心理社会因素在非糜烂性反流病发病中作用的研究

背景：心理社会因素在功能性胃肠病中起重要作用，但在非糜烂性反流病（NERD）中的作用尚不明确。目的：探讨心理社会因素在NERD发病中的作用。方法：对在消化专科门诊就诊的有烧心、胸骨后疼痛、反酸和反食等症状的病例，行胃镜和24h食管pH监测等检查。对NERD进行分组，并对病理性酸反流组（n=49）、生理性酸反流组（n=50）和对照组（n=99）进行心理学评估。评估采用症状自评量表（SCL-90）、Beck抑郁自评量表、状态-特质焦虑问卷（STAI）等量表。结果：SCL-90评估显示NERD患者的躯体化、强迫、人际关系、抑郁、焦虑、敌对、偏执等因子分和总症状分均显著高于对照组（P〈0．05）；NERD患者病理性酸反流组的躯体化、人际关系、焦虑、偏执等因子分和总症状分均显著高于生理性酸反流组（P〈0．05），而强迫、抑郁、敌对、恐怖、精神病性等因子分，则两组间差异无显著性（P〉0．05）；NERD患者的状态焦虑量表（SAI）评分显著高于对照组（P〈0．01），而Beck抑郁自评量表、特质焦虑量表评分与对照组的差异无显著性（P〉0．05）；病理性酸反流组的状态焦虑量表（SAI）评分高于生理性酸反流组（P〈0．01）。结论：心理社会因素在NERD的症状产生中可能有一定的作用；病理性酸反流组的心理异常较生理性酸反流组更为明显。

Psychological Profile of Non-erosive Reflux Disease

Background: Psychosocial factors played important role in the pathogenesis of functional gastrointestinal disorders, but the role of psychosocial factors in the non-erosive gastroesophageal reflux disease (NERD) has not been clarifed. Aims: To investigate the role of psychosocial factors in the pathogenesis of NERD. Methods: Subjects with symptoms of heartburn, substernal chest pain, acid and food regurgitation in the out-patient department of digestive disease were referred for upper gastrointestinal endoscopy and 24 hour esophageal pH monitoring. NERD patients were divided into pathological acid regurgitation group (n=49), physological acid regurgitation group (n=50) and control group (n=99). Psychological assessments were performed in all three groups using the Symptom Check List (SCL-90), Beck Depression Inventory, and State-Trait Anxiety Inventory (STAI). Results: The SCL-90 assessment showed that NERD patients had higher scores of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility and obstinacy than the controls with a statistically significant difference (P<0.05). The scores of somatization, interpersonal sensitivity, anxiety, obstinacy and global severity index in NERD patients with pathological acid regurgitation group were significantly higher than that in NERD patients with physiological acid regurgitation group (P<0.05). But there were no statistically significant differences between these two groups in the aspects of obsessive-compulsive, depression, hostility, terror and psychotics traits (P>0.05). NERD patients presented higher scores than control group (P<0.01) in the State Anxiety Inventory analysis, whilst there were no significant difference between two groups in the scores of Beck depression self-estimation and trait anxiety(P>0.05). The pathological acid exposure group presented higher scores than physiological acid exposure group in the State Anxiety Inventory (P<0.01). Conclusions: The psychosocial factors play an important role in the pathogenesis of NERD. NERD patients with pathological acid exposure display even higher levels of psychological profiles than those with physiological acid exposure.