功能性消化不良罗马Ⅳ标准亚型临床特征研究
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摘要
背景功能性消化不良(FD)是消化不良患者的最常见原因,其症状重叠及精神心理异常十分常见,目前FD的诊断主要以功能性胃肠病的罗马标准为依据。目的了解符合罗马Ⅳ标准的FD不同分型患者的症状、重叠症状及精神心理状况。方法选取2017年6—12月于南通大学附属吴江区第一人民医院消化内科门诊就诊、18周岁以上接受胃镜检查的FD患者为研究对象,根据症状分型分为上腹痛综合征(EPS)48例、餐后不适综合征(PDS)74例及混合型(PDS重叠EPS)50例。对其症状构成、重叠症状及合并焦虑和/或抑郁状态情况进行归纳分析。结果EPS患者有餐后饱胀感、早饱、嗳气、上腹胀气症状者占比低于PDS患者,有上腹痛症状者占比高于PDS患者(P<0.017);混合型患者有餐后饱胀感、早饱、餐后恶心或呕吐症状者占比高于EPS患者,有上腹痛、上腹灼烧感症状者占比高于PDS患者(P<0.017)。混合型患者有重叠症状者占比高于EPS患者(P=0.015)。EPS患者症状总积分低于PDS患者,混合型患者症状总积分高于PDS、EPS患者(P<0.05)。无焦虑状态但有抑郁状态、有抑郁状态EPS患者症状总积分低于PDS患者,无焦虑状态但有抑郁状态、有焦虑状态且有抑郁状态、无焦虑状态且无抑郁状态、有焦虑状态、有抑郁状态混合型患者症状总积分高于PDS、EPS患者(P<0.05)。有重叠症状时,EPS患者症状总积分低于PDS患者;不管有无重叠症状,混合型患者症状总积分高于PDS、EPS患者(P<0.05)。结论 PDS患者较EPS患者的症状更复杂及严重,混合型患者较PDS、EPS患者的症状更复杂及严重。
Background Functional dyspepsia(FD) is the most common dyspepsia problem.Symptom overlap and psychosocial abnormalities are very prevalent in FD patients.Current diagnosis of FD is mainly based on the Roman criteria for functional gastrointestinal disorders.Objective To investigate the symptoms,overlapping symptoms,and mental and psychological conditions in patients with different subtypes of Rome Ⅳ FD.Methods A total of 172 adult outpatients(≥ 18 years old) with FD who received medical services in Department of GI Medicine,the First People's Hospital of Wujiang District Affiliated to Nantong University were enrolled from June to December 2017.All of them underwent gastroscopy,and according to the symptom-based results,48 of them were identified with epigastric pain syndrome(EPS),74 with postprandial discomfort syndrome(PDS),and 50 with PDS and EPS.Inductive analysis of symptom composition,overlapping symptoms,and combined anxiety and/or depression status was performed.Results EPS patients showed lower percentages of postprandial fullness,early satiety,belching and upper abdominal distension,and higher percentage of upper abdominal pain than PDS patients(P<0.017).Those with EPS and PDS had higher percentages of postprandial fullness early satiety and postprandial nausea or vomiting compared with those with only EPS,and had higher percentages of upper abdominal pain and upper abdominal burning sensation than those with only PDS(P<0.017).The proportion of those with PDS and EPS with overlapping symptoms was higher than that of those with EPS(P=0.015).The average total symptom score of patients with EPS was lower than that of patients with PDS(P<0.05).Those with PDS and EPS had higher average total symptom score than those with PDS or EPS(P<0.05).The average total symptom score was found to be lower in EPS patients without anxiety symptom and with depressive symptom,or with depressive symptom compared with corresponding subgroups of PDS patients(P<0.05).The average total symptom score was identified to be higher in patients with both EPS and PDS without anxiety symptom and with depressive symptom,with anxiety symptom and depressive symptom,without anxiety symptom and depressive symptom,with anxiety symptom,or with depressive symptom compared with corresponding subgroups of PDS or EPS patients(P<0.05).EPS patients with overlapping symptoms showed lower average total symptom score compared with PDS patients with overlapping symptoms(P<0.05).Those with PDS and EPS had higher average total symptom score than those with only PDS or EPS(P<0.05),which was not influenced by the prevalence of overlapping symptoms.Conclusion The symptoms of PDS patients are more complicated and serious than those of EPS patients.But when the patients develop both EPS and PDS,the symptoms become even more complicated and severe.
Background Functional dyspepsia(FD) is the most common dyspepsia problem.Symptom overlap and psychosocial abnormalities are very prevalent in FD patients.Current diagnosis of FD is mainly based on the Roman criteria for functional gastrointestinal disorders.Objective To investigate the symptoms,overlapping symptoms,and mental and psychological conditions in patients with different subtypes of Rome Ⅳ FD.Methods A total of 172 adult outpatients(≥ 18 years old) with FD who received medical services in Department of GI Medicine,the First People's Hospital of Wujiang District Affiliated to Nantong University were enrolled from June to December 2017.All of them underwent gastroscopy,and according to the symptom-based results,48 of them were identified with epigastric pain syndrome(EPS),74 with postprandial discomfort syndrome(PDS),and 50 with PDS and EPS.Inductive analysis of symptom composition,overlapping symptoms,and combined anxiety and/or depression status was performed.Results EPS patients showed lower percentages of postprandial fullness,early satiety,belching and upper abdominal distension,and higher percentage of upper abdominal pain than PDS patients(P<0.017).Those with EPS and PDS had higher percentages of postprandial fullness early satiety and postprandial nausea or vomiting compared with those with only EPS,and had higher percentages of upper abdominal pain and upper abdominal burning sensation than those with only PDS(P<0.017).The proportion of those with PDS and EPS with overlapping symptoms was higher than that of those with EPS(P=0.015).The average total symptom score of patients with EPS was lower than that of patients with PDS(P<0.05).Those with PDS and EPS had higher average total symptom score than those with PDS or EPS(P<0.05).The average total symptom score was found to be lower in EPS patients without anxiety symptom and with depressive symptom,or with depressive symptom compared with corresponding subgroups of PDS patients(P<0.05).The average total symptom score was identified to be higher in patients with both EPS and PDS without anxiety symptom and with depressive symptom,with anxiety symptom and depressive symptom,without anxiety symptom and depressive symptom,with anxiety symptom,or with depressive symptom compared with corresponding subgroups of PDS or EPS patients(P<0.05).EPS patients with overlapping symptoms showed lower average total symptom score compared with PDS patients with overlapping symptoms(P<0.05).Those with PDS and EPS had higher average total symptom score than those with only PDS or EPS(P<0.05),which was not influenced by the prevalence of overlapping symptoms.Conclusion The symptoms of PDS patients are more complicated and serious than those of EPS patients.But when the patients develop both EPS and PDS,the symptoms become even more complicated and severe.
引文
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[7]童晶晶,潘琦,高晓阳,等.罗马Ⅲ标准在功能性消化不良诊断和鉴别诊断中的价值[J].中华消化杂志,2009,29(1):25-28.DOI:10.3760/cma.j.issn.0254-1432.2009.01.008.TONG J J,PAN Q,GAO X Y,et al.The value of RomeⅢcriteria in diagnosis and differentiation of functional dyspepsia[J].Chinese Journal of Digestion,2009,29(1):25-28.DOI:10.3760/cma.j.issn.0254-1432.2009.01.008.
[8]潘琦,童晶晶,高晓阳,等.罗马Ⅱ及罗马Ⅲ标准诊断功能性消化不良的比较[J].中华内科杂志,2008,47(12):1030-1032.DOI:10.3321/j.issn.0578-1426.2008.12.019.PAN Q,TONG J J,GAO X Y,et al.Comparison of RomeⅡand RomeⅢcriteria for diagnosis of functional dyspepsia[J].Chinese Journal of Internal Medicine,2008,47(12):1030-1032.DOI:10.3321/j.issn.0578-1426.2008.12.019.
[9]汪龙德,毛兰芳.功能性消化不良的相关研究进展[J].世界华人消化杂志,2017,25(1):84-90.DOI:10.11569/wcjd.v25.i1.84.WANG L D,MAO L F.Research progress on functional dyspepsia[J].World Chinese Journal of Digestion,2017,25(1):84-90.DOI:10.11569/wcjd.v25.i1.84.
[10]KAYAR Y,DANALIOGLU A,KAFEE A A,et al.Gastric myoelectrical actⅣity abnormalities of electrogastrography in patients with functional dyspepsia[J].Turkish Journal of Gastroenterology,2016,27(5):415-420.DOI:10.5152/tjg.2016.16281.
[11]NAPTHALI K,KOLOSKI N,WALKER M M,et al.Women and functional dyspepsia[J].Womens Health(Lond),2016,12(2):241-250.DOI:10.2217/whe.15.88.
[12]ABID S,SIDDIQUI S,JAFRI W.Discriminant value of RomeⅢquestionnaire in dyspeptic patients[J].The Saudi Journal of Gastroenterology,2011,17(2):129-133.DOI:10.4103/1319-3767.77244.
[13]PAUWELS A,ALTAN E,TACK J.The gastric accommodation response to meal intake determines the occurrence of transient lower esophageal sphincter relaxations and reflux events in patients with gastro-esophageal reflux disease[J].Neurogastroenterology Motility,2014,26(4):581-588.DOI:10.1111/nmo.12305.
[14]赵思宁,梁列新.罗马Ⅲ与罗马Ⅳ标准诊断功能性消化不良的差异[J].右江民族医学院学报,2018,40(2):123-127.DOI:CNKI:SUN:YJMZ.0.2018-02-008.ZHAO S N,LIANG L X.Differences between RomanⅢand RomeⅣcriteria in the diagnosis of functional dyspepsia[J].Journal of Youjiang Medical University for Nationalities,2018,40(2):123-127.DOI:CNKI:SUN:YJMZ.0.2018-02-008.
[15]吴改玲,蓝宇.符合罗马Ⅲ标准FD患者心理测试及自主神经功能观察44例[J].世界华人消化杂志,2012,20(16):1473-1477.WU G L,LAN Y.Psychological states and autonomic nervous system function in 44 patients with functional dyspepsia diagnosed based on the RoomⅢcriteria[J].World Chinese Journal of Digestion,2012,20(16):1473-1477.
[16]MIRANDA A.Early life stress and pain:an important link to functional bowel disorders[J].Pediatr Ann,2009,38:279-282.DOI:10.9999/00904481-20090417-010.
[17]ARO P,TALLEY N J,RONKAINEN J,et al.Anxiety is associated with uninvestigated and functional dyspepsia(RomeⅢcriteria)in a Swedish population-based study[J].Gastroenterology,2009,137:94-100.DOI:10.1053/j.gastro.2009.03.039.
[18]HSU Y C,LIOU J M,LIAO S C,et al.Psychopathology and personality trait in subgroups of functional dyspepsia based on RomeⅢcriteria[J].Am J Gastroenterol,2009,104:2534-2542.DOI:10.1038/ajg.2009.328.2019010820190308
[2]宋志强,柯美云,王智凤,等.功能性消化不良重叠症状与精神心理因素关系的初步研究[J].中华消化杂志,2008,28(7):468-471.DOI:10.3760/j.issn.0254-1432.2008.07.012.SONG Z Q,KE M Y,WANG Z F,et al.Relationship between overlapping symptoms and psycho-mental factors in patients with functional dyspepsia[J].Chinese Journal of Digestion,2008,28(7):468-471.DOI:10.3760/j.issn.0254-1432.2008.07.012.
[3]DOUGLAS A,DORSSMAN M D.罗马Ⅳ功能性胃肠病[M].方秀才,侯晓华,译.4版.北京:科学出版社,2016.
[4]孙晓红.功能性消化不良的罗马Ⅳ标准解读[J].中华全科医师杂志,2017,16(9):661-663.DOI:10.3760/cma.j.issn.1671-7368.2017.09.002.SUN X H.Interpretation of RomeⅣcriteria for functional dyspepsia[J].Chinese Journal of General Practitioners,2017,16(9):661-663.DOI:10.3760/cma.j.issn.1671-7368.2017.09.002.
[5]GHOSHAL U C,GWEE K A,CHEN M,et al.Development,translation and validation of enhangced Asian RomeⅢquestionnaires for diagnosis of functional bowel diseases in major Asian languages:a rome foundation-Asian neurogastroenterology and motility association working team report[J].Journal of Neurogastroenterology and Motility,2015,21(1):83-92.DOI:10.5056/jnm14045.
[6]王长虹,丛中.临床心理治疗学[M].北京:人民军医出版社,2001:575-578.
[7]童晶晶,潘琦,高晓阳,等.罗马Ⅲ标准在功能性消化不良诊断和鉴别诊断中的价值[J].中华消化杂志,2009,29(1):25-28.DOI:10.3760/cma.j.issn.0254-1432.2009.01.008.TONG J J,PAN Q,GAO X Y,et al.The value of RomeⅢcriteria in diagnosis and differentiation of functional dyspepsia[J].Chinese Journal of Digestion,2009,29(1):25-28.DOI:10.3760/cma.j.issn.0254-1432.2009.01.008.
[8]潘琦,童晶晶,高晓阳,等.罗马Ⅱ及罗马Ⅲ标准诊断功能性消化不良的比较[J].中华内科杂志,2008,47(12):1030-1032.DOI:10.3321/j.issn.0578-1426.2008.12.019.PAN Q,TONG J J,GAO X Y,et al.Comparison of RomeⅡand RomeⅢcriteria for diagnosis of functional dyspepsia[J].Chinese Journal of Internal Medicine,2008,47(12):1030-1032.DOI:10.3321/j.issn.0578-1426.2008.12.019.
[9]汪龙德,毛兰芳.功能性消化不良的相关研究进展[J].世界华人消化杂志,2017,25(1):84-90.DOI:10.11569/wcjd.v25.i1.84.WANG L D,MAO L F.Research progress on functional dyspepsia[J].World Chinese Journal of Digestion,2017,25(1):84-90.DOI:10.11569/wcjd.v25.i1.84.
[10]KAYAR Y,DANALIOGLU A,KAFEE A A,et al.Gastric myoelectrical actⅣity abnormalities of electrogastrography in patients with functional dyspepsia[J].Turkish Journal of Gastroenterology,2016,27(5):415-420.DOI:10.5152/tjg.2016.16281.
[11]NAPTHALI K,KOLOSKI N,WALKER M M,et al.Women and functional dyspepsia[J].Womens Health(Lond),2016,12(2):241-250.DOI:10.2217/whe.15.88.
[12]ABID S,SIDDIQUI S,JAFRI W.Discriminant value of RomeⅢquestionnaire in dyspeptic patients[J].The Saudi Journal of Gastroenterology,2011,17(2):129-133.DOI:10.4103/1319-3767.77244.
[13]PAUWELS A,ALTAN E,TACK J.The gastric accommodation response to meal intake determines the occurrence of transient lower esophageal sphincter relaxations and reflux events in patients with gastro-esophageal reflux disease[J].Neurogastroenterology Motility,2014,26(4):581-588.DOI:10.1111/nmo.12305.
[14]赵思宁,梁列新.罗马Ⅲ与罗马Ⅳ标准诊断功能性消化不良的差异[J].右江民族医学院学报,2018,40(2):123-127.DOI:CNKI:SUN:YJMZ.0.2018-02-008.ZHAO S N,LIANG L X.Differences between RomanⅢand RomeⅣcriteria in the diagnosis of functional dyspepsia[J].Journal of Youjiang Medical University for Nationalities,2018,40(2):123-127.DOI:CNKI:SUN:YJMZ.0.2018-02-008.
[15]吴改玲,蓝宇.符合罗马Ⅲ标准FD患者心理测试及自主神经功能观察44例[J].世界华人消化杂志,2012,20(16):1473-1477.WU G L,LAN Y.Psychological states and autonomic nervous system function in 44 patients with functional dyspepsia diagnosed based on the RoomⅢcriteria[J].World Chinese Journal of Digestion,2012,20(16):1473-1477.
[16]MIRANDA A.Early life stress and pain:an important link to functional bowel disorders[J].Pediatr Ann,2009,38:279-282.DOI:10.9999/00904481-20090417-010.
[17]ARO P,TALLEY N J,RONKAINEN J,et al.Anxiety is associated with uninvestigated and functional dyspepsia(RomeⅢcriteria)in a Swedish population-based study[J].Gastroenterology,2009,137:94-100.DOI:10.1053/j.gastro.2009.03.039.
[18]HSU Y C,LIOU J M,LIAO S C,et al.Psychopathology and personality trait in subgroups of functional dyspepsia based on RomeⅢcriteria[J].Am J Gastroenterol,2009,104:2534-2542.DOI:10.1038/ajg.2009.328.2019010820190308