本文選題：腸易激綜合征 + 功能性消化不良�。� 參考：《北京中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：背景：腸易激綜合征(irritable bowel syndrome,IBS)與功能性消化不良(functional dyspepsia,FD)重疊的情況在臨床上日見增多；并且重疊患者比單病患者具有更嚴(yán)重的臨床癥狀,消耗更多的的醫(yī)療資源,所以臨床對(duì)其的研究需要更加的重視。IBS重疊FD的病因病機(jī)尚未完全明確,但可能涉及精神心理因素、腦-腸軸及腦腸肽、內(nèi)臟高敏感性以及胃腸運(yùn)動(dòng)障礙等,臨床有許多的證據(jù)證明,并且與其對(duì)應(yīng)的治療措施也列入了治療方案。比如心理療法、抗抑郁藥物,胃腸動(dòng)力調(diào)節(jié)藥物的治療等。然而幽門螺桿菌(Helicobacter pylori, Hp)感染作為可能引起IBS重疊FD的因素之一,臨床研究相對(duì)較少。臨床研究發(fā)現(xiàn)FD及IBS的Hp感染率都比常人要高；關(guān)于FD的Hp感染率,以及根除Hp對(duì)FD的影響,臨床研究大部分都已經(jīng)確認(rèn),而對(duì)于IBS與Hp感染的關(guān)系,臨床研究極少,有文獻(xiàn)報(bào)道IBS的Hp感染率較常人高：除此之外,并無其他相關(guān)報(bào)道。關(guān)于IBS重疊FD患者的Hp感染率,根除Hp對(duì)于IBS重疊FD是否具有治療意義等,都未見相關(guān)報(bào)道。臨床上IBS重疊FD的中醫(yī)研究相對(duì)較少,多處于病因病機(jī)層次;臨床也大都支持IBS重疊FD的基本病機(jī)在于肝郁脾虛。對(duì)于其后的研究,包括證候分型,以及治療都尚未進(jìn)展太深。目的：在中醫(yī)理論指導(dǎo)下,對(duì)IBS重疊FD的進(jìn)行中醫(yī)證候分型,并探查各證型的所占比率,以指導(dǎo)臨床治療。探查根除Hp治療對(duì)于IBS重疊FD患者是否具有治療意義,進(jìn)一步研究Hp感染與IBS重疊FD的關(guān)系。方法：對(duì)于符合納入標(biāo)準(zhǔn)的患者,在患者入組時(shí),分別采取腸易激綜合征癥狀量表(IBS-SSS)、功能性消化不良生活質(zhì)量量表(FD-QOL)、醫(yī)院焦慮抑郁自評(píng)量表(HAD)以及胃腸疾病中醫(yī)證候評(píng)分表對(duì)患者進(jìn)行問卷調(diào)查；而在患者根除Hp治療后,予IBS-SSS 及 FD-QOL對(duì)根除治療過后的患者再次進(jìn)行問卷調(diào)查；采用統(tǒng)計(jì)學(xué)方法,對(duì)治療前后進(jìn)行比較,根除Hp治療結(jié)束后1個(gè)月,囑患者采用復(fù)查Hp,記錄Hp根除情況。結(jié)果：(1)Hp在IBS重疊FD患者中的感染率高達(dá)89.13%;比臨床對(duì)于單純IBS患者以及單純FD患者的感染率高。經(jīng)根除Hp治療后,排除未治療或未復(fù)查患者,治療成功率占總治療數(shù)的86.49%。(2)IBS重疊FD患者中,腹痛患者占74.60%；腹脹患者占76.19%。腹痛腹脹同時(shí)存在的情況占50.79%。根除Hp治療后,腹痛癥狀、腹脹癥狀、排便情況以及對(duì)生活的影響情況都得到改善,根據(jù)統(tǒng)計(jì)學(xué)結(jié)果,具有治療意義。(3)IBS重疊FD患者中,腹瀉占總數(shù)的30.16%;便秘占19.05%。排便伴腹痛占76.19%；腹痛時(shí)大便次數(shù)增多且大便更稀,且排便后腹痛癥狀減輕。大便不成形占77.78%；根據(jù)布里斯托爾大便分類方法,4型正常大便占12.70%,根除治療后,占68.75%。(4)IBS重疊FD患者的生活質(zhì)量情況中,壓力的影響嚴(yán)重程度最高。結(jié)合統(tǒng)計(jì)學(xué)研究結(jié)果,根除Hp治療在各領(lǐng)域都具有統(tǒng)計(jì)學(xué)差異。其中,根除Hp治療對(duì)于患者在焦慮、不適癥狀、應(yīng)對(duì)疾病、壓力對(duì)疾病的影響以及總體方面都具有顯著治療意義。(5)IBS重疊FD患者中,處于焦慮狀態(tài)的患者占22.22%,處于抑郁狀態(tài)的患者占26.98%。(6)IBS重疊FD患者中,脾虛濕阻證占15.87%；肝郁脾虛證占12.70%；肝脾(胃)不和證占19.05%；脾胃(腸)濕熱證占19.05%；胃腸燥熱證占11.11%；脾腎(胃)陽虛證所占比例數(shù)為4.76%,為所有證型中最少的證型。寒熱錯(cuò)雜證占17.46%。
[Abstract]:BACKGROUND : The overlap between irritable bowel syndrome ( IBS ) and functional dyspepsia ( FD ) is increasing in clinic .
The pathogenesis of IBS overlapping FD has not been completely clear , but it may involve psychological factors , brain - intestinal axes and intestinal peptide , visceral hypersensitivity and gastrointestinal motility disorders .
Objective : To study the relationship between Hp infection rate and Hp infection rate in patients with IBS and Hp infection .
After eradication of Hp in patients , IBS - SSS and FD - QOL were investigated again after eradication therapy .
Results : ( 1 ) The infection rate of Hp in patients with IBS overlapping FD was 89.13 % . Results : ( 1 ) The infection rate of Hp in patients with IBS overlapping FD was 89.13 % .
After eradication of Hp , the symptoms of abdominal pain , symptoms of abdominal distension , defecation and the influence on life were improved . According to the statistical results , the symptoms of abdominal pain , symptoms of abdominal distension , defecation and the influence on life were improved . According to the statistical results , the diarrhea accounted for 30.16 % of the total .
When abdominal pain , the stool frequency is increased and stool is thinner , and the symptoms of abdominal pain after defecation are relieved , and the stool is not formed to occupy 77.78 % ;
( 4 ) In patients with IBS overlapping FD patients , 22 . 22 % of patients who were in the state of anxiety and 26 . 98 % of the patients who were in the state of depression . ( 6 ) Of the patients with IBS overlap FD , the spleen deficiency wet resistance was 15.87 % .
Liver depression and spleen deficiency accounted for 12.70 % ;
Liver and spleen ( stomach ) were not confirmed to be 19.05 % ;
The damp - heat syndrome of spleen and stomach ( intestine ) accounted for 19.05 % ;
gastrointestinal dryness and heat syndrome accounted for 11 . 11 % ;
The proportion of yang deficiency of spleen and kidney ( stomach ) was 4.76 % , which was the least of all types . The cold and heat syndrome accounted for 17.46 % .
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259

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