Correlation between autonomic nervous function and clinical manifestations of patients with functional constipation
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摘要:
目的：根据功能性便秘（functional constipation，FC）患者临床资料分析内脏自主神经功能与便秘症状特征、心理状态及生活质量的相关性。方法：评估102例FC患者和42例健康对照者的一般资料、精神心理状态和心率变异性（heart rate variability，HRV）检测结果，再根据HRV检测结果将FC患者分为自主神经张力偏向正常组、严重偏向交感神经张力组和严重偏向副交感神经张力组；比较各组间Zung’s焦虑自评量表（self-rating anxiety scale，SAS）和抑郁自评量表（self-rating depression scale，SDS）、便秘评分系统（constipation scoring system，CSS）和便秘患者症状自评量表（patient assessment of constipation symptoms， PAC-SYM）、便秘患者生活质量自评问卷（patient assessment of constipation quality of life，PAC-QOL）分值差异，同时比较不同 HRV分组间肛直肠测压参数、肠电图参数差异，分析便秘患者生活质量与自主神经功能、精神心理状态、便秘症状之间的相关性。结果：与健康对照组相比，FC患者焦虑抑郁水平显著升高，HRV检测结果显示自主神经功能异常率高。不同HRV分组的 FC患者间肛直肠测压参数、肠电图参数差异无统计学意义；与交感-副交感神经张力偏向正常组相比，严重偏向交感神经张力组患者明显存在明显的焦虑抑郁情绪、PAC-SYM较高、生活质量降低（主要是躯体不适和担心焦虑两个维度）。严重偏向副交感神经张力组患者CSS评分最高，可能与抑郁情绪为主导有关。多重线性回归显示，患者的焦虑抑郁情绪、自主神经功能显著影响便秘患者生活质量。结论：自主神经功能紊乱的便秘患者存在明显的焦虑抑郁情绪，与便秘严重程度相比，自主神经功能紊乱、焦虑抑郁情绪对便秘患者的生活质量具有更明显的负面影响。调节自主神经功能、心理干预或中枢神经药物等治疗可能具有重要临床意义。
Abstract:
Objective：The aim of this study was to evaluate the associations between autonomic nervous function and constipation symptoms，psychological status and quality of life in function constipation(FC)patients. Methods：The characteristics，psychological status and heart rate variability(HRV)test of 102 FC patients and 42 healthy controls were evaluated. Then the FC patients were divided into three groups according to the result of HRV test，the autonomic tone balance normal group，the balance severely sympathetic tone group and the balance severely parasympathetic tone group. The results of self - rating anxiety and depression scale (SAS/SDS)，constipation scoring system(CSS)and patient assessment of constipation symptom(PAC - SYM)，patient assessment of constipation quality of life(PAC-QOL)were compared among three groups. Meanwhile，anorectal manometry and electrointestinogram parameters were assessed. We also analyzed the potential association of PAC - QOL with ANS function，mental status，constipation symptoms in all the constipation patients. Results：Compared with the healthy control group，the scores of SAS and SDS in FC patients increased significantly. HRV test results showed that the abnormal rates of autonomic nervous function were higher in FC patients than that in normal controls. Anorectal physiology and intestinal electric activity showed no significant difference among the FC patients with different HRV. Compared with patients in the autonomic tone balance normal group，patients in the balance severely sympathetic tone group had higher SAS/SDS scores，higher PAC - SYM score and lower PAC - QOL，especially for the dimension of“physical discomfort”and“worry/anxiety”of PAC -QOL. The balance severely parasympathetic tone group showed higher CSS score than the other two groups which maybe correlated with the prominence of depressed emotion. Multiple regression analysis showed that anxiety/ depression emotion and ANS function state could significantly affect the quality of life. Conclusion：FC patients with autonomic dysfunction are prone to anxiety or depression. The QOL of FC patients correlates strongly with ANS function and emotion，but not symptoms. Treatrnents such as autonomic adjustment，psychological interventions and central nervous system drugs may have clinical significance for FC patients.
