合并上消化道症状对功能性便秘患者焦虑、抑郁及生活质量的影响

俞汀; 朱锋; 林琳; 汤玉蓉

doi:10.16766/j.cnki.issn.1674-4152.002668

合并上消化道症状对功能性便秘患者焦虑、抑郁及生活质量的影响

doi: 10.16766/j.cnki.issn.1674-4152.002668

南京医科大学第一附属医院消化科，江苏南京 210029

基金项目:

国家自然科学基金面上项目 81870378

国家自然科学基金青年基金项目 82000508

详细信息

通讯作者:
汤玉蓉, E-mail: story_tyr@163.com

中图分类号: R57 R442.2
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出版历程
- 收稿日期: 2021-12-05
- 网络出版日期: 2022-11-30

Impact of combined upper gastrointestinal symptoms on anxiety, depression and quality of life of patients with functional constipation

Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China

摘要

摘要: 目的探讨合并上消化道症状(GI)对功能性便秘(FC)患者焦虑、抑郁及生活质量(HRQoL)的影响。方法根据罗马Ⅳ标准纳入2016年10月—2019年10月于南京医科大学第一附属医院胃肠动力中心就诊的156例FC患者，分别采用胃肠道症状评分量表(GSRS)、ZUNG焦虑、抑郁自评量表(SAS/SDS)和简明健康调查问卷(SF-36)评估患者上消化道症状、焦虑、抑郁及健康相关生活质量。结果 156例FC患者中有95例(60.90%)合并上消化道症状。其中，单纯合并反酸/烧心11例(7.05%)，单纯合并上腹胀23例(14.74%)，单纯合并嗳气11例(7.05%)，同时合并反酸/烧心与上腹胀7例(4.49%)，同时合并嗳气与上腹胀32例(20.51%)，同时合并嗳气与反酸/烧心11例(7.05%)。与无上消化道症状组相比，合并上消化道症状组SAS、SDS评分显著增高(均P < 0.05)，生理功能、生理职能、一般健康、情感职能、精神健康评分显著降低(均P < 0.05)。而在合并上消化道症状的FC患者中，同时合并嗳气与上腹胀组SAS、SDS评分最高，生理职能、社会功能、情感职能评分最低。多元线性回归分析显示，同时合并嗳气与上腹胀及SAS评分高是SF-36总评分的负性预测因子(均P＜0.05)。结论反酸/烧心、上腹胀及嗳气是FC患者最常见的上消化道症状，合并上消化道症状加重FC患者焦虑、抑郁，降低健康相关生活质量。
- 功能性便秘 /
- 上消化道症状 /
- 焦虑 /
- 抑郁 /
- 健康相关生活质量
Abstract: Objective To explore the effect of combined upper gastrointestinal (GI) symptoms on anxiety, depression and health-related quality of life (HRQoL) in patients with functional constipation (FC). Methods According to the Rome Ⅳ diagnostic criteria, patients with FC who were admitted to the Gastrointestinal Motility Center of the First Affiliated Hospital of Nanjing Medical University from October 2016 to October 2019 were included. Gastrointestinal symptom rating scale, ZUNG anxiety and depression self-rating scale (SAS and SDS) and concise health questionnaire (SF-36) were used in assessing upper GI symptoms, anxiety and depression and HRQoL. Results Among 156 patients with FC, 95 (60.90%) had upper gastrointestinal symptoms: 11(7.05%) only had acid reflux and heartburn, 23(14.74%) only had upper abdominal distension, 11(7.05%) only had belching, 7(4.49%) had acid reflux, heartburn and upper abdominal distension, 32(20.51%) had belching and upper abdominal distension and 11(7.05%) had belching, acid reflux and heartburn. Compared with FC patients without upper GI symptoms, those who had upper GI symptoms show higher scores of SAS and SDS (all P < 0.05), and lower score of role physical, physical functioning, general health, role emotional and mental health (all P < 0.05). Among patients with upper GI symptoms, patients who had both belching and upper abdominal distension show higher scores of SAS and SDS, and lower scores of physical functioning, social functioning and role emotional. Furthermore, combined with both belching and upper abdominal distension and high score of SAS was predictor of poorer SF-36 total score (all P < 0.05). Conclusion Acid reflux and heartburn, upper abdominal distension and belching are the most common upper GI symptoms in patients with FC. The combined upper GI symptoms increases anxiety and depression and reduce the HRQoL in the patients.
- Functional constipation /
- Upper gastrointestinal symptoms /
- Anxiety /
- Depression /
- Health-related quality of life

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表 1 合并上消化道症状与不合并上消化道症状的FC患者SAS、SDS评分比较(x±s，分)

Table 1. Comparison of SAS and SDS scores between FC patients with and without upper gastrointestinal symptoms (x±s, points)

组别	例数	SAS	SDS
合并上消化道症状组	95	42.83±8.05	50.43±10.75
不合并上消化道症状组	61	39.47±8.71	45.74±9.09
t值		2.413	2.771
P值		0.017	0.006

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表 2 合并不同上消化道症状的FC患者SAS、SDS评分比较(x±s，分)

Table 2. Comparison of SAS and SDS scores in FC patients with different upper gastrointestinal symptoms (x±s, points)

组别	例数	SAS	SDS
单纯合并反酸/烧心组	11	35.73±6.54	45.18±10.45
单纯合并上腹胀组	23	42.87±7.70^a	48.74±10.44
单纯合并嗳气组	11	37.36±7.61^b	43.64±9.78
合并反酸/烧心与上腹胀组	7	45.57±7.35^ac	52.14±9.35
合并嗳气与上腹胀组	32	48.03±6.00^abc	55.13±9.52^abc
合并嗳气与反酸/烧心组	11	38.45±5.77	51.27±12.15
F值		8.770	3.097
P值		< 0.001	0.013
注：与单纯合并反酸/烧心组比较，^aP＜0.05；与单纯合并上腹胀组比较，^bP＜0.05；与单纯合并嗳气组比较，^cP＜0.05。

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表 3 合并上消化道症状与不合并上消化道症状的FC患者SF-36各维度评分比较[M(P₂₅, P₇₅)，分]

Table 3. Comparison of SF-36 scores in FC patients with and without upper gastrointestinal symptoms [M(P₂₅, P₇₅), points]

组别	例数	生理功能	生理职能	躯体疼痛	一般健康状况	精力	社会功能	情感职能	精神健康
合并上消化道症状组	95	85.0(54.0，95.0)	75.0(25.0, 100.0)	82.0(67.0, 100.0)	73.0(47.0, 88.0)	67.0(40.0，85.0)	55.0(40.0, 80.0)	40.0(0, 76.0)	60.0(48.0, 77.0)
不合并上消化道症状组	61	95.0(90.0, 100.0)	100.0(25.0, 100.0)	88.0(71.0, 100.0)	88.0(63.0, 100.0)	75.0(60.0, 85.0)	52.0(35.0, 67.0)	100.0(33.0, 100.0)	68.0(60.0, 84.0)
Z值		-3.570	-2.177	-1.919	-3.410	-1.262	-1.487	-4.123	-2.453
P值		< 0.001	0.030	0.055	0.001	0.207	0.137	< 0.001	0.014

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表 4 合并不同上消化道症状的FC患者SF-36各维度评分比较[M(P₂₅, P₇₅)，分]

Table 4. Comparison of SF-36 scores in FC patients with different upper gastrointestinal symptoms [M(P₂₅, P₇₅), points]

组别	例数	生理功能	生理职能	躯体疼痛	一般健康状况
单纯合并反酸/烧心组	11	85.0(80.0, 100.0)	100.0(50.0, 100.0)	82.0(70.0, 100.0)	77.5(55.0, 90.0)
单纯合并上腹胀组	23	95.0(50.0, 100.0)	87.5(50.0, 100.0)	81.5(63.0, 100.0)	70.0(45.0, 87.5)
单纯合并嗳气组	11	75.0(19.0，100.0)	87.5(78.0，100.0)	75.0(72.0，91.0)	77.5(60.0, 87.5)
合并反酸/烧心与上腹胀组	7	85.0(65.0, 95.0)	25.0(25.0, 100.0)^ab	69.5(65.0, 100.0)	100.0(68.0, 100.0)
合并嗳气与上腹胀组	32	80.0(50.0, 90.0)	25.0(0，100.0)^abc	79.8(62.0, 86.9)	66.3(41.0, 77.5)
合并嗳气与反酸/烧心组	11	90.0(70.0, 95.0)	75.0(25.0, 100.0)	94.0(70.0, 100.0)	75.0(55.0, 100.0)
H值		7.120	17.192	3.205	7.858
P值		0.212	0.004	0.668	0.164

组别	例数	精力	社会功能	情感职能	精神健康
单纯合并反酸/烧心组	11	70.0(60.0, 80.0)	50.0(40.0, 65.0)	100.0(0, 100.0)	68.0(52.0, 76.0)
单纯合并上腹胀组	23	55.0(33.0, 100.0)	80.0(40.0, 95.0)	40.0(30.0, 75.0)	52.0(44.0, 80.0)
单纯合并嗳气组	11	83.3(33.0，100.0)	90.0(87.5, 95.0)^a	62.0(38.0, 72.0)	74.0(63.0, 80.0)
合并反酸/烧心与上腹胀组	7	75.0(70.0, 85.0)	70.0(50.0, 70.0)^c	100.0(33.0, 100.0)	76.0(30.0, 80.0)
合并嗳气与上腹胀组	32	65.0(41.0, 79.0)	45.0(40.0, 63.7)^abc	0(0, 100.0)^abcd	58.0(40.0, 71.0)
合并嗳气与反酸/烧心组	11	72.5(50.0, 85.0)	55.0(30.0, 65.0)^c	66.7(33.3, 100.0)	68.0(52.0, 84.0)
H值		4.719	25.838	17.572	7.175
P值		0.451	< 0.001	0.004	0.208
注：与单纯合并反酸/烧心组比较，^aP＜0.05；与单纯合并上腹胀组比较，^bP＜0.05；与单纯合并嗳气组比较，^cP＜0.05；与合并嗳气与反酸/烧心组比较，^dP＜0.05。

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表 5 所有FC患者SF-36总评分的预测因素分析

Table 5. Analysis of predictors of total SF-36 score in all FC patients

变量	B	SE	β	t值	P值
年龄	-0.720	0.680	-0.086	-1.059	0.291
女性	-12.208	25.529	-0.038	-0.478	0.633
不合并上消化道症状	-19.691	51.405	-0.060	-0.383	0.702
单纯合并反酸/烧心	-46.641	65.823	-0.077	-0.709	0.480
单纯合并上腹胀	-28.059	53.617	-0.063	-0.523	0.602
单纯合并嗳气	19.691	51.405	0.031	0.383	0.702
合并反酸/烧心与上腹胀	15.577	73.747	0.021	0.211	0.833
合并嗳气与上腹胀	-98.839	53.787	-0.257	-1.838	0.038
合并嗳气与反酸/烧心	-34.588	67.563	-0.057	-0.512	0.610
SAS	-6.887	1.190	-0.461	-5.788	< 0.001
SDS	0.412	1.565	0.024	0.263	0.793
注：各变量赋值方法如下，年龄、SAS和SDS均以实际值赋值，女性(是=1，否=0)，不合并上消化道症状(是=1，否=0)，单纯合并反酸/烧心(是=1，否=0)，单纯合并上腹胀(是=1，否=0), 单纯合并嗳气(是=1，否=0), 合并反酸/烧心与上腹胀(是=1，否=0), 合并嗳气与上腹胀(是=1，否=0), 合并嗳气与反酸/烧心(是=1，否=0)。

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