难治性肠易激综合征患者的情绪障碍和治疗

背景:肠易激综合征(IBS)是目前最常见的功能性胃肠道疾病之一,然而其病因和发病机制至今尚不太清楚,临床治疗效果亦不十分理想。目的:探讨心理因素在难治性IBS发病中的作用和抗抑郁药对IBS的疗效。方法:分别对36例经常规治疗无效的腹泻型IBS患者和22名健康成人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)鄄90评分以了解其心理状态,并对IBS患者的主要症状(腹部不适、疼痛和排便异常等)进行分级。在常规治疗的基础上随机予IBS患者选择性5鄄羟色胺再摄取抑制剂(SSRI)类抗抑郁药治疗,20例患者使用盐酸帕罗西汀,16例患者使用盐酸氟西汀,疗程均为12周。疗程结束后1周再进行上述量表评分和主要症状分级。结果:除精神病性因子分外,IBS患者HAMD、HAMA和SCL鄄90的总分和各因子分均显著高于健康对照组(P<0.001);接受抗抑郁药治疗12周后,各量表评分均显著低于治疗前(P<0.001或P<0.01),主要症状分级亦明显降低,按意图治疗(ITT)和方案(PP)分析,治愈率分别为47.2%和51.5%,总有效率分别为91.7%和100%。 结论:心理因素在IBS的发病中起重要作用。难治性IBS患者普遍存在抑郁、焦虑等情绪障碍,应用抗抑郁药治疗能显著改善IBS患者躯体和精神两方面的症状。

Emotional Disorders and Treatment in Patients with Refractory Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal functional disorders, how-ever, its etio-pathogenesis has not been fully clarified, and the efficacy of the drugs used currently is not satisfactory. Aims: To investigate the role of psychological factors in the occurrence of refractory IBS and the effects of antidepressants on IBS. Methods: The psychological status of 36 diarrhea-predominant IBS patients that were resistant to routine treatment and 22 healthy adults, were analyzed by using Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA) and symptom checklist (SCL)-90. The major symptoms such as abdominal pain or discomfort, and abnormal frequency or consistency of defecation of these IBS patients were also graded. On the basis of routine treatment, selective serotonin reuptake inhibitor (SSRI) antidepressants were randomly given to IBS patients for 12 weeks, among them, 20 received paroxetine hydrochloride, 16 received fluoxetine hydrochloride. The score of the scales mentioned above and the major symptoms were evaluated again one week after the course of treatment. Results: Except for the psychopathic factor, the total score and factorial score of HAMD, HAMA and SCL-90 in IBS patients were significantly higher than those of the healthy controls (P<0.001). After 12 weeks antidepressants treatment, the score of all these scales significantly improved than those before treatment (P<0.001 or P<0.01), the grading of major symptoms were also reduced obviously. The healing rate and total efficacy rate were 47.2% and 91.7% at intention-to-treat (ITT) analysis, and 51.5% and 100% at per-protocol (PP) analysis, respectively. Conclusions: Psychological factors play an important role in the pathogenesis of IBS. The refractory IBS patients commonly have emotional disorders, such as depression and anxiety. Antidepressants are effective in the treatment of IBS in improving both somatic and psychological symptoms.