编制炎症性肠病病人药物自我管理测评量表

目的 为炎症性肠病病人药物自我管理水平提供测评工具.方法 通过半结构访谈、文献回顾和专家咨询形成量表初稿,采用便利抽样法对2019年2—9月江苏大学附属医院120例炎症性肠病病人进行问卷调查,测定量表的信效度.结果 炎症性肠病病人药物自我管理测评量表共包含11个条目,条目的内容效度指数0.89～1.00,量表Cronbach'sα系数都>0.7.结论 本研究编制的量表可用于测评炎症性肠病病人药物自我管理水平.     

青少年肠易激综合征调查表的制定及考评

目的制定青少年肠易激综合征调查表。方法采用选题小组和议题小组的程序化决策方式来制定青少年肠易激综合征调查表，并通过对247例中学生的测试对调查表进行信度、效度及反应度考评。结果制定出含45个条目的青少年肠易激综合征调查表。饮食习惯、诊断标准、诱发因素、胃肠道症状及躯体精神5个领域的克郎巴赫系数分别为0．668、0．752、0．824、0．749及0．824。主成分累积贡献率为70．72％。结论青少年肠易激综合征调查表具有较好的信度、效度及反应度，可作为青少年肠易激综合征流行病学调查的测评工具。     

子宫内膜异位症中医师存质量量表理论框架建立及条目池初步筛选的研究

目的建立子宫内膜异位症中医师存质量量表的理论框架,形成其条目池并对其进行初步筛选。方法在中医理论指导下,根据国际、国内量表研制一般程序,采用文献调研法、专家咨询(评审)等方法,分析及讨论现行医学量表的理论框架,收集条目,并对条目池条目进行筛选。结果量表包含身体感受、情志、社会功能三个维度,以及总体评价。共筛选出条目68条,身体感受维度40条,情志维度17条,社会功能维度8条,总体评价3条。结论理论框架的确立及条目池的筛选,均以中医理论为基础,遵循了量表的研制规范,比较全面的反应了子宫内膜异住症的内涵,为高质量量表的形成奠定基础。     

肝硬化患者报告结局量表条目的筛选

目的根据美国食品与药品管理局(FDA)所规定的患者报告结局(PRO)量表的制作原则与流程,开发肝硬化患者报告的临床结局评价量表。方法通过文献查阅、患者访谈及参照国内外有关量表,收集和提取肝硬化患者的重要信息,构建概念框架,进而形成条目池。再经由患者认知测试、患者评价及专家评审,完善条目池,形成最初的量表。用此量表分别在山西省不同地区的不同级别的8所医院进行小规模的预调查,回收问卷后,应用经典测量理论、项目反应理论(IRT)共7种方法对条目进行筛选,将其结果与专业知识结合后删除不符合要求的条目,形成初始量表。最后使用初始量表在上述8所医院开展大规模的正式调查,用与预调查相同的方法对条目进行第二次筛选,形成终选量表。结果终选量表含有50个条目,分为生理、心理、社会、治疗4个领域,共计13个维度。结论形成的终选量表基本符合理论框架,筛选出的条目能够较好地反映肝硬化患者生命质量的内涵。     

哮喘患者报告临床结局量表的研制和条目筛选

目的研制具有良好信度、效度与反应度,适用于新药临床试验或临床疗效评价的哮喘患者报告临床结局(PRO)量表。方法遵照美国食品药品管理局(FDA)PRO量表研制的程序化方法,建立量表的理论框架,建立条目池,并通过专家咨询、患者访谈等修改量表,得到含有72个条目的初量表。现场调查共收集108例样本,使用离散趋势法、因子分析法、相关系数法、克朗巴赫α系数法及修正条目的总相关系数法和项目反应理论5种方法对初量表进行条目筛选。结果经过条目筛选,调整量表的框架结构,共保留67个条目,分为生理、心理、社会、治疗4个领域及13个方面。结论哮喘PRO量表严格按照国际量表的操作原则和方法进行,科学性强、结论可信,有利于临床研究中推广使用。     

防风治疗肠易激综合征的网络药理学研究

目的 采用网络药理学方法筛选防风治疗肠易激综合征的作用靶点,探讨其治疗肠易激综合征的作用机制.方法 通过TCMSP数据库,以口服利用度(oB)≥30％,类药性(DL)≥0.18为阈值,筛选得到防风的主要化学成分及其所作用的基因靶点.通过GeneCards数据库筛选肠易激综合征相关的基因靶点,取疾病与中药的基因靶点交集,...     

心理护理干预对治疗肠易激综合征疗效影响的观察

目的探讨心理护理干预对治疗肠易激综合征疗效影响情况。方法分析两院收治的肠易激综合征患者120例临床资料,实施心理护理将患者进行分组,常规护理组60例和心理护理组60例。结果心理护理组肠易激综合征患者SCL-90症状自评量表评分和睡眠质量评分均显著低于常规护理组（P〈0.05）,差异均有统计学意义。结论心理护理干预可以明显改善肠易激综合征心理状态,改善睡眠,有利于临床治疗,值得临床推广应用。     

肠易激综合征伴随或不伴随功能性消化性不良患者的精神因素分析

目的探讨肠易激综合征伴随功能性消化性不良患者比不伴随功能性消化性不良患者是否有更严重的精神疾病。方法对18例肠易激综合征伴随功能性消化性不良患者和22例不伴随功能性消化性不良患者采用汗密顿抑郁量表17项版本和汗密顿焦虑量表14项进行心理测试,比较分析各组的评分特点。结果肠易激综合征伴随功能性消化性不良患者比不伴随功能性消化性不良患者其焦虑抑郁障碍发病率更高。结论肠易激综合征与功能性消化性不良重叠的患者由于心理及精神的压力导致心脏更敏感,其精神方面的疾病更重,更应该接受心理治疗。     

曲美布汀联合双歧三联活菌治疗肠易激综合征的Meta分析

目的评价曲美布汀联合双歧三联活菌药物治疗肠易激综合征的有效性。方法通过计算机检索中国期刊全文数据库、中国科技期刊全文数据库、数字化期刊数据库(万方)、中国生物医学文献数据库,检索时限均为从建库至2011年2月,并手工检索相关参考文献,对检索到的文献进行筛选和质量评价,纳入了9个曲美布汀联合双歧三联活菌治疗肠易激综合征的RCTs(随机对照试验),再应用RevMan 5.0对这9篇RCTs研究结果进行Meta分析。结果曲美布汀联合双歧三联活菌治疗肠易激综合征的显效率和总有效率均高于单用曲美布汀治疗肠易激综合征,合并RR值分别为1.29和1.20,95%可信区间分别为1.15～1.45和1.14～1.27。结论曲美布汀联合双歧三联活菌治疗肠易激综合征比单用曲美布汀治疗肠易激综合征疗效更好。     

2011年昆明医科大学第一附属医院细菌耐药性监测结果

<正>为了解昆明医科大学第一附属医院常见革兰阳性菌和革兰阴性菌对常用抗菌药物的耐药性,分析该院耐药性监测数据,为临床合理使用抗菌药物提供依据,现将我院临床微生物室2011年监测的结果报道如下。资料与方法收集昆明医科大学第一附属医     

性别及心理因素对肠易激综合征患者生活质量的影响

目的探讨性别及性别相关心理差异对肠易激综合征（iBs）患者生活质量的影响。方法由消化科医师对IBS患者进行问卷调查,问卷内容包括：一般人口学资料、焦虑和抑郁量表、生活质量量表。统计调查资料、分析IBS患者性别及性别相关心理差异对生活质量的影响。结果根据罗马Ⅲ标准收集IBS患者452例,年龄分布在14～79岁;男193例（42．7％）,女259例（57．3％）,男女比例为l：1．3。女性IBS患者SAS、SDS评分分别为（53．57±6．70）分、（40．81±7．15）分,男性分别为（49．19±5．99）分、（36．67±6．40）分,女性患者均明显高于男性患者（t=7．191、6．459,均P〈0．01）。女性IBS患者IBS．QOL总分低于男性IBS患者（t=9．119,P〈0．01）。在量表包括的8个纬度中,女性IBS患者在烦躁不安、身体角色、健康忧虑、社会反应、异性概念等5个纬度得分低于男性（t=11．021、22．175、7．256、10．409、7．113,均P〈0．01）,在冲突行为、饮食限制、家庭关系等3个纬度与男性无明显差异（均P〉0．05）。IBS患者SAS、SDS评分与IBS-QOL评分（总分及各个纬度评分）均呈明显负相关（均P〈0．01）。结论性别不同IBS患者存在心理及生活质量差异,IBS患者性别相关的心理差异影响患者的生活质量。     

The Visceral Sensitivity Index: development and validation of a gastrointestinal symptom-specific anxiety scale

BACKGROUND: Anxiety related to gastrointestinal sensations, symptoms or the contexts in which these may occur is thought to play a significant role in the pathophysiology as well as in the health outcomes of patients with irritable bowel syndrome. AIM: To develop a valid and reliable psychometric instrument that measures gastrointestinal symptom-specific anxiety. METHODS: External and internal expert panels as well as a patient focus group evaluated a large pool of potential item stems gathered from the psychological and gastrointestinal literature. Potential scale items were then administered to 96 patients diagnosed with irritable bowel syndrome along with a set of validating questionnaires. Final item selection was based upon rigorous empirical criteria and the psychometric properties of the final scale were examined. RESULTS: A final unidimensional 15-item scale, the Visceral Sensitivity Index, demonstrated excellent reliability as well as good content, convergent, divergent and predictive validity. CONCLUSIONS: The findings suggest that the Visceral Sensitivity Index is a reliable, valid measure of gastrointestinal symptom-specific anxiety that may be useful for clinical assessment, treatment outcome studies, and mechanistic studies of the role of symptom-related anxiety in patients with irritable bowel syndrome.     

Impact of functional gastrointestinal disorders on health-related quality of life: a population-based case-control study

BACKGROUND: The health-related quality of life is impaired in patients with functional gastrointestinal disorders seen in referral centres. AIM: To determine whether the health-related quality of life is impaired in subjects with functional disorders in the community and whether any differences can be explained by psychological co-morbidity. METHODS: In a population-based, nested, case-control study, subjects reporting symptoms of either dyspepsia or irritable bowel syndrome and healthy controls were interviewed and completed a battery of psychological measures plus a validated, generic, health-related quality of life measure (Medical Outcomes Study 36-item short form health survey, SF-36). The association between irritable bowel syndrome and dyspepsia and the physical and mental composite scores of SF-36 were assessed with and without adjustment for psychological state. RESULTS: One hundred and twelve cases (30 dyspepsia, 39 irritable bowel syndrome, 32 dyspepsia and irritable bowel syndrome and 11 gastrointestinal symptoms but not dyspepsia or irritable bowel syndrome) and 110 controls were enrolled. In the unadjusted linear regression models, irritable bowel syndrome (but not dyspepsia) was negatively associated with the physical composite score (P < 0.05); in an adjusted model, the association between the physical health-related quality of life and irritable bowel syndrome was explained by the Symptom Checklist-90 somatization score alone. In unadjusted models, irritable bowel syndrome and dyspepsia were each negatively associated with the mental composite score (P < 0.05). The association between the mental health-related quality of life and dyspepsia remained after adjusting for psychological covariates, but the association between this and irritable bowel syndrome was not significant after adjustment. CONCLUSIONS: In the community, health-related quality of life is impaired in subjects with irritable bowel syndrome and dyspepsia; however, much of this association can be explained by psychological factors.     

Utility of red flag symptom exclusions in the diagnosis of irritable bowel syndrome

BACKGROUND: Studies suggest that the positive predictive value of the Rome II criteria for diagnosing irritable bowel syndrome can be enhanced by excluding red flag symptoms suggestive of organic diseases. AIM: We assessed the utility of red flags for detecting organic diseases in patients diagnosed irritable bowel syndrome by their physicians. METHODS: Systematic chart reviews were completed in 1434 patients with clinical diagnoses of irritable bowel syndrome, abdominal pain, diarrhoea or constipation, who also completed questionnaires to identify Rome II criteria for irritable bowel syndrome and red flag symptoms. RESULTS: The overall incidence of gastrointestinal cancer was 2.5% (but 1.0% in those with irritable bowel syndrome), for inflammatory bowel disease 2.0% (1.2% in irritable bowel syndrome), and for malabsorption 1.3% (0.7% in irritable bowel syndrome). Red flags were reported by 84% of the sample. The positive predictive value of individual red flags for identifying organic disease was 7-9%. Excluding any patient with a red flag improved the agreement between Rome II and clinical diagnosis by a modest 5%, but left 84% of patients who were diagnosed with irritable bowel syndrome by their physicians, without a diagnosis. CONCLUSIONS: Red flags may be useful for identifying patients who require additional diagnostic evaluation, but incorporating them into the Rome criteria would not improve sensitivity and would result in too many missed irritable bowel syndrome diagnoses.     

Anxiety but not depression determines health care-seeking behaviour in Chinese patients with dyspepsia and irritable bowel syndrome: a population-based study

AIMS: To study the prevalence of dyspepsia and irritable bowel syndrome and the effects of co-existing anxiety and depression on health care utilization by a population survey in Chinese. METHODS: Ethnic Chinese households were invited to participate in a telephone survey using a validated bowel symptom questionnaire and the hospital anxiety and depression scale. Gastrointestinal symptoms were classified as dyspepsia and irritable bowel syndrome according to the Rome I criteria and gastro-oesophageal reflux disease by the presence of weekly heartburn or acid regurgitation. The anxiety and depression scores were compared between patients who sought medical attention and those who did not, using multiple logistic regression analysis. RESULTS: One thousand, six hundred and forty-nine subjects completed the interview (response rate, 62%). The population prevalences of dyspepsia, irritable bowel syndrome and gastro-oesophageal reflux disease were 18.4%, 4.1% and 4.8%, respectively. Dyspepsia and irritable bowel syndrome were associated with anxiety, depression, medical consultation, sick leave and adverse effects on social life. The degree of anxiety was an independent factor associated with health care-seeking behaviour in both dyspeptics (P = 0.003) and irritable bowel syndrome patients (P = 0.036). CONCLUSIONS: Irritable bowel syndrome and dyspepsia are associated with anxiety, depression, significant social morbidity, health care utilization and days off work. Anxiety is an independent factor in determining health care utilization in patients with dyspepsia and irritable bowel syndrome.     

Meta-analysis: The treatment of irritable bowel syndrome

To evaluate therapies available for the treatment of irritable bowel syndrome, and provide consensus recommendations for their use, a total of 51 double-blind clinical trials using bulking agents, prokinetics, antispasmodics, alosetron, tegaserod and antidepressants were selected. The quality of studies was assessed using 5-point scale. Meta-analyses were performed on all studies, and on 'high-quality studies'. The efficacy of fibre in the global irritable bowel syndrome symptoms relief (OR: 1.9; 95% CI:1.5-2.4) was lost after exclusion of low-quality trials (OR: 1.4; 95% CI: 1.0-2.0, P = 0.06). When excluding the low-quality trials, an improvement of global irritable bowel syndrome symptoms with all antispasmodics (OR: 2.1; 95% CI:1.8-2.9) was maintained only for octylonium bromide, but on the basis of only two studies. Antidepressants were effective (OR: 2.6, 95% CI: 1.9-3.5), even after exclusion of low-quality studies (OR: 1.9, 95% CI: 1.3-2.7). Alosetron (OR: 2.2; 95% CI: 1.9-2.6) and tegaserod (OR: 1.4; 95% CI: 1.2-1.5) showed a significant effect in women. We recommend the use of tegaserod for women with irritable bowel syndrome with constipation and alosetron for women with severe irritable bowel syndrome with diarrhoea. Antidepressants can be beneficial for irritable bowel syndrome with diarrhoea patients with severe symptoms. Loperamide can be recommended in painless diarrhoea. Evidence is weak to recommend the use of bulking agents in the treatment of irritable bowel syndrome with constipation.     

Review article: the role of antibiotics vs. conventional pharmacotherapy in treating symptoms of irritable bowel syndrome

BACKGROUND: The concept of augmenting the management of irritable bowel syndrome with antibiotics is evolving, and many questions remain regarding this therapy relative to known and hypothesized irritable bowel syndrome pathophysiology. The clinical evidence of small intestinal bacterial overgrowth as an important aetiology of irritable bowel syndrome continues to accumulate. Clinical symptoms of bacterial overgrowth and irritable bowel syndrome are similar; however, a definitive cause-and-effect relationship remains unproven. It is unclear whether motility dysfunction causes bacterial overgrowth or gas products of enteric bacteria affect intestinal motility in irritable bowel syndrome. AIM: To discusses the efficacy and tolerability of current symptom-directed pharmacotherapies and of antibiotics in the treatment of irritable bowel syndrome. METHODS: A computerized search of PubMed was performed with search terms "IBS", "pharmacotherapy" and "antibiotics". Relevant articles were selected, and the reference list of selected articles was reviewed to identify additional references. RESULTS: Antibiotic treatment benefits a subset of irritable bowel syndrome patients. The non-absorbed antibiotic rifaximin has a favourable safety and tolerability profile compared with systemic antibiotics and demonstrates a therapeutic efficacy comparable with symptom-based irritable bowel syndrome pharmacotherapies. CONCLUSION: Rifaximin is the only antibiotic with demonstrated sustained benefit beyond therapy cessation in irritable bowel syndrome patients in a placebo-controlled trial. Whether antibiotics can improve quality of life in patients with irritable bowel syndrome warrants further research.     

Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications

BACKGROUND: Somatic comorbid symptoms might identify irritable bowel syndrome patients with different aetiologies and needs of treatment. AIMS: To measure comorbid symptoms in patients with irritable bowel syndrome in general practice, and to explore characteristics of patients with low, intermediate and high somatic comorbidity. METHODS: Prospective study of 208 of 278 consecutive patients with irritable bowel syndrome (Rome II) in nine general practices. Questionnaires assessed 22 comorbid symptoms (subjective health complaint inventory), psychosocial factors including psychological distress (Symptom Check list-10) and quality of life (Short form-12). Subjective health complaint data from 1240 adults (controls) constituted a reference material. Patients with low, intermediate and high somatic comorbidity were identified by a somatic comorbidity score (17 subjective health complaint items). Health care seeking was assessed after 6-9 months. RESULTS: Patients with irritable bowel syndrome (67% females, mean age 50, s.d. 16) reported 20 of 22 comorbid symptoms significantly more frequent than controls (odds ratios = 2-7, P < 0.001). The somatic comorbidity score correlated with psychological distress (R = 0.46, P < 0.001). Patients with high somatic comorbidity reported higher levels of mood disorder, health anxiety, neuroticism, adverse life events and reduced quality of life and increased health care seeking when compared to those with low and intermediate somatic comorbidity (P-values < 0.05). CONCLUSIONS: Our findings support the hypothesis that structured assessment of comorbid somatic symptoms might identify subgroups with different aetiology and needs of treatment.     

The validity and accuracy of the Work Productivity and Activity Impairment questionnaire--irritable bowel syndrome version (WPAI:IBS)

BACKGROUND: Irritable bowel syndrome is a common chronic functional gastrointestinal disorder characterized by recurrent abdominal pain and discomfort associated with alterations in bowel habit. Irritable bowel syndrome affects patients' quality of life and increases productivity loss. AIM: To assess validity and accuracy of the Work Productivity and Activity Impairment questionnaire in irritable bowel syndrome as a tool for quantifying the effects of irritable bowel syndrome on productivity and daily activities. METHODS: Validity and accuracy were evaluated in 135 irritable bowel syndrome patients relative to three measures of irritable bowel syndrome disease severity; a debriefing questionnaire; retrospective diary; Work Limitations Questionnaire, and an activity impairment measure (Dimensions of Daily Activities). RESULTS: Symptom severity scores, diary scores, Work Limitations Questionnaire and Dimensions of Daily Activities were significant predictors of work productivity and activity impairment questionnaire in irritable bowel syndrome measures of work time missed, and work and activity productivity loss (P = 0.04 to < 0.0001). Impairment due to irritable bowel syndrome was estimated to be 2.9-4.3% for work time missed and 22-32% for impairment at work, the equivalent of 9.7 -14 h lost productivity per week. Activity impairment was 24-41%. CONCLUSIONS: Discriminative validity of the Work Productivity and Activity Impairment questionnaire in irritable bowel syndrome was established, making it the only validated tool for measuring the relative differences between disease severity groups and quantifying work productivity loss and activity impairment in irritable bowel syndrome patients.     

Hydrogen glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in irritable bowel syndrome

BACKGROUND: Studies assessing the prevalence of small intestinal bacterial overgrowth in irritable bowel syndrome gave contrasting results. Differences in criteria to define irritable bowel syndrome patients and methods to assess small intestinal bacterial overgrowth may explain different results. Moreover, no data exist on small intestinal bacterial overgrowth prevalence in a significant population of healthy non-irritable bowel syndrome subjects. AIM: To assess the prevalence of small intestinal bacterial overgrowth by glucose breath test in patients with irritable bowel syndrome symptoms with respect to a consistent control group. METHODS: Consecutive patients with irritable bowel syndrome according to Rome II criteria were enrolled. The control population consisted of 102 sex- and age-matched healthy subjects without irritable bowel syndrome symptoms. All subjects underwent glucose breath test. A peak of H2 values >10 p.p.m above the basal value after 50 g of glucose ingestion was considered suggestive of small intestinal bacterial overgrowth. RESULTS: A total of 65 irritable bowel syndrome patients and 102 healthy controls were enrolled. Positivity to glucose breath test was found in 31% of irritable bowel syndrome patients with respect to 4% in the control group, the difference between groups resulting statistically significant (OR: 2.65; 95% CI: 3.5-33.7, P < 0.00001). CONCLUSIONS: The present case-control study showed an epidemiological association between irritable bowel syndrome and small intestinal bacterial overgrowth. Placebo-controlled small intestinal bacterial overgrowth-eradication studies are necessary to clarify the real impact of small intestinal bacterial overgrowth on irritable bowel syndrome symptoms.