic regression analysis was performed to analyze the possible risk factors influencing the efficacy of proton pump inhibitor(PPI). Results The incidence of anxiety and depression in GERD patients was 47.5%, 40.0%,and 57.5%, significantly higher than 7.5%, 5.0%, and 10.0% in the control group(P<0.05). There were no statistically significant difference between RE(41.7%, 37.5% and 66.7%) and NERD(50.0%, 41.1% and 53.6%) with anxiety depression and sleep disorders(P>0.05). Multiple logistic regression analysis showed NERD, anxiety, depression and sleep disorders were independent predictors of therapeutic effect of PPI(P<0.05). Conclusion Varying degrees of depression, anxiety and sleep disorders can exist in GERD patients, and considering the role of psychological factors in the treatment of GERD patients with PPI drug can improve the clinical efficacy.
引文
[1]高亚楠,费素娟.精神心理障碍与胃食管反流疾病共病的研究进展[J].医学综述, 2017, 23(15):3036-3040.
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[3]屈亚威,王伟岸,张晓,等.精神心理因素与难治性胃食管反流病发病关系的研究[J].胃肠病学和肝病学杂志, 2015, 24(12):1445-1447.
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[7] KAHRILAS PJ, HOWDEN CW, WERNERSSON B, et al. Impact of persistent, frequent regurgitation on quality of life in heartburn responders treated with acid suppression:a multinational primary care study[J]. Aliment Pharmacol Ther, 2013, 37(10):1005-1010.
[8]陈颖,刘建生,陈胜良.质子泵抑制剂治疗对胃食管反流病患者胃黏膜组织学变化的影响[J].胃肠病学, 2015, 20(12):717-721.
[9]陈一萍,王彩花,李慧春,等.质子泵抑制剂联合氟哌噻吨美利曲辛对伴焦虑抑郁的非糜烂性胃食管反流病的治疗作用[J].中华消化杂志, 2013, 33(7):347-440.
[10] SCHEY R, DICKMAN R, PARTHASARATHY S, et al. Sleep deprivation is hyperalgesic in patients with gastroesophageal reflux disease[J]. Gaftroenterology, 2007, 133(6):1787-1795.
[11]侯慧,荣亮.氟哌噻吨美利曲辛联合质子泵抑制剂对伴焦虑抑郁的非糜烂性胃食管反流病的临床效果观察[J].胃肠病学和肝病学杂志, 2014, 23(7):755-758.
[12]李雁,揭淑英.抗焦虑药联合质子泵抑制剂治疗胃食管反流病的效果研究[J].医学信息, 2016, 29(17):212-213.
[13]王亚洲,高会军,杨新民,等.抗焦虑抑郁药物对难治性胃食管反流病辅助治疗作用的临床研究[J].中国实用神经疾病杂志, 2013, 16(22):42-43.
[14]张仕菊,田字彬.胃食管反流病患者心理因素与疾病症状的相关性分析[J].泰山医学院学报, 2016, 37(9):983-986.
[15]杨凌玲,李继昌,罗欣,等.老年反流性食管炎患者的心理状态及药物疗效分析[J].国际精神病学杂志, 2016, 43(5):879-881.
[16]王伟伟,王亚雷,许建明,等.胃食管反流病患者焦虑抑郁状态及其对治疗的影响[J].安徽医科大学学报, 2014, 49(6):856-859.
[2]孙振刚.胃食管反流病老年患者精神心理因素、自主神经功能与疾病症状的关系[J].中国老年学杂志, 2013, 33(18):4448-4449.
[3]屈亚威,王伟岸,张晓,等.精神心理因素与难治性胃食管反流病发病关系的研究[J].胃肠病学和肝病学杂志, 2015, 24(12):1445-1447.
[4]张国玲.胃食管反流病患者的临床特征及其预后的影响因素分析[J].中国综合临床, 2016, 32(11):1009-1012.
[5]牛小平,余保平,王运东.心理因素对质子泵抑制剂维持治疗老年非糜烂性反流病患者生活质量的影响[J].中华老年医学杂志,2012, 31(4):279-282.
[6]黄艳.胃食管反流病患者精神心理状态与临床疗效的相关性研究[J].中国医学前沿杂志:电子版, 2016, 8(8):60-63.
[7] KAHRILAS PJ, HOWDEN CW, WERNERSSON B, et al. Impact of persistent, frequent regurgitation on quality of life in heartburn responders treated with acid suppression:a multinational primary care study[J]. Aliment Pharmacol Ther, 2013, 37(10):1005-1010.
[8]陈颖,刘建生,陈胜良.质子泵抑制剂治疗对胃食管反流病患者胃黏膜组织学变化的影响[J].胃肠病学, 2015, 20(12):717-721.
[9]陈一萍,王彩花,李慧春,等.质子泵抑制剂联合氟哌噻吨美利曲辛对伴焦虑抑郁的非糜烂性胃食管反流病的治疗作用[J].中华消化杂志, 2013, 33(7):347-440.
[10] SCHEY R, DICKMAN R, PARTHASARATHY S, et al. Sleep deprivation is hyperalgesic in patients with gastroesophageal reflux disease[J]. Gaftroenterology, 2007, 133(6):1787-1795.
[11]侯慧,荣亮.氟哌噻吨美利曲辛联合质子泵抑制剂对伴焦虑抑郁的非糜烂性胃食管反流病的临床效果观察[J].胃肠病学和肝病学杂志, 2014, 23(7):755-758.
[12]李雁,揭淑英.抗焦虑药联合质子泵抑制剂治疗胃食管反流病的效果研究[J].医学信息, 2016, 29(17):212-213.
[13]王亚洲,高会军,杨新民,等.抗焦虑抑郁药物对难治性胃食管反流病辅助治疗作用的临床研究[J].中国实用神经疾病杂志, 2013, 16(22):42-43.
[14]张仕菊,田字彬.胃食管反流病患者心理因素与疾病症状的相关性分析[J].泰山医学院学报, 2016, 37(9):983-986.
[15]杨凌玲,李继昌,罗欣,等.老年反流性食管炎患者的心理状态及药物疗效分析[J].国际精神病学杂志, 2016, 43(5):879-881.
[16]王伟伟,王亚雷,许建明,等.胃食管反流病患者焦虑抑郁状态及其对治疗的影响[J].安徽医科大学学报, 2014, 49(6):856-859.