本文選題：非糜爛性反流病　切入點：飲食習(xí)慣　出處：《北京協(xié)和醫(yī)學(xué)院》2016年博士論文

【摘要】：非糜爛性反流病和反流性食管炎癥狀譜及其相關(guān)因素分析目的：通過問卷調(diào)查了解NERD和RE患者的一般人口學(xué)特點、反流癥狀譜、飲食習(xí)慣、生活質(zhì)量和精神心理狀態(tài)等,為進一步探討GERD的發(fā)病機制和有效治療提供依據(jù)。對象和方法：本研究納入95例GERD患者,其中NERD患者50例(男18例,女32例,年齡44.1±13.4歲),RE患者45例(男22例,女23例,年齡46.5±9.9歲)。采用問卷調(diào)查的形式對NERD和RE患者的一般人口學(xué)特征、癥狀學(xué)特點、飲食和生活習(xí)慣、生活質(zhì)量、精神心理等方面進行分析比較。結(jié)果：(1)NERD組反食癥狀評分和反食癥狀發(fā)生率均低于RE組[0(0,2)vs.2.0(0,3.0),P0.05；45.0% vs.64.4%,P0.05],兩組癥狀總評分無顯著性差異[8.0(6.0,11.0)vs.10.0(7.0,13.0),P0.05]。(2)NERD組反流癥狀的飲食結(jié)構(gòu)的誘因前五位依次是：牛奶、辛辣飲食、蔥或姜、巧克力、酸奶,除飲食外的生活方式前五位依次是：情緒、進食過快、著涼、鍛煉少、睡眠差。(3)NERD合并心理異常組的反流癥狀積分顯著高于無心理異常組(10.9±4.7 vs.8.3±2.8, P0.05)。(4) NERD患者焦慮、抑郁評分與反流癥狀積分相關(guān)(r=0.42,P0.01;r=0.29,P0.05),反流癥狀積分與GERD-HRQL顯著相關(guān)(r=0.49,P0.01)。結(jié)論：NERD組反食癥狀較RE組輕,但兩組癥狀總評分無顯著性差異。飲食和不良生活習(xí)慣在NERD癥狀發(fā)生中起一定作用。NERD患者反流癥狀和生活質(zhì)量、精神心理狀態(tài)顯著相關(guān)。MII-pH監(jiān)測結(jié)合酸灌注試驗評價NERD遠端食管功能及NERD患者的生活質(zhì)量觀察與評價目的：24h食管多通道腔內(nèi)阻抗-pH (MII-pH)監(jiān)測及酸灌注試驗研究非糜爛性反流病(NERD)患者食管功能。同時通過SF-36生活量表評價NERD患者的生活質(zhì)量。對象和方法：選取2014年9月至2015年7月我院的NERD患者45例和健康志愿者30例,行24h MII-pH監(jiān)測、酸灌注試驗及和SF-36生活量表測評。一、結(jié)果： (1)NERD組24 h MII-pH監(jiān)測DeMeester評分6.7(3.6-10.1),酸反流27.8(13.9-43.2)次,非酸反流26.8(18.0-42.6)次,均顯著高于健康對照組(1.4(0.2-3.2),0.4(0.2-0.7)%,5.0(2.2-10.7),5.7(3.6-9.1),P0.01)。(2)NERD患者食管遠端阻抗基線和阻抗恢復(fù)速率顯著低于健康對照組(2996±701 Ω vs.3880±1054 Ω, P0.01; 30.1±14.0 Ω/min vs.53.0±14.5 Ω/min,P0.01)。(3)酸灌注試驗陽性的NERD患者食管阻抗基線和阻抗恢復(fù)速率顯著低于酸灌注試驗陰性的患者(2758±660 Ω vs. 3410±536 Ω, P 0.01; 24.9±13.3 Ω/min vs.33.7±10.3 Ω/min, P0.05)。(4)與HS相比,NERD在所有8個維度和2個綜合評分均明顯低于HS(P0.05),尤其是在生理職能(RP)、情感職能(RE)和總體健康(GH)的維度下降更突出。結(jié)論：1.NERD患者教健康者比較存在明顯的食管功能異常。2.NERD患者生活質(zhì)量評價中精神心理健康受損比較明顯,3.臨床診治中都應(yīng)注意患者有無異常的精神心理因素,并給予心理支持。非糜爛性反流病的特異性治療目的：非糜爛性反流病患者隨機分為經(jīng)驗治療組和特異治療組,觀察特異性治療非糜爛性食管炎的治療效果,對NERD的治療有積極的指導(dǎo)作用。對象和方法：2014年1月至2015年12月期間,多家醫(yī)院消化內(nèi)科門診的非糜爛性食管炎患者48例。所有納入觀察的NERD患者,簽署知情同意書,采用問卷形式調(diào)查患者性別、年齡、身高、體量、病程、家族史。RDQ記錄患者臨床癥狀程度積分,HAM-D/HAM-A記錄患者焦慮抑郁狀況；食管動力監(jiān)測及24 h MII-pH監(jiān)測。隨機分為特異治療組和經(jīng)驗治療組各24例。結(jié)果：(1)特異治療組中,動力異常10例(占41.7%),心理精神異常14例(占58.3%)。經(jīng)驗治療組中,動力異常11例(占45.7%),心理精神異常13例(占54.3%)。(2)治療前兩組患者RDQ癥狀程度積分比較,差異無統(tǒng)計學(xué)意義(P0.05)；治療后兩組患者臨床癥狀程度總評分均顯著低于同組治療前,癥狀積分降低程度比較,特異治療組低于經(jīng)驗治療組,差異均有統(tǒng)計學(xué)意義(P0.05)。(3)治療前兩組的焦慮、抑郁評分比較,差異無統(tǒng)計學(xué)意義；治療后兩組的焦慮、抑郁評分均低于同組治療前,評分降低程度比較,特異治療組低于經(jīng)驗治療組,差異均有統(tǒng)計學(xué)意義(P0.05)。結(jié)論：在NERD的治療方案中,特異性的治療可增強療效,有效緩解疾病的臨床癥狀,增加患者機體耐受性,值得臨床推廣應(yīng)用。
[Abstract]:Objective : To investigate the general demographic characteristics , reflux symptoms , dietary habits , quality of life and mental state of NERD and RE patients by questionnaire . The general demographic characteristics , symptoms , diet and living habits , quality of life and mental state of NERD and RE patients were analyzed by questionnaire . Results : ( 1 ) The incidence of anti - food symptom scores and anti - food symptoms in NERD group were lower than that in RE group ( 0 , 2 ) vs . 2.0 ( 0 , 3.0 ) , P0.05 ;
( 3 ) The scores of anti - reflux symptoms in NERD patients were significantly higher than those in the group without psychological abnormality ( 10.9 鹵 4.7 vs . 8.3 鹵 2.8 , P0.05 ) . The results were as follows : ( 1 ) The results were as follows : ( 1 ) In NERD patients , 45 patients with NERD and 30 healthy volunteers were evaluated . The results were as follows : ( 1 ) The results were as follows : ( 1 ) The control group NERD patients were monitored by pH monitoring and acid perfusion . The results showed that the baseline and impedance recovery rate of NERD patients was significantly lower than those in healthy controls ( P 0.01 ; 30.1 鹵 14.0 惟 / min vs . 53.0 鹵 14.5 惟 / min , P0.01 ) . Conclusion : Compared with HS , NERD significantly lower than HS ( P0.05 ) , especially in physiological function ( RP ) , emotional function ( RE ) and overall health ( GH ) . Conclusion : 1 . Patients with non - erosive reflux disease have obvious mental health impairment .
Results : ( 1 ) There were 10 cases ( 45.7 % ) in the specific treatment group and 14 cases ( 58.3 % ) of mental disorders .
The scores of clinical symptoms were significantly lower in the two groups after treatment than that before treatment ( P0.05 ) . ( 3 ) There was no significant difference in the anxiety and depression scores between the two groups before treatment .
Conclusion : In the treatment of NERD , the specific treatment can enhance the curative effect , effectively alleviate the clinical symptoms of the disease , increase the tolerance of the patient , and is worthy of clinical application .

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R571

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