抗抑郁药治疗功能性胃肠病的研究进展

功能性胃肠病（FGIDs）包括功能性消化不良（FD）和肠易激综合征（IBS）等。近年来诸多研究显示精神心理因素在FGIDs的发生、发展过程中起重要作用。在临床上抗抑郁药被广泛应用于FGIDs的治疗。与传统剂量相比,小剂量抗抑郁药具有疗效相似、不良反应小、依从性高的特点。本文就抗抑郁药治疗FGIDs的研究进展作一综述。     

抗抑郁药治疗功能性胃肠病的现状

功能性胃肠病（functional gastrointestinal disorders,FGIDs）是消化内科常见的一组疾病.近年来诸多研究表明FGIDs患者存在明显的精神心理异常,其中焦虑抑郁情绪障碍尤为突出,改善精神心理状态的药物对FGIDs有一定的疗效.临床上广泛用抗抑郁药来治疗功能性胃肠病.本文就抗抑郁药治疗功能性胃肠病的有关文献作一概述.     

精神心理因素在功能性胃肠病症状重叠中的作用及其机制

功能性胃肠病（FGIDs）是消化系统常见疾病,其发病机制复杂,至今尚未完全明了。近来研究发现,不同类型的FGIDs之间常存在症状重叠,且精神心理因素在FGIDs症状重叠的发生、发展中具有重要作用。本文就精神心理因素在FGIDs症状重叠中的作用及其机制作一综述。     

肠神经系统在功能性胃肠病发病中的作用

肠神经系统对胃肠道运动、分泌和血液供应具有独立的调节作用,功能性胃肠病（FGIDs）的慢性症状如腹泻、便秘和疼痛与肠神经调控的胃肠道功能异常有关。某些FGIDs存在肠神经递质表达异常,甚至神经元退行性改变;肠神经系统与肠道Cajal间质细胞、胶质细胞和免疫细胞连接和功能的异常亦可能参与了FGIDs的发病;脑-肠轴功能紊乱是应激和感染后肠易激综合征的发病机制之一。肠神经系统在FGIDs的发病中具有重要作用,以肠神经为靶点为开发治疗FGIDs的有效药物开辟了广阔的前景。     

抗抑郁药治疗难治性消化不良的临床研究

目的探讨精神心理因素与难治性功能性消化不良(FD)的关系及抗抑郁药、心理治疗的疗效。方法对常规治疗无效的难治性功能性消化不良患者用Zung氏抑郁量表(SDS)检测，在常规FD治疗基础上，加用抗抑郁药、心理治疗12周，治疗前后用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分。结果难治性功能性消化不良与精神心理因素有关。36例患者普遍存在程度不同抑郁状态。加用抗抑郁药、心理治疗，能改善躯体与精神症状。     

难治性功能性胃肠病发病机制进展及其对药物治疗学的启示

功能性胃肠病(FGIDs)是以症状为处置目标的一类疾病。FGIDs病因和发病机制复杂,又极具个体化特点,故很难把握治疗靶点,精准选择治疗药物是难治性FGIDs的临床挑战之一。近年来,关于FGIDs症状产生机制和发病机制的研究有不少进展,本文运用心身消化整体医学思维,分析这些进展机制中的关键可干预靶点,探讨提升难治性FGIDs的若干实用药物治疗策略。     

功能性消化不良患者的精神心理因素测评及联合帕罗西汀抗抑郁治疗的临床观察

目的 探讨精神心理因素与功能性消化不良（FD）的关系，并观察抗抑郁药物帕罗西汀对FD的临床疗效。方法 对127例FD患者使用焦虑自评量表（SAS）、抑郁自评量表（SDS）进行精神心理因素测评，将其标准分与我国常模进行比较。对FD患者进行症状评分，将精神心理因素测评异常的FD患者随机分为2组，分别给予抗消化不良及在此基础上加用小剂量帕罗西汀的治疗，比较两组治疗的总有效率。结果 FD患者的焦虑、抑郁情绪发生率显著高于我国常模水平，综合治疗组的总有效率明显高于常规治疗组。结论F D患者存在精神心理异常，在常规治疗中加抗抑郁药有助于提高疗效。     

伴有精神心理障碍的难治性功能性胃肠病的诊治进展

功能性胃肠病(FGIDs)患者常伴有精神心理障碍和生活质量下降,常规药物治疗无效的难治性FGIDs的临床处理是消化科医师面临的挑战之一。目前关于FGIDs的认识和理解并不深入,且治疗手段有限。本文拟对伴有精神心理障碍的难治性FGIDs的临床特征及其诊治研究进展进行综述,以期提高临床医师对该病的认识并规范其诊治。     

慢传输型便秘发病机制的研究

慢传输型便秘（STC）是指由于结肠动力障碍,使内容物滞留在结肠及结肠运输缓慢所致的便秘。STC的病因复杂,确切的发病机制尚不完全清楚,症状顽固,治疗困难,主要与精神心理因素、肠神经系统（ENS）病理变化、Cajal间质细胞（ICC）的病理改变、平滑肌及肠神经递质变化等因素有关。此文就STC发病机制方面的研究进展作一综述,以期对临床治疗提供指导。     

抗抑郁药治疗功能性消化不良的临床研究

目的探讨精神、心理因素与功能性消化不良（ＦＤ）的关系及抗抑郁药对其的疗效。方法对２４例正常人和２４例ＦＤ患者进行汉密尔顿抑郁量表（ＨＡＭＤ）、汉密尔顿焦虑量表（ＨＡＭＡ）和症状自评量表（ＳＣＬ９０）评分;用抗抑郁药、５羟色胺再摄取抑制剂（ＳＳＲＩ）帕罗西汀（赛乐特）和盐酸氟西汀（百忧解）治疗ＦＤ患者,疗程均为８周,治疗后再行量表评分。结果三种量表（ＨＡＭＤ、ＨＡＭＡ、ＳＣＬ９０）评分对比,均显示ＦＤ患者的精神躯体症状与正常人之间差异有非常显著性（Ｐ＜０．００１）,但在日夜变化和精神病理上,差异无显著性;ＦＤ患者接受抗抑郁药治疗８周后,精神和躯体症状均有明显改善。结论ＦＤ与精神心理因素相关,普遍存在抑郁和焦虑情绪,用抗抑郁药治疗能显著改善精神和躯体两方面症状。     

Use of neurotransmitter regulators in functional gastrointestinal disorders based on symptom analysis

It has been a great challenge for gastroenterologists to cope with functional gastrointestinal disorders (FGIDs) in clinical practice due to the contemporary increase in stressful events. A growing body of evidence has shown that neuroregulators such as anti‐anxiety agents and antidepressants function well on FGIDs, particularly in cases that are refractory to classical gastrointestinal (GI) medications. Among these central‐acting agents, small individualized doses of tricyclic antidepressants and selective serotonin reuptake inhibitors are usually recommended as a complement to routine GI management. When these drugs are chosen to treat FGIDs, both their central effects and the modulation of peripheral neurotransmitters should be taken into consideration. In this article we recommend strategies for choosing drugs based on an analysis of psychosomatic GI symptoms. The variety and dosage of the neurotransmitter regulators are also discussed.     

Atypical Antipsychotic Quetiapine in the Management of Severe Refractory Functional Gastrointestinal Disorders

Management of severe refractory functional gastrointestinal disorders (FGIDs) is difficult. Quetiapine, an atypical antipsychotic, may benefit patients by mitigating associated anxiety and sleep disturbances, augmenting the effect of antidepressants, and providing an independent analgesic effect. Outpatient records from a university-based FGID clinic were reviewed, and 21 patients with refractory symptoms who received quetiapine were identified and interviewed. Outcomes included global relief of symptoms, treatment efficacy questionnaire, and change in gastrointestinal (GI) and psychological symptoms. Eleven of 21 patients continued therapy at the time of interview. Six of 11 demonstrated global relief of symptoms, and 9 were satisfied with treatment. The remaining 10 of 21 discontinued therapy because of somnolence and lack of GI benefits. Quetiapine in low doses appeared beneficial in more than half of the adults with severe FGIDs who stayed on treatment. This response in otherwise refractory patients suggests quetiapine might augment the effectiveness of antidepressants in severe FGIDs.     

炎症免疫与功能性胃肠病

功能性胃肠病(functional gastrointestinal disorders,FGIDs)与精神心理因素密切相关,黏膜免疫和炎症是部分FGIDs患者胃肠道症状产生的基础.炎症因子在抑郁的发生发展中有重要作用,其对胃肠动力的影响也越来越受到人们的重视.本文简要综述了炎症免疫在FGIDs中的作用及可能机制.     

积极面对有心理障碍的功能性胃肠病患者

功能性胃肠病(FGIDs)十分常见,严重影响患者的生活质量。胃肠道是最大的"情绪器官",无论是环境因素还是心理因素,通过脑-肠互动表现,都可表现出心理社会因素对FGIDs时空的影响。精神心理障碍与FGIDs发病和结果有关。消化科医师应认识FGIDs患者的心理障碍,提高认知和认知行为治疗技巧,对伴有中、重度心理障碍的FGIDs患者应使用抗焦虑抑郁药物治疗。     

脑肠互动与针刺治疗功能性胃肠病的相关性

功能性胃肠病是临床上常见的消化系统疾病,也是针刺治疗的优势病种.近年来的研究表明,脑肠轴功能失调是功能性胃肠病发病的重要原因,而针刺对脑肠轴的调节作用是其治疗功能性胃肠病的主要着眼点.随着脑功能成像技术的发展和脑肠肽研究的进展,功能性胃肠病与中枢神经系统及脑肠肽代谢相关性的研究日益增多.针灸作为传统中医疗法的一部分,治疗功能性胃肠病疗效显著,被广泛运用于临床.大量研究显示,针刺既能调节中枢神经系统,也能调控脑肠肽代谢.本文拟从中枢神经系统、脑肠肽代谢两方面,探讨脑肠互动与针刺治疗功能性胃肠病的相关性.     

功能性胃肠病诊断中应该注意的几个问题

本文对功能性胃肠病诊断中的一些重要问题进行了详细讨论,包括把握排除器质性疾病的原则,充分认识亚型分类和病情分级对治疗的指导意义、胃肠功能检查在诊断与治疗中作用、精神心理因素对诊断的影响、功能性疾病与器质性疾病的重叠现象等。     

Metabolic Kinetics of 5-Hydroxytryptamine and the Research Targets of Functional Gastrointestinal Disorders

5-Hydroxytryptamine (5-HT) is an important neurotransmitter in both the central and enteric nervous systems. It has diverse functions in regulating gastrointestinal motility and visceral sensitivity, emotion, appetite, pain and sensory perception, cognition, sexual activity and sleep. These functions are mainly associated with the metabolic kinetics of 5-HT in different tissues. Tryptophan hydroxylase is the rate-limiting enzyme and modulates serotonin synthesis. Vesicular monoamine transporter 1 plays a role in 5-HT storage and release. Degradation of 5-HT is mediated by monoamine oxidase-A. All these factors influence the action of 5-HT in vivo. Functional gastrointestinal disorders (FGIDs) are characterized by a series of symptoms including abdominal pain, diarrhea, constipation, anxiety and depression, in the absence of identifiable structural or biochemical abnormalities. They are frequently accompanied by changed gut motility or visceral sensitivity. An increasing body of research has found FGIDs to be closely associated with 5-HT, and drugs such as citalopram, paroxetine, venlafaxine, alosetron, tegaserod, prucalopride and mosapride have all been developed or discovered from the perspective of the metabolic kinetics of 5-HT. This review discusses the relationship between the metabolic kinetics of 5-HT and research targets in the field of FGIDs and suggests areas of future study that may be useful for understanding these disorders and identification of potential therapeutic targets.