本文選題：功能性消化不良 + 胃排空��； 參考：《河北醫(yī)科大學(xué)》2008年碩士論文

【摘要】： 目的:功能性消化不良(functional dyspepsia, FD)是臨床常見(jiàn)病,其發(fā)病機(jī)制至今尚不完全明確。目前國(guó)內(nèi)外多數(shù)學(xué)者傾向于認(rèn)為胃動(dòng)力障礙是FD發(fā)生的主要機(jī)制,并被認(rèn)為是引起餐后飽脹感、早飽、餐后惡心、噯氣等上消化道癥狀的主要原因。隨著對(duì)FD認(rèn)識(shí)的不斷深入,羅馬Ⅲ學(xué)術(shù)委員會(huì)對(duì)FD的診斷提出新的標(biāo)準(zhǔn),并根據(jù)不同的病理生理學(xué)異常為基礎(chǔ)又將FD分為兩種亞型,即上腹痛綜合征(epigastric pain syndrome, EPS)和餐后不適綜合征(post-prandial distress syndrome, PDS)。因羅馬Ⅲ標(biāo)準(zhǔn)認(rèn)為PDS型FD患者以餐后飽脹感、早飽、餐后惡心、噯氣等為主要臨床癥狀,且癥狀與進(jìn)餐相關(guān),故本研究應(yīng)用核素法對(duì)PDS型FD患者和健康人進(jìn)行胃排空檢測(cè),比較二者胃排空情況,從而明確PDS型FD患者是否存在胃動(dòng)力障礙,探討其發(fā)病相關(guān)的病理生理機(jī)制,為臨床治療PDS型FD患者是否應(yīng)用促動(dòng)力藥物提供依據(jù)。同時(shí)通過(guò)對(duì)PDS型FD患者的各種臨床癥狀及其嚴(yán)重程度與胃排空進(jìn)行相關(guān)性研究,分析臨床癥狀與胃排空的關(guān)系。 近年來(lái),亦有許多學(xué)者提出重視心理因素在FD發(fā)生中的作用。本研究通過(guò)對(duì)PDS型FD患者和健康人進(jìn)行焦慮、抑郁量表調(diào)查,明確PDS型FD患者是否較健康人易存在焦慮、抑郁狀態(tài),同時(shí)對(duì)PDS型FD患者臨床癥狀的嚴(yán)重程度與焦慮、抑郁狀態(tài)進(jìn)行相關(guān)性研究,明確二者相關(guān)性,探討PDS型FD的發(fā)病機(jī)制,為臨床對(duì)PDS型FD患者進(jìn)行心理治療提供依據(jù)。 方法:采用德國(guó)西門(mén)子公司雙探頭1英寸晶體e.camduet型PET/SPECT儀,對(duì)PDS型FD患者和健康人進(jìn)行胃排空檢測(cè)。34例PDS型FD患者中男性14例,女性20例,平均年齡(歲) 45.94±13.19,平均體重指數(shù)(kg/m~2) 23.04±3.32;21例健康人中男性9例,女性12例,平均年齡(歲) 42.47±14.52,平均體重指數(shù)(kg/m~2) 22.50±2.25。觀察PDS型FD患者和健康人在進(jìn)餐后即刻、30分鐘、60分鐘、90分鐘、120分鐘時(shí)胃內(nèi)放射性計(jì)數(shù),依此計(jì)算出胃半排空時(shí)間(gastric emptying half-time, GET(1/2))及120min胃排空率(gastric emptying rate at 120 minutes, GE_(120))。應(yīng)用LDQ對(duì)PDS組進(jìn)行臨床癥狀評(píng)分,并計(jì)算癥狀總積分。 應(yīng)用焦慮自評(píng)量表(self-rating anxiety scale , SAS)、抑郁自評(píng)量表(self-rating depression scale, SDS)分別對(duì)PDS型FD患者和健康人進(jìn)行評(píng)分。20例PDS型FD患者中男性4例,女性16例,平均年齡(歲)38.00±10.09;30例健康人中男性8例,女性22例,平均年齡(歲)37.17±11.08。同樣應(yīng)用LDQ對(duì)PDS組進(jìn)行臨床癥狀評(píng)分,并計(jì)算癥狀總積分。 所有數(shù)據(jù)均應(yīng)用SPSS 10.0統(tǒng)計(jì)軟件進(jìn)行分析。在胃排空研究試驗(yàn)中,應(yīng)用兩獨(dú)立樣本t檢驗(yàn)方法對(duì)PDS組和健康對(duì)照組的年齡、體重指數(shù)、GET_(1/2)、GE_(120)結(jié)果進(jìn)行分析。在心理狀態(tài)研究試驗(yàn)中同樣應(yīng)用兩獨(dú)立樣本t檢驗(yàn)方法對(duì)兩組的年齡、焦慮標(biāo)準(zhǔn)總分、抑郁標(biāo)準(zhǔn)總分及各評(píng)價(jià)抑郁狀態(tài)的4個(gè)因子總分結(jié)果進(jìn)行分析。應(yīng)用Spearman相關(guān)分析方法對(duì)PDS型FD患者的臨床癥狀與胃排空及心理狀態(tài)進(jìn)行相關(guān)性研究。 結(jié)果:1在胃排空研究中,發(fā)現(xiàn)PDS型FD患者GET_(1/2) (min)為105.54±25.66,健康人GET_(1/2) (min)為78.19±14.33,兩組間差異具有統(tǒng)計(jì)學(xué)意義(t=5.066, P=0.000)。PDS型FD患者GE120(%)為56.32±12.91 ,健康人GE_(120)(%)為70.71±11.18 ,兩組間差異具有統(tǒng)計(jì)學(xué)意義(t=-4.221, P=0.000)。 34例PDS型FD患者餐后飽脹感與GET_(1/2)的Spearman相關(guān)分析結(jié)果為r_s=0.086,P=0.627,無(wú)統(tǒng)計(jì)學(xué)意義;早飽與GET_(1/2)的Spearman相關(guān)分析結(jié)果為r_s=-0.058,P=0.745,無(wú)統(tǒng)計(jì)學(xué)意義。上腹痛、上腹燒灼感、餐后惡心、噯氣癥狀與GET_(1/2)的Spearman相關(guān)分析結(jié)果均無(wú)統(tǒng)計(jì)學(xué)意義。34例PDS型FD患者餐后飽脹感與GE_(120)的Spearman相關(guān)分析結(jié)果為r_s=-0.025,P=0.888,無(wú)統(tǒng)計(jì)學(xué)意義。早飽與GE120的Spearman相關(guān)分析結(jié)果為r_s=0.013,P=0.944,無(wú)統(tǒng)計(jì)學(xué)意義。上腹痛、上腹燒灼感、餐后惡心、噯氣癥狀與GE120的Spearman相關(guān)分析結(jié)果均無(wú)統(tǒng)計(jì)學(xué)意義。 2在評(píng)價(jià)PDS型FD患者心理狀態(tài)研究中,發(fā)現(xiàn)PDS型FD患者SAS平均總粗分為39.90±6.45分,平均標(biāo)準(zhǔn)總分為49.90±8.07分;健康人SAS平均總粗分為29.73±8.35分,平均標(biāo)準(zhǔn)總分為36.73±10.45分。兩組SAS標(biāo)準(zhǔn)總分間的差異具有統(tǒng)計(jì)學(xué)意義(t=4.761, P =0.000)。PDS型FD患者SDS平均總粗分為40.50±8.38分,平均標(biāo)準(zhǔn)總分為50.3±10.50分;健康人SDS平均總粗分為30.31±5.79分,平均標(biāo)準(zhǔn)總分為38.03±8.59分。兩組SDS平均標(biāo)準(zhǔn)總分間的差異具有統(tǒng)計(jì)學(xué)意義(t=4.524, p=0.000)。 在SDS評(píng)分中,將抑郁狀態(tài)分為4個(gè)因子,即軀體癥狀和焦慮因子、樂(lè)觀情緒因子、生理狀態(tài)因子及惡劣心境因子。PDS型FD患者與健康人在上述4個(gè)因子之間的差異均具有統(tǒng)計(jì)學(xué)意義(t=3.344, P=0.002; t=2.680, P=0.011; t=5.488, P=0.000; t=2.472, P =0.017)。 PDS型FD患者臨床癥狀總積分與SAS、SDS評(píng)分之間均呈正相關(guān)關(guān)系,具有統(tǒng)計(jì)學(xué)意義(r_s=0.502, P=0.024; r_s=0.911, P=0.000)。 結(jié)論:1 PDS型FD患者的GET_(1/2)較健康人明顯延遲, GE_(120)則明顯低于健康人,說(shuō)明PDS型FD患者較健康人存在明顯胃動(dòng)力障礙。 2 PDS型FD患者各種臨床癥狀評(píng)分及癥狀總積分與GET_(1/2)和GE_(120)之間無(wú)相關(guān)性。說(shuō)明不能用PDS型FD患者臨床癥狀的嚴(yán)重程度來(lái)評(píng)價(jià)其胃動(dòng)力情況。 3 PDS型FD患者的SAS、SDS評(píng)分明顯高于健康人,說(shuō)明PDS型FD患者比健康人易存在心理障礙。 4 PDS型FD患者的SAS、SDS評(píng)分與其臨床癥狀之間呈正相關(guān),說(shuō)明PDS型FD患者的心理障礙程度越嚴(yán)重,其臨床癥狀越嚴(yán)重。
[Abstract]:Objective : Functional dyspepsia ( FD ) is a common disease in clinic , and the pathogenesis of FD is not completely clear . At present , most scholars tend to think that gastric motility disorder is the main mechanism of FD , and it is considered to be the main cause of upper gastrointestinal symptoms such as post - meal fullness sensation , early saturation , post - meal nausea , belch and other upper gastrointestinal symptoms . According to the different pathological physiology abnormalities , the FD is divided into two subtypes , namely upper abdominal pain syndrome ( EPS ) and post - postprandial discomfort syndrome ( PDS ) . Objective To investigate the relationship between clinical symptoms and gastric emptying in patients with PDS type FD patients .


In recent years , many scholars have put forward the role of psychological factors in the development of FD . By investigating the anxiety and depression scale of PDS type FD patients and healthy people , it is clear whether or not PDS type FD patients are more likely to have anxiety and depression status than healthy people .


Methods : The gastric emptying of PDS type FD patients and healthy persons was detected by using the double probe 1 inch crystal e.camduet type PET / SPECT instrument of Siemens AG . The average body mass index ( kg / m ~ 2 ) 23.04 鹵 3.32 , the average body mass index ( kg / m ~ 2 ) 23.04 鹵 3.32 , the average body mass index ( kg / m ~ 2 ) 22.50 鹵 2.25 . The gastric emptying time ( gastric emptying half - time , GET ( 1 / 2 )) and gastric emptying rate ( 120 minutes , GE _ ( 120 )) were calculated .


The self - rating anxiety scale ( SAS ) , self - rating depression scale ( SDS ) and self - rating depression scale ( SDS ) were used to evaluate the patients with PDS type FD and healthy persons . Among 20 patients with PDS type FD , 4 were male , 16 were female , average age ( years ) was 38.00 鹵 10.09 ; 30 healthy persons were male 8 , female 22 , mean age ( years ) 37.17 鹵 11.08 . The clinical symptom score of PDS group was also applied with LDQ and the total score of symptoms was calculated .


The age , body mass index , GET _ ( 1 / 2 ) and GE _ ( 120 ) of PDS group and healthy control group were analyzed by using two independent sample t - test methods .


Results : In the study of gastric emptying , it was found that the GET _ ( 1 / 2 ) ( min ) was 105.54 鹵 25.66 in patients with PDS type FD , 78.19 鹵 14.33 for healthy persons ( 1 / 2 ) ( min ) and 78.19 鹵 14.33 for healthy persons ( t = 5.066 , P = 0.000 ) . GE120 ( % ) of PDS type FD was 56.32 鹵 12.91 , GE _ ( 120 ) ( % ) was 70.71 鹵 11.18 , there was significant difference between the two groups ( t = - 4.221 , P = 0.000 ) .


In 34 patients with PDS type FD , the results were r _ s = - 0.058 , P = 0.745 , and no statistical significance . The results were r _ s = - 0.025 , P = 0 .


2 In the study of PDS type FD patients , the mean total score of SAS in patients with PDS was 39.90 鹵 6.45 , the mean standard was 49.90 鹵 8.07 , the average total score of SAS was 29.73 鹵 8.35 , the mean standard was 36.73 鹵 10.45 , the difference between the two groups was statistically significant ( t = 4.761 , P = 0.000 ) . The mean total score of SDS in patients with PDS was 40.50 鹵 8.38 , the mean total score was 50.3 鹵 10.50 , the mean total score of SDS was 30.31 鹵 5.79 , the mean standard was 38.03 鹵 8.59 . The difference between the two groups was statistically significant ( t = 4.524 , p = 0.000 ) .


In the SDS score , the depressive state was divided into 4 factors , somatic symptoms and anxiety factors , optimistic mood factors , physiological status factors and bad mood factors . The difference between PDS type FD patients and healthy persons was statistically significant ( t = 3.344 , P = 0.002 ; t = 2.680 , P = 0 . 011 ; t = 5.488 , P = 0.000 ; t = 2.472 , P = 0 . 017 ) .


There was a positive correlation between the total score of clinical symptoms and SAS and SDS scores in patients with PDS type FD , with statistical significance ( r _ s = 0.502 , P = 0 . 024 ; r _ s = 0.911 , P = 0.000 ) .


Conclusion : The GET _ ( 1 / 2 ) of patients with PDS type FD was significantly delayed than that in healthy individuals , and GE _ ( 120 ) was significantly lower than that of healthy persons , indicating that there were significant gastric motility disorders in patients with PDS type FD .


There was no correlation between the scores of clinical symptoms and the total score of symptoms and GET _ ( 1 / 2 ) and GE _ ( 120 ) in patients with PDS type FD .


The SAS and SDS scores of patients with PDS type FD were significantly higher than those of healthy persons , indicating that PDS type FD patients were more susceptible to psychological disorders than healthy persons .


There was a positive correlation between SAS and SDS scores of PDS type FD patients and their clinical symptoms . The more serious the degree of mental disorder in PDS type FD patients , the more serious the clinical symptoms were .
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R57;R395

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