生活事件对功能性消化不良患者精神心理状况和疾病的影响

目的探讨功能性消化不良(FD)患者生活事件、心理异常状况以及它们与症状间的关系。方法对114例FD患者和100例对照组进行Zung焦虑自评量表、Zung抑郁自评量表和生活事件量表的问卷调查,对FD患者进行症状评分,然后分析比较。结果(1)FD患者经历的生活事件总值(P=0.014)和负性生活事件值(P<0.001)均高于对照组,正性生活事件值低于对照组(P=0.001);(2)FD患者焦虑、抑郁发生率(P<0.005)和平均焦虑、抑郁程度均高于对照组(P<0.001);(3)FD患者的症状积分与生活事件值无相关性;(4)FD患者的生活事件总值和负性生活事件值与焦虑(P<0.01)、抑郁程度(P<0.05)均呈正相关,正性生活事件值则与它们无相关性。结论患者经历过更多的负性生活事件是FD的特征和诱因之一,它可能通过诱发患者的精神心理因素异常而影响FD的发生发展。     

体重指数、生活满意度和负性生活事件在功能性消化不良发病中的作用

背景：社会和心理因素与功能性胃肠病密切相关,两者在功能性消化不良（FD）中的作用逐渐成为研究热点。目的：探讨体重指数（BMI）、生活满意度和负性生活事件在FD发病中的作用。方法：纳入2009年6月～2010年1月上海市第一人民医院的80例FD患者和80名健康对照者,采用调查问卷和生活事件量表（LES）评估各种因素在FD发病中的作用。结果：FD组的BMI和生活满意度显著低于对照组（P〈0.05）,而性别、年龄、婚姻状况、文化程度、职业情况、居住地、抽烟/饮酒、体育锻炼、医疗费用支付方式与对照组相比无明显差异。FD组负性生活事件频数和刺激量明显高于对照组（P〈0.05）,而正性生活事件无明显差异;Logistic回归分析发现FD的发生与负性生活事件相关。结论：FD的发生与BMI和生活满意度可能相关,负性生活事件可能是FD的危险因素。     

性别对慢性心力衰竭患者生活质量和社会支持的影响

目的：探讨性别对慢性心力衰竭（CHF）患者生活质量和社会支持的影响。方法：采用横断面研究方法,以问卷调查方式分别使用简明健康调查问卷、明尼苏达心力衰竭生活质量问卷和社会支持评判量表对CHF患者的生活质量及社会支持度进行调查。结果：（1）生活质量：①简明健康调查问卷：除生理职能、躯体疼痛维度外,总分和其余6个维度分女性组均明显低于男性组（P〈0．05～〈0．001）;②明尼苏达心力衰竭生活质量问卷：在身体领域、情绪领域、其他领域分和总分方面,女性组的均明显高于男性组的（P〈0．001）;（2）社会支持度：除主观支持维度分外,客观支持、对支持利用度分以及总分女性组明显低于男性组（P〈0．05）。结论 慢性心衰患者在生活质量及社会支持方面存在性别差异,女性患者明显低于男性患者。     

上胃肠道功能和动力障碍性疾病患者的生活质量评价

背景：功能性胃肠病（FGIDs）和胃肠动力障碍性疾病（DGIMs）严重影响患者的生活质量。研究患者的健康相关生活质量（HRQL）对深入理解FGIDs和DGIMs的特点以及评价疗效具有重要意义。目的：评估不同上胃肠道FGIDs和DGIMs患者的生活质量。揭示我国FGIDs和DGIMs患者的生活质量状况和意义。方法：以汉化版简明健康调查量表（SF-36）对140名健康对照者以及135例功能性消化不良（FD）患者、50例非糜烂性反流病（NERD）患者和100例反流性食管炎（RE）患者进行生活质量调查,得到生活质量8个维度的评分和2个综合评分[躯体生理健康总评（PCS）和精神心理健康总评（MCS）]并进行分析比较。瘩果：FD、NERD和RE组的所有8个维度和2个综合评分均显著低于健康对照组（P〈0.05）。其中,FD组生活质量最低。MCS评分下降最为突出。除躯体疼痛外。FD组其他7个维度和2个综合评分均显著低于RE组（P〈0.05）。与NERD组相比,FD组的社会功能、情感职能、精神健康维度和MCS评分显著降低（P〈0．05）。NERD组的生活质量较RE组下降更明显,总体健康、活力维度和PCS评分显著低于RE组（P〈0．05）。结论：FGIDs和DGIMs患者的生活质量明显下降,躯体生理健康和精神心理健康均明显受损。FGIDs患者的生活质量较DGIMs患者更低。尤其是在精神心理健康方面。诊治FGIDs和DGIMs时应重视患者生活质量的评价和改善。     

乙型肝炎肝硬化患者生活质量与社会支持的调查研究

目的调查乙型肝炎肝硬化患者的生活质量和社会支持状况,分析社会支持与生活质量的相关性,为临床有效提高乙型肝炎肝硬化患者的生活质量提供科学依据。方法采用生活质量量表和社会支持评定量表对104例乙型肝炎肝硬化患者的生活质量和社会支持状况进行调查分析。结果乙型肝炎肝硬化患者的生活质量总分及各维度得分均低于常模人群;肝硬化患者客观支持、主观支持和对支持的利用度三方面与常模人群比较,差异有显著性意义（t=-9．875,P〈0．01）;肝硬化患者生活质量与社会支持总分呈显著的正相关（r=-0．597,P〈0．001）,客观支持、主观支持及对支持的利用度三个维度也与生活质量呈正相关（P〈0．05或P〈0．001）。结论帮助乙型肝炎肝硬化患者建立有效的社会支持系统,对提高其生活质量有重要的意义。     

功能性消化不良患者水负荷试验结果及其影响因素

背景：功能性消化不良（FD）与胃肠功能失调、内脏高敏感性、心理因素等有关。目的：分析水负荷试验（WLT）结果与FD患者消化道症状、心理因素和生活质量之间的相关性。方法：纳入180例FD患者和120名健康对照者,以WLT结合B超检查测定受试者的胃容受性舒张和排空功能。评估受试者WLT前后的胃肠道症状,以汉密尔顿焦虑／抑郁量表（HAMA／HAMD）评价心理因素．SF-36量表评价生活质量。结果：FD组WLT最大饮水量显著低于健康对照组（P〈0．05）,38％（68例）的患者最大饮水量异常（〈300m1）,胃液体半排空时间较健康对照组显著延长（P=0．036）,WLT前后胃肠道症状评分均显著高于健康对照组（P〈0．05）。两组男性最大饮水量均显著高于女性（P〈0．05）。FD组最大饮水量与WLT诱发的胃肠道症状评分呈负相关（r=-0．25,P=0．025）,与HAMA／HAMD总分呈负相关（r=-0．47,P〈0．05）,与SF-36评分呈正相关（r=0．45,P〈0．01）。结论：WLT评价FD患者的胃容受性舒张功能和内脏敏感性方法简单,结果可靠。FD患者的最大饮水量显著低于健康人．并受性别和心理因素的影响。     

贲门失弛缓症患者的精神心理因素和生活质量调查

背景：贲门失弛缓症患者的症状常受情绪影响，但情绪因素在贲门失弛缓症发病中的作用尚不清楚。目的：了解贲门失弛缓症患者的生活质量以及精神心理因素在其发病中的作用。方法：对近10年在北京协和医院确诊并完成扩张治疗的347例贲门失弛缓症患者，通过发信以问卷形式进行调查，内容包括患者一般资料、发病诱因和症状加重原因、症状以及汉化版简明健康调查量表SF-36。结果：共收回问卷166份，应答率为47．8％。发病有明显诱因者占63．9％．其中受情绪影响51．2％，过度劳累21.1％，工作压力15．7％，应激事件15．7％；症状加重有明显原因者占62．0％．其中受情绪影响48．8％，过度劳累27．7％，应激事件15．7％，工作压力12．7％。扩张治疗后，患者8项症状均显著改善（P〈0．05），但各维度生活质量仍显著低于健康对照组（P〈0．05）。结论：精神心理因素可诱发、加重贲门失弛缓症患者的症状。扩张治疗可使患者的食管、气道等症状明显改善，并有维持疗效的作用。但患者在生理和心理两方面的生活质量仍明显低于健康人。     

功能性消化不良重叠肠易激综合征患者的消化道症状和生活质量特点

背景：流行病学研究表明，功能性消化不良（FD）与肠易激综合征（IBS）的症状存在相当多的重叠。目的：探讨FD重叠IBS患者的消化道症状和生活质量特点。方法：选取济南市三家医院同期FD重叠IBS以及单纯FD、IBS患者共1410例，行FD和（或）IBS症状以及生活质量问卷调查并评分，对结果进行统计分析。结果：FD重叠IBS组男女比例为1：1．8，其上、下消化道症状分别较单纯FD和IBS组严重fP〈0．01），生活质量受到影响。结论：FD与IBS症状重叠提示两者可能具有共同的神经胃肠病学基础。女性患者多见且消化道症状严重，可能与胃肠道敏感性增高有关。     

网络医疗健康管理对介入患者生活质量的影响

目的：探讨网络医疗健康管理应用对冠状动脉介入（PCI）术后患者生活质量的影响及其影响因素。方法：采用中文版西雅图心绞痛量表（SAQ）对PCI术后出院前100例患者进行测评,并于网络医疗健康管理6个月后再次进行调查。结果：100例PCI术后患者经6个月的网络医疗健康管理后,生活质量5个维度较健康管理前显著提高（P〈0．01）;经多元逐步回归分析表明病程、民族、家族史、文化程度、月收入、年龄对介入术后患者生活质量有显著影响（B=16．005～-5．677,P〈0．05～〈0．01）。结论：对经皮冠状动脉介入术后患者进行网络医疗健康管理有益于预防疾病的发生与发展,有助于提高PCI术后患者的生活质量;病程、民族、家族史、文化程度、月收入、年龄是影响生活质量的主要因素。     

胃食管反流病并功能性消化不良患者临床反流症状及生活质量的特点

[目的]探讨反流性食管炎（RE）和非糜烂性胃食管反流病（NERD）合并功能性消化不良（FD）患者反流症状及生活质量特点。[方法]该研究为多中心临床研究,在济南市的三家医院同期入选RE并FD 35例,NERD并FD73例。均符合内镜下RE的诊断标准,无RE者则为24 h食管pH监测阳性的NERD。进行反流症状及生活质量问卷调查并记录积分,然后对上述资料进行统计比较分析。[结果]①胃食管反流病（GERD）和FD病因尚不清楚,但症状可互相重叠。②NERD并FD临床反流症状积分（13.8±2.2）分,患者尽管没有可见的食管糜烂,但比RE并FD[（10.5±1.9）分]患者重（P〈0.01）,NERD并FD与RE并FD比较,在活力、躯体疼痛和总体健康3个维度上前者低于后者（P〈0.01）,余维度无统计学意义。[结论]①GERD和FD病因可能具有共同的神经胃肠病学基础。②NERD并FD患者反流症状严重,可能与NERD患者食管内脏高敏感性有关,对生活质量影响更大。     

脑卒中与正常人的负性情绪对照研究

目的:探讨负性情绪与脑卒中的发病关系。方法:49例脑卒中病人和50例正常人应用简明智力状态检查表, 症状、焦虑、抑郁自我评定量表,生活事件量表,社会支持评定量表等进行对照调查。结果:脑卒中组的焦虑,抑郁, 强迫,人际敏感,恐怖,偏执,躯体化等因子分均明显高于对照组(P<0．01-<0．001),在一年内的负性生活事件也明显高于对照组(P<0．001),社会支持度却低于对照组(P<0．01)。结论:负性情绪,负性生活事件发生率高, 缺乏社会支持可能是脑卒中发生发展的危险因素。     

个性特征与功能性消化不良的关系

背景:焦虑、抑郁与神经质个性有着密切的联系,并与功能性胃肠病的发病密切相关。目的:调查功能性消化不良(FD)患者与健康人在个性和焦虑、抑郁状态方面的差异,探讨个性特征与FD发病的关系。方法:采用龚耀先修订的艾森克人格问卷(EPQ成人版)和Zung焦虑自评量表(SAS)、抑郁自评量表(SDS)对130例FD患者和110名健康人进行评分,比较两组受试者在精神质、神经质、内外向和掩饰质四个特质个性,以及焦虑、抑郁情绪方面的差异。结果:FD患者的神经质和SAS、SDS分值显著高于健康对照组(P<0.001),内外向分值显著低于健康对照组(P<0.05),两组间精神质和掩饰质分值则无显著差异(P>0.05)。FD患者个性异常的发生率显著高于健康对照组,其神经质评分与SAS、SDS评分呈正相关(P<0.001和P<0.05)。结论:神经质和内向个性与FD密切相关,可能是FD的病理心理学特征和病因之一。     

Psychosocial distress is associated with abnormal gastric myoelectrical activity in patients with functional dyspepsia

OBJECTIVE: Functional dyspepsia (FD) is a heterogeneous and loosely defined clinical syndrome that is characterized by persistent or recurrent abdominal pain or discomfort centered in the upper abdomen without any identifiable structural or biochemical basis. Gastric myoelectrical activity in functional dyspepsia patients with gastric reddish streaks as a subgroup has not previously been investigated and the potential role of psychosocial distress in the genesis of gastric dysrhythmia in patients with FD is unclear. MATERIAL AND METHODS: Electrogastrography was performed in 45 patients with FD and 35 healthy controls for 30 min in the fasting state and 30 min postprandially. Psychological distress and the number and severity of stressful life events were measured using self-rating questionnaires. RESULTS: FD patients had a higher percentage of pre- and postprandial dysrhythmia, lower dominant frequency, and a higher instability coefficient as compared to healthy controls. In FD patients, severity of stressful life events was positively correlated with the percentage of tachygastria in the fasting state (r=0.43, p=0.005) and marginally positively correlated with the percentage of postprandial tachygastria (r=0.253, p=0.098) and instability coefficient of the dominant frequency (r=0.256, p=0.093). Total number of stressful life events was marginally positively correlated with fasting tachygastria (r=0.25, p=0.098) and instability coefficient of the postprandial dominant frequency (r=0.287, p=0.056). Interpersonal sensitivity was found to be negatively correlated with fasting dominant frequency in FD patients (r= - 0.311, p<0.05). CONCLUSIONS: FD patients with gastric reddish streaks have abnormal fasting and postprandial gastric myoelectrical activity. Perceived severity of stressful life events and interpersonal sensitivity are associated with disturbance of gastric myoelectrical activity.     

Factors that impact health-related quality of life in adults with celiac disease： A multicenter study

AIM： TO evaluate the factors involved in the impairment of health-related quality of life （HRQOL） in patients with celiac disease. METHODS： A multicenter, cross-sectional prospective study was performed in patients with celiac disease who completed two HRQOL questionnaires： the gastrointestinal quality of life index （GIQLI） and the EuroQol-5D （EQ）. RESULTS： Three hundred and forty patients （163 controlled with a gluten-free diet, and 177 newly diagnosed with a normal diet） were included. The GIQLI score was significantly better in patients on a gluten- free diet （GFD） than in non-treated patients on their usual diet, both in terms of the overall score （3.3 vs 2.7, respectively; P 〈 0.001）, as well as on the individual questionnaire dimensions. Both the preference value of the EQ as the visual analogue scale were significantly better in treated than in non-treated patients （0.93 vs 0.72 P 〈 0.001 and 80 vs 70 P 〈 0.001, respectively）. Variables significantly associated with a worse HRQOL score were female gender, failure to adhere to a GFD, and symptomatic status. CONCLUSION： In untreated celiac disease, the most important factors that influence patient perception ofhealth are the presence of symptoms and a normal diet. HRQOL improves to levels similar to those described in the general population in celiac disease patients well controlled with a GFD.     

Anxiety and Quality of Life Outcomes After Coronary Artery Bypass Graft Surgery - A Prospective Cohort Study

Improvements in physical and adaptive psychosocial challenges after Coronary artery bypass grafting (CABG) is unclear to what extent these outcomes impact patients' health-related quality of life. This study was to determine the quality of life among patients 3 months after CABG surgery. More specifically, the study examines the contribution of a set of variables on the quality of life. A prospective cohort study was performed over 3 months among 219 adult patients prepared for elective Coronary Artery Bypass Grafting. The data on the baseline measurements Short Form-36 to measure self-reported health-related quality of life and the state-trait anxiety inventory scale to assess anxiety were collected two days before and three months after CABG surgery. The Pearson correlation coefficient was adopted to examine the relationship between confounding, predictor, and dependent variables. Shapiro–Wilk test tested the normality of the distribution of numerical variables. A 2-tailed level of P-value < 0.05 was set to be statistically significant for all analyses. Mean preoperative postoperative physical and mental component score was 34.57 ± 9.6, 43.53 ± 7 and 54.87 ± 1.19, 51.65 ± 9.67, respectively, indicating poor quality of life. Preoperative anxiety uniquely explained with the variation 32.1% and 29.9% and it significantly predicts postoperative physical health quality of life as (β = .535, t = 8.433, P < 0.001) and postoperative mental health quality of life as (β = .475, t = 7.147, P < 0.001) respectively. Significant improvement in physical health over the 3 months was confirmed, but mental health-related quality of life is unconvincing with the substantial contribution of anxiety.     

Long-Term Outcome After Ileal Pouch-Anal Anastomosis: Function and Health-Related Quality of Life

Purpose This study was designed to investigate long-term pouch function and health-related quality of life in a single, large cohort of patients with ileal pouch-anal anastomosis for ulcerative colitis. Methods Data from 370 patients were included in the study. Thirty-nine patients (11 percent) did not have a functioning pouch (failures) but were included in the health-related quality of life analyses. Pouch function (?resland score) and health-related quality of life (Short Form-36) were evaluated by postal questionnaires. A total of 88 percent of the patients with a functioning ileal pouch-anal anastomosis returned the questionnaires vs. 76 percent of the failures. Median follow-up time after ileal pouch-anal anastomosis was 15 years vs. 11 years after failure. An age-matched and gender-matched reference sample (n = 286) was randomly drawn from the Swedish Short Form-36 database. Results Median bowel frequency was six per 24 hours: 76 percent emptied the reservoir at night, 23 percent had urgency, 12 percent had evacuation difficulties, and 17 percent experienced soiling during the day. Fifty-two percent of the males and 32 percent of the females suffered from soiling at night. More than one-half of the patients had occasional perianal soreness, 6 percent considered the pouch to be a social handicap, and 94 percent were satisfied with their pouch. Patients with a functioning ileal pouch-anal anastomosis did not differ from the reference sample on any Short Form-36 domain, except for a reduced score in General Health (P = 0.02). Pouch function was positively correlated to health-related quality of life. Patients with pouch failure had reduced health-related quality of life in most domains. Conclusions Patients’ satisfaction is high and functional outcome is good after ileal pouch-anal anastomosis. Poor pouch function affects health-related quality of life negatively. Patients with failure after ileal pouch-anal anastomosis are substantially limited in a variety of health-related quality of life domains. Supported by the Department of Surgery, Sahlgrenska University Hospital, and by the Anna-Lisa and Bror Bj?rnsson Foundation. Presented at the meeting of the European Council and Association of Coloproctology, September 15 to 17, 2005.     

Quality of Life on Arterial Hypertension: Validity of Known Groups of MINICHAL

Introductions

In the care of hypertension, it is important that health professionals possess available tools that allow evaluating the impairment of the health-related quality of life, according to the severity of hypertension and the risk for cardiovascular events. Among the instruments developed for the assessment of health-related quality of life, there is the Mini-Cuestionario of Calidad de Vida en la Hipertensión Arterial (MINICHAL) recently adapted to the Brazilian culture.

Objective

To estimate the validity of known groups of the Brazilian version of the MINICHAL regarding the classification of risk for cardiovascular events, symptoms, severity of dyspnea and target-organ damage.

Methods

Data of 200 hypertensive outpatients concerning sociodemographic and clinical information and health-related quality of life were gathered by consulting the medical charts and the application of the Brazilian version of MINICHAL. The Mann-Whitney test was used to compare health-related quality of life in relation to symptoms and target-organ damage. The Kruskal-Wallis test and ANOVA with ranks transformation were used to compare health-related quality of life in relation to the classification of risk for cardiovascular events and intensity of dyspnea, respectively.

Results

The MINICHAL was able to discriminate health-related quality of life in relation to symptoms and kidney damage, but did not discriminate health-related quality of life in relation to the classification of risk for cardiovascular events.

Conclusion

The Brazilian version of the MINICHAL is a questionnaire capable of discriminating differences on the health‑related quality of life regarding dyspnea, chest pain, palpitation, lipothymy, cephalea and renal damage.