胃食管反流病中医证型分布与焦虑抑郁关系的研究
|
摘要
目的探讨胃食管反流病(GERD)的中医证型与病程、年龄、性别及自身焦虑、抑郁的相关性。方法选取2010年1月～2012年4月上海龙华医院消化科符合GERD的西医诊断的146例患者进行问卷调查,收集数据进行统计分析,探求证型与相关因素之间的关系。结果在纳入的146例病例中,脾虚气逆型56例,肝胃郁热型49例,气郁痰阻型36例,胆热犯胃型4例,瘀血阻络型1例。GERD好发于40～59岁的患者,该年龄段各证型发生率基本一致;在20～39岁,GERD患者多为肝胃郁热型,而>60岁的患者多为脾虚气逆型。脾虚气逆型患者病程明显长于肝胃郁热及气郁痰阻型患者(P=0.02)。性别与肝胃郁热型及气郁痰阻型GERD相关(P=0.003,P=0.001),肝胃郁热型的GERD患者中男性显著多于女性,而气郁痰阻型的患者中女性显著多于男性。三个证型焦虑、抑郁积分比较,差异均有统计学意义(P=0.02,P <0.001)。结论 GERD的发生与年龄显著相关,其肝胃郁热型以及气郁痰阻型患者普遍存在焦虑、抑郁。
Objective To investigate the relationship between traditional Chinese medicine syndrome types of gastroesophageal reflux disease(GERD) and disease duration, age, gender and self-anxiety and depression. Methods From January 2010 to April 2012, 146 patients from the Department of Gastroenterology of Shanghai Longhua Hospital who met the GERD diagnosis of Western medicine were selected for questionnaire survey. Data were collected for statistical analysis to explore the relationship between syndrome types and related factors. Results Among the 146 cases included,56 cases were spleen-deficiency type, 49 cases were liver-stomach-stagnation type, 36 cases were qi-stagnation-resistance type, 4 cases were biliary-heat-stomach type, and 1 case was phlegm-blocking type. GERD always occurred in40-59 years old patients, and the incidence of each type of syndrome was basically the same in this age group. In 20-39 years old, most patients with GERD were liver-stomach-stagnation type, while those over 60 years old were mainly spleen-deficiency type. The course of disease in patients of spleen-deficiency type was significantly longer than that in patients of liver-stomach-stagnation type and qi-stagnation-resistance type(P = 0.02). Gender was correlated with GERD of liver-stomach-stagnation type and qi-stagnation-resistance type(P = 0.003, P = 0.001). Males were significantly more than females in GERD of liver-stomach-stagnation type, while females were significantly more than males in GERD of qi-stagnation-resistance type. The scores of anxiety and depression of the three syndromes were significantly different(P = 0.02, P < 0.001). Conclusion The occurrence of GERD is significantly correlated with age. Anxiety and depression are common in patients with liver-stomach-stagnation type and qi-stagnationresistance type.
Objective To investigate the relationship between traditional Chinese medicine syndrome types of gastroesophageal reflux disease(GERD) and disease duration, age, gender and self-anxiety and depression. Methods From January 2010 to April 2012, 146 patients from the Department of Gastroenterology of Shanghai Longhua Hospital who met the GERD diagnosis of Western medicine were selected for questionnaire survey. Data were collected for statistical analysis to explore the relationship between syndrome types and related factors. Results Among the 146 cases included,56 cases were spleen-deficiency type, 49 cases were liver-stomach-stagnation type, 36 cases were qi-stagnation-resistance type, 4 cases were biliary-heat-stomach type, and 1 case was phlegm-blocking type. GERD always occurred in40-59 years old patients, and the incidence of each type of syndrome was basically the same in this age group. In 20-39 years old, most patients with GERD were liver-stomach-stagnation type, while those over 60 years old were mainly spleen-deficiency type. The course of disease in patients of spleen-deficiency type was significantly longer than that in patients of liver-stomach-stagnation type and qi-stagnation-resistance type(P = 0.02). Gender was correlated with GERD of liver-stomach-stagnation type and qi-stagnation-resistance type(P = 0.003, P = 0.001). Males were significantly more than females in GERD of liver-stomach-stagnation type, while females were significantly more than males in GERD of qi-stagnation-resistance type. The scores of anxiety and depression of the three syndromes were significantly different(P = 0.02, P < 0.001). Conclusion The occurrence of GERD is significantly correlated with age. Anxiety and depression are common in patients with liver-stomach-stagnation type and qi-stagnationresistance type.
引文
[1]Vakil N,van Zanten SV,Kahrilas P,et al. The Montreal definition and classification of gastroesophageal reflux disease:a global evidence based consensus[J]. Am J Gastroenteml,2006,101(8):1900-1920.
[2]Yadlapati R,DeLay K. Proton pump inhibitor-refractory gastroesophageal reflux disease[J]. Med Clin North Am,2019,103(1):15-27.
[3]李华岳,马昕宇.针刺督脉背段联合中药治疗非糜烂性胃食管反流疗效观察[J].上海针灸杂志,2018,37(11):1229-1234.
[4]Lee SW,Lien HC,Chang CS,et al. Association of metabolic syndrome with erosive esophagitis and Barret′s esophagus in a Chinese population[J]. J Chin Med Assoc,2017,80(1):15-18.
[5]张晓静,戴昌志,兰丽,等.上海地区居民健康与居住环境的关联性分析[J].上海交通大学学报,2014,48(6):798-803.
[6]中国胃食管反流病共识意见专家组.2006年中国胃食管反流病专家共识意见[J].中华内科杂志,2007,46(2):170-173.
[7]中华中医药学会脾胃病分会.胃食管反流病中医诊疗共识意见(2009,深圳)[J].中医杂志,2010,51(9):844-847.
[8]郭念锋.国家职业资格培训教程心理咨询师(三级)[M].北京:民族出版社,2012.
[9]韩天明.应用焦虑自评量表(SAS)对心理咨询患者的心理分析[J].海南医学,2003,14(7):59.
[10]Kulig M,Nocon M,Vieth M,et al. Risk factors of gastrophageal reflux disease:methodology ang first epidemiological results of ProGERD study[J]. J Clin Epidenmiol,2004,57(6):580-589.
[11]de Bortoli N,Tolone S,Frazzoni M,et al. Gastroesophageal reflux disease,functional dyspepsia and irritable bowel syndrome:common overlapping gastrointestinal disorders[J].Ann Gastroenterol,2018,31:639-648.
[12]潘国宗,许国铭,郭慧平,等.北京上海胃食管反流症状的流行病学调查[J].中华消化杂志,1999,19:223-226.
[13]Chen MH,Xiong LS,Chen HX,et al. Prevalence,risk factors and impact gastroesophageal reflux disease symptoms:a population-based study in South China[J]. Scand J Gastroenterol,2005,40(7):759-767.
[14]魏蓉溪.胃食管反流病中医虚实证候患者高分辨率食管压力测定特点分析[D].北京:北京中医药大学,2018.
[15]陈思羽,朱永钦,朱永苹,等.“舒肝和胃汤”联合雷贝拉唑钠肠溶胶囊治疗反流性食管炎60例临床研究[J].江苏中医药,2018,50(9):33-35.
[16]张鑫,穆秋红,陈峭.小柴胡汤配合背俞指针疗法治疗胃食管反流病肝胃郁热证的临床疗效观察[J].中医临床研究,2018,10(13):25-27.
[17]穆湘霖.慢性胃炎伴焦虑抑郁状态的证候研究[D].南宁:广西中医药大学,2018.
[18]郝悦,黄裕新,王景杰.心理性应激对大鼠胃排空的影响及胃粘膜的损伤[J].第四军医大学学报,2002,23(7):60.
[19]Bilgi MM,Vardar R,Y?ld?r?m E,et al. Prevalence of Psychiatric Comorbidity in Symptomatic Gastroesophageal Reflux Subgroups[J]. Dig Dis Sci,2017,62:984-993.
[20]黄艳.胃食管反流病患者精神心理状态与临床疗效的相关性研究[J].中国医学前沿杂志:电子版,2016,8(8):60-63.
[2]Yadlapati R,DeLay K. Proton pump inhibitor-refractory gastroesophageal reflux disease[J]. Med Clin North Am,2019,103(1):15-27.
[3]李华岳,马昕宇.针刺督脉背段联合中药治疗非糜烂性胃食管反流疗效观察[J].上海针灸杂志,2018,37(11):1229-1234.
[4]Lee SW,Lien HC,Chang CS,et al. Association of metabolic syndrome with erosive esophagitis and Barret′s esophagus in a Chinese population[J]. J Chin Med Assoc,2017,80(1):15-18.
[5]张晓静,戴昌志,兰丽,等.上海地区居民健康与居住环境的关联性分析[J].上海交通大学学报,2014,48(6):798-803.
[6]中国胃食管反流病共识意见专家组.2006年中国胃食管反流病专家共识意见[J].中华内科杂志,2007,46(2):170-173.
[7]中华中医药学会脾胃病分会.胃食管反流病中医诊疗共识意见(2009,深圳)[J].中医杂志,2010,51(9):844-847.
[8]郭念锋.国家职业资格培训教程心理咨询师(三级)[M].北京:民族出版社,2012.
[9]韩天明.应用焦虑自评量表(SAS)对心理咨询患者的心理分析[J].海南医学,2003,14(7):59.
[10]Kulig M,Nocon M,Vieth M,et al. Risk factors of gastrophageal reflux disease:methodology ang first epidemiological results of ProGERD study[J]. J Clin Epidenmiol,2004,57(6):580-589.
[11]de Bortoli N,Tolone S,Frazzoni M,et al. Gastroesophageal reflux disease,functional dyspepsia and irritable bowel syndrome:common overlapping gastrointestinal disorders[J].Ann Gastroenterol,2018,31:639-648.
[12]潘国宗,许国铭,郭慧平,等.北京上海胃食管反流症状的流行病学调查[J].中华消化杂志,1999,19:223-226.
[13]Chen MH,Xiong LS,Chen HX,et al. Prevalence,risk factors and impact gastroesophageal reflux disease symptoms:a population-based study in South China[J]. Scand J Gastroenterol,2005,40(7):759-767.
[14]魏蓉溪.胃食管反流病中医虚实证候患者高分辨率食管压力测定特点分析[D].北京:北京中医药大学,2018.
[15]陈思羽,朱永钦,朱永苹,等.“舒肝和胃汤”联合雷贝拉唑钠肠溶胶囊治疗反流性食管炎60例临床研究[J].江苏中医药,2018,50(9):33-35.
[16]张鑫,穆秋红,陈峭.小柴胡汤配合背俞指针疗法治疗胃食管反流病肝胃郁热证的临床疗效观察[J].中医临床研究,2018,10(13):25-27.
[17]穆湘霖.慢性胃炎伴焦虑抑郁状态的证候研究[D].南宁:广西中医药大学,2018.
[18]郝悦,黄裕新,王景杰.心理性应激对大鼠胃排空的影响及胃粘膜的损伤[J].第四军医大学学报,2002,23(7):60.
[19]Bilgi MM,Vardar R,Y?ld?r?m E,et al. Prevalence of Psychiatric Comorbidity in Symptomatic Gastroesophageal Reflux Subgroups[J]. Dig Dis Sci,2017,62:984-993.
[20]黄艳.胃食管反流病患者精神心理状态与临床疗效的相关性研究[J].中国医学前沿杂志:电子版,2016,8(8):60-63.