焦虑及抑郁评分与慢性便秘患者临床不同伴随症状关系研究
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摘要
目的探讨焦虑、抑郁评分与慢性便秘患者临床不同伴随症状的关系。方法收集2017年2月至2017年8月于青岛市市立医院干部保健科就诊且符合慢性便秘诊断标准的患者(研究组)49例,男29例,女20例,同时选取34例无便秘患者作为对照组,男18例,女16例。运用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估两组患者焦虑、抑郁评分之间的差异。结果慢性便秘患者的SAS评分为43.03±7.19、SDS评分为45.38±9.56,高于无便秘患者的SAS评分38.39±6.56、SDS评分38.54±7.27,差异有统计学意义(tSAS=2.571,PSAS=0.013;tSDS=3.005,PSDS=0.004);女性便秘患者SAS评分为47.21±7.31,高于男性便秘患者的SAS评分40.41±5.85,差异有统计学意义(t=3.212,P=0.003),而女性与男性便秘患者SDS积分相比,差异无统计学意义(t=0.738,P=0.465);对于慢性便秘患者临床不同伴随症状,伴有腹痛的慢性便秘患者SDS评分为48.60±8.98高于对照组38.94±7.36,差异有统计学意义(t=3.347,P=0.002),伴有腹痛的慢性便秘患者SAS评分与对照组患者相比,差异无统计学意义(t=1.659,P=0.105);伴或不伴有腹胀、排便费力、排便不尽感的慢性便秘患者SAS评分、SDS评分相比,差异均无统计学意义(P>0.05)。结论慢性便秘患者与无便秘患者相比,焦虑、抑郁评分较高,性别、腹痛与慢性便秘患者焦虑、抑郁状态有一定关系。
Objective To investigate the relationship of anxiety,depression score with different clinical symptoms in patients with chronic constipation. Methods A total of 49 patients with chronic constipation were enrolled from Feb. to Aug. 2017 in Qingdao Municipal Hospital,including 29 males and 20 females. And a total of 34 patients without chronic constipation were as control group,including 18 males and 16 females. Self-rating anxiety scale(SAS),Self-rating depression scale(SDS) were used to assess the difference between two groups. Results The SAS score and SDS score in patients with chronic constipation(SAS: 43. 03 ± 7. 19,SDS: 45. 38 ± 9. 56) were obviously higher than those in patients without chronic constipation(SAS: 38. 39 ± 6. 56,SDS: 38. 54 ± 7. 27),the difference was statistically significant(tSAS= 2. 571,PSAS= 0. 013; tSDS= 3. 005,PSDS= 0. 004). The SAS score in female patients with chronic constipation was(47. 21 ± 7. 31) higher than that in the male patients with chronic constipation(40. 41 ± 5. 85),and the difference was statistically significant(t = 3. 212,P = 0. 003). However,there was no significant difference in SAS score between female and male patients with chronic constipation(t = 0. 738,P = 0. 465). As different clinical symptoms in patients with chronic constipation,the SDS score in chronic constipation patients with abdominal pain was(48. 60 ± 8. 98) higher than that in the control group(38. 94 ± 7. 36),the difference was statistically significant(t =3. 347,P = 0. 002),and there was no significance difference between two group in SDS score(t = 1. 659,P = 0. 105);SAS score and SDS score in patients with or without abdominal distension,defecation difficulty,defecation imcompletion were not statistically significant(P > 0. 05). Conclusion Patients with chronic constipation have higher scores of anxiety and depression,there is a certain relationship between the gender or abdominal pain and the anxiety or depression.
Objective To investigate the relationship of anxiety,depression score with different clinical symptoms in patients with chronic constipation. Methods A total of 49 patients with chronic constipation were enrolled from Feb. to Aug. 2017 in Qingdao Municipal Hospital,including 29 males and 20 females. And a total of 34 patients without chronic constipation were as control group,including 18 males and 16 females. Self-rating anxiety scale(SAS),Self-rating depression scale(SDS) were used to assess the difference between two groups. Results The SAS score and SDS score in patients with chronic constipation(SAS: 43. 03 ± 7. 19,SDS: 45. 38 ± 9. 56) were obviously higher than those in patients without chronic constipation(SAS: 38. 39 ± 6. 56,SDS: 38. 54 ± 7. 27),the difference was statistically significant(tSAS= 2. 571,PSAS= 0. 013; tSDS= 3. 005,PSDS= 0. 004). The SAS score in female patients with chronic constipation was(47. 21 ± 7. 31) higher than that in the male patients with chronic constipation(40. 41 ± 5. 85),and the difference was statistically significant(t = 3. 212,P = 0. 003). However,there was no significant difference in SAS score between female and male patients with chronic constipation(t = 0. 738,P = 0. 465). As different clinical symptoms in patients with chronic constipation,the SDS score in chronic constipation patients with abdominal pain was(48. 60 ± 8. 98) higher than that in the control group(38. 94 ± 7. 36),the difference was statistically significant(t =3. 347,P = 0. 002),and there was no significance difference between two group in SDS score(t = 1. 659,P = 0. 105);SAS score and SDS score in patients with or without abdominal distension,defecation difficulty,defecation imcompletion were not statistically significant(P > 0. 05). Conclusion Patients with chronic constipation have higher scores of anxiety and depression,there is a certain relationship between the gender or abdominal pain and the anxiety or depression.
引文
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[2]中华医学会消化病学分会胃肠动力学组,中华医学会外科学分会结直肠肛门外科学组.中国慢性便秘诊治指南(2013年,武汉)[J].中华消化杂志,2013,33(5):291-297.DOI:10.3760/cma.j.issn.0254-1432.2013.05.002.
[3]叶彬,陈春晓.老年住院慢性便秘患者的焦虑抑郁状态和睡眠状态[J].中国老年学杂志,2016,36(8):1996-1998.DOI:10.3969/j.issn.1005-9202.2016.08.009.
[4]吴嘉媛,刘晓红,刘魏.慢性便秘患者精神心理状况及生活质量调查-多中心临床调查[J].中国实用内科杂志,2009,3(29):237-239.WU J Y,LIU XH,LIU W.Investigation of mental-psychological status and quality of life in chronic constipation out-patients[J].Chinese Journal of Practical Internal Medicine,2009,3(29):237-239.
[5]丁元伟,吴婉清,陈德,等.焦虑抑郁状态功能性便秘患者肛门直肠动力和直肠感觉变化[J].广东医学,2010,31(18):2432-2433.DOI:10.3969/j.issn.1001-9448.2010.18.041.DING Y W,WU W Q,CHEN D,et al.The comparing study of anorectal motility and rectal sensation between patients with functional constipation accompanying with and without depression and/or anxiety status[J].Guangdong Medical Journal,2010,31(18):2432-2433.DOI:10.3969/j.issn.1001-9448.2010.18.041.
[6]余跃,蒋楠,黄康,等.生物反馈治疗便秘型肠易激综合征的临床疗效研究[J].中华行为医学与脑科学杂,2014,23(1):37-39.DOI:10.3760/cma.j.issn.1674-6554.2014.01.011.YU Y,JIANG N,HUANG K,et al.Clinical efficacy of biofeedback therapy on constipation-predominant irritable bowel syndrome[J].Chin J Behav Med Brain Sci,2014,23(1):37-39.DOI:10.3760/cma.j.issn.1674-6554.2014.01.011.
[7]LEE C,DOO E,CHOI J M,et al.The increased level of depression and anxiety in irritable bowel syndrome patients compared with healthy controls:systematic review and Meta-analysis[J].J Neurogastroenterol Motil,2017,23(3):349-362.DOI:10.5056/jnm16220.
[8]谢振年,李东冰,贾小强,等.焦虑和抑郁在慢传输型便秘患者发病过程中的作用评估初探[J].世界中医药,2013,8(9):1033-1035.DOI:10.3969/j.issn.1673-7202.2013.09.012.XIE Z N,LI D B,JIA X Q,et al.Effect of anxiety and depression in the process of slow transit constipation patients[J].World Chinese Medicine,2013,8(9):1033-1035.DOI:10.3969/j.issn.1673-7202.2013.09.012.
[9]MCCREA G L,MIASKOWSKI C,STOTTS N A,et al.Pathophysiology of constipation in the older adult[J].World J Gastroenterol,2008,14(17):2631-2638.
[10]虞阳,于晓峰,严晶璐,等.乳果糖联合氟哌噻吨/美利曲辛对伴有焦虑状态老年便秘患者的疗效观察[J].中华老年多器官疾病杂志,2014,13(3):170-173.DOI:10.3724/SP.J.1264.2014.00041.YU Y,YU X F,YAN J L,et al.Effect of flupentixol/melitracen combined with lactulose on treatment of constipation in the elderly with anxiety[J].Chin J Mult Organ Dis Elderly,2014,13(3):170-173.DOI:10.3724/SP.J.1264.2014.00041.
[11]JAMALI R,JAMALI A,POORRAHNAMA M,et al.Evaluation of health related quality of life in irritable bowel syndrome patients[J].Health Qual Life Outcomes,2012,10:1-6.DOI:10.1186/1477-7525-10-12.
[12]BOUCHOUCHA M,HEJNAR M,DEVROEDA G,et al.Patients with irritable bowel syndrome and constipation are more depressed than patients with functional constipation[J].Dig Liver Dis,2014,46(3):213-218.DOI:10.1016/j.dld.2013.10.009.
[13]匡荣光,匡彦,吕国萍,等.便秘患者肛门直肠功能与焦虑抑郁的性别差异[J].中国医师进修杂,2014,37(z1):46-49.KUANG R G,KUANG Y,LV G P,et al.The gender differences of anal rectal function and depression and/or anxiety in elderly patients with constipation[J].Chinese Journal of Postgraduates of Medicine,2014,37(z1):46-49.
[14]陆文玲,蔡棠,姜莉,等.功能性便秘患者的精神心理分析及护理干预[J].国际护理学杂志,2013,32(2):346-348.DOI:10.3760/cma.j.issn.1673-4351.2013.02.065.LU W L,CAI T,JIANG L,et al.Psychoanalysis of the patients with functional constipation and nursing intervention[J].International Journal of Nursing,2013,32(2):346-348.DOI:10.3760/cma.j.issn.1673-4351.2013.02.065.
[15]ROOHAFZA H,BIDAKI E Z,Hasanzadeh-Keshteli A,et al.Anxiety,depression and distress among irritable bowel syndrome and their subtypes:An epidemiological population based study[J].Adv Biomed Res,2016,5:1-7.DOI:10.4103/2277-9175.190938.
[16]PARK J M,CHOI M G,CHO Y K,et al.Functional Gastrointestinal Disorders Diagnosed by Rome III Questionnaire in Korea[J].J Neurogastroenterol Motil,2011,17(3):279-286.DOI:10.5056/jnm.2011.17.3.279.
[17]汤玉蓉,王平,林琳.肠易激综合征患者大脑皮质兴奋性与腹痛、焦虑或抑郁的关系[J].中华医学杂志,2012,92(38):2733-2735.DOI:10.3760/cma.j.issn.0376-2491.2012.38.020.
[18]GERRITS M M,VAN OPPEN P,LEONE S S,et al.Pain,not chronic disease,is associated with the recurrence of depressive and anxiety disorders[J].BMC Psychiatry,2014,14:1-9.DOI:10.1186/1471-244X-14-187.
[19]KANAZAWA M,MIWA H,NAKAGAWA A,et al.Abdominal bloating is the most bothersome symptom in irritable bowel syndrome with constipation(IBS-C):a large population-based Internet survey in Japan[J].Bio Psycho Soc Med,2016,10:19.DOI:10.1186/s13030-016-0070-8.
[2]中华医学会消化病学分会胃肠动力学组,中华医学会外科学分会结直肠肛门外科学组.中国慢性便秘诊治指南(2013年,武汉)[J].中华消化杂志,2013,33(5):291-297.DOI:10.3760/cma.j.issn.0254-1432.2013.05.002.
[3]叶彬,陈春晓.老年住院慢性便秘患者的焦虑抑郁状态和睡眠状态[J].中国老年学杂志,2016,36(8):1996-1998.DOI:10.3969/j.issn.1005-9202.2016.08.009.
[4]吴嘉媛,刘晓红,刘魏.慢性便秘患者精神心理状况及生活质量调查-多中心临床调查[J].中国实用内科杂志,2009,3(29):237-239.WU J Y,LIU XH,LIU W.Investigation of mental-psychological status and quality of life in chronic constipation out-patients[J].Chinese Journal of Practical Internal Medicine,2009,3(29):237-239.
[5]丁元伟,吴婉清,陈德,等.焦虑抑郁状态功能性便秘患者肛门直肠动力和直肠感觉变化[J].广东医学,2010,31(18):2432-2433.DOI:10.3969/j.issn.1001-9448.2010.18.041.DING Y W,WU W Q,CHEN D,et al.The comparing study of anorectal motility and rectal sensation between patients with functional constipation accompanying with and without depression and/or anxiety status[J].Guangdong Medical Journal,2010,31(18):2432-2433.DOI:10.3969/j.issn.1001-9448.2010.18.041.
[6]余跃,蒋楠,黄康,等.生物反馈治疗便秘型肠易激综合征的临床疗效研究[J].中华行为医学与脑科学杂,2014,23(1):37-39.DOI:10.3760/cma.j.issn.1674-6554.2014.01.011.YU Y,JIANG N,HUANG K,et al.Clinical efficacy of biofeedback therapy on constipation-predominant irritable bowel syndrome[J].Chin J Behav Med Brain Sci,2014,23(1):37-39.DOI:10.3760/cma.j.issn.1674-6554.2014.01.011.
[7]LEE C,DOO E,CHOI J M,et al.The increased level of depression and anxiety in irritable bowel syndrome patients compared with healthy controls:systematic review and Meta-analysis[J].J Neurogastroenterol Motil,2017,23(3):349-362.DOI:10.5056/jnm16220.
[8]谢振年,李东冰,贾小强,等.焦虑和抑郁在慢传输型便秘患者发病过程中的作用评估初探[J].世界中医药,2013,8(9):1033-1035.DOI:10.3969/j.issn.1673-7202.2013.09.012.XIE Z N,LI D B,JIA X Q,et al.Effect of anxiety and depression in the process of slow transit constipation patients[J].World Chinese Medicine,2013,8(9):1033-1035.DOI:10.3969/j.issn.1673-7202.2013.09.012.
[9]MCCREA G L,MIASKOWSKI C,STOTTS N A,et al.Pathophysiology of constipation in the older adult[J].World J Gastroenterol,2008,14(17):2631-2638.
[10]虞阳,于晓峰,严晶璐,等.乳果糖联合氟哌噻吨/美利曲辛对伴有焦虑状态老年便秘患者的疗效观察[J].中华老年多器官疾病杂志,2014,13(3):170-173.DOI:10.3724/SP.J.1264.2014.00041.YU Y,YU X F,YAN J L,et al.Effect of flupentixol/melitracen combined with lactulose on treatment of constipation in the elderly with anxiety[J].Chin J Mult Organ Dis Elderly,2014,13(3):170-173.DOI:10.3724/SP.J.1264.2014.00041.
[11]JAMALI R,JAMALI A,POORRAHNAMA M,et al.Evaluation of health related quality of life in irritable bowel syndrome patients[J].Health Qual Life Outcomes,2012,10:1-6.DOI:10.1186/1477-7525-10-12.
[12]BOUCHOUCHA M,HEJNAR M,DEVROEDA G,et al.Patients with irritable bowel syndrome and constipation are more depressed than patients with functional constipation[J].Dig Liver Dis,2014,46(3):213-218.DOI:10.1016/j.dld.2013.10.009.
[13]匡荣光,匡彦,吕国萍,等.便秘患者肛门直肠功能与焦虑抑郁的性别差异[J].中国医师进修杂,2014,37(z1):46-49.KUANG R G,KUANG Y,LV G P,et al.The gender differences of anal rectal function and depression and/or anxiety in elderly patients with constipation[J].Chinese Journal of Postgraduates of Medicine,2014,37(z1):46-49.
[14]陆文玲,蔡棠,姜莉,等.功能性便秘患者的精神心理分析及护理干预[J].国际护理学杂志,2013,32(2):346-348.DOI:10.3760/cma.j.issn.1673-4351.2013.02.065.LU W L,CAI T,JIANG L,et al.Psychoanalysis of the patients with functional constipation and nursing intervention[J].International Journal of Nursing,2013,32(2):346-348.DOI:10.3760/cma.j.issn.1673-4351.2013.02.065.
[15]ROOHAFZA H,BIDAKI E Z,Hasanzadeh-Keshteli A,et al.Anxiety,depression and distress among irritable bowel syndrome and their subtypes:An epidemiological population based study[J].Adv Biomed Res,2016,5:1-7.DOI:10.4103/2277-9175.190938.
[16]PARK J M,CHOI M G,CHO Y K,et al.Functional Gastrointestinal Disorders Diagnosed by Rome III Questionnaire in Korea[J].J Neurogastroenterol Motil,2011,17(3):279-286.DOI:10.5056/jnm.2011.17.3.279.
[17]汤玉蓉,王平,林琳.肠易激综合征患者大脑皮质兴奋性与腹痛、焦虑或抑郁的关系[J].中华医学杂志,2012,92(38):2733-2735.DOI:10.3760/cma.j.issn.0376-2491.2012.38.020.
[18]GERRITS M M,VAN OPPEN P,LEONE S S,et al.Pain,not chronic disease,is associated with the recurrence of depressive and anxiety disorders[J].BMC Psychiatry,2014,14:1-9.DOI:10.1186/1471-244X-14-187.
[19]KANAZAWA M,MIWA H,NAKAGAWA A,et al.Abdominal bloating is the most bothersome symptom in irritable bowel syndrome with constipation(IBS-C):a large population-based Internet survey in Japan[J].Bio Psycho Soc Med,2016,10:19.DOI:10.1186/s13030-016-0070-8.