自主神经功能与功能性便秘患者临床症状的相关性分析
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1.南京医科大学第一附属医院;2.南京医科大学第一附属医院消化内科

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国家自然科学基金面上项目


Correlation between autonomic nervous function and clinical manifestations of patients with functional constipationGao Xiangyue1, Jiang Ya1, Li Fei1, Yu Ting1, Tang Yurong1, Lin Lin1.
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National Natural Science foundation of China

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    摘要:

    【摘要】 背景及目的:脑-肠互动异常在功能性胃肠病发病中的作用被广泛认可和关注。脑-肠轴通路中的自主神经功能可能受情绪影响,并影响肛门直肠功能以及便秘患者的疾病状态,但以上各因素之间的关联尚未明确。本研究从功能性便秘患者(FC)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:回顾性分析81例FC患者的临床资料,根据心率变异性(HRV)检测结果分为3组:交感/迷走神经(LF/HF)偏向正常、严重偏向交感和严重偏向迷走;比较组间焦虑自评量表(SAS)、抑郁自评量表(SDS)、和便秘症状严重程度评分(CSS)和自评量表(PAC-SYM)、便秘患者生活质量量表(PAC-QOL)分值差异。同时比较三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:三组间肛直肠测压参数、肠电图参数无统计学差异;与正常组相比,HRV严重偏向交感组患者明显具有焦虑抑郁情绪、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、自主神经功能能够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:

    Abstract Backgrounds and Aims: The role of abnormal brain-gut interaction mechanism in functional gastrointestinal disorders (FGIDs)has been recognized widely. As a part of the brain-gut axis , autonomic nervous function (ANS),which is controlled emotion, may affect the anorectal physiology function and disease state of constipation patients. However, the correlations between them remain unclear. The aim of this study was to evaluate the associations between ANS function and constipation symptoms, psychological status and quality of life in function constipation (FC) patients. Methods: We retrospectively analyzed the clinical data of 81 FC patients, who were eligible in our study. They were divided into three groups according to the result of heart rate variability(HRV) test: sympathovagal balance normal group ,balance severely sympathetic group and balance severely vagal group. The results of Self-Rating Anxiety and Depression Scale (SAS/SDS), Constipation Scoring System (CSS), Patient Assessment of Constipation Symptom (PAC-SYM), as well as the Quality of life(PAC-QOL) were compared between groups. Meanwhile, anorectal manometry and electrointestinogram parameters were assessed. We also analyzed the potential association between PAC-QOL and ANS function, mental status, constipation symptoms in all the constipation patients. Result: Anorectal physiology and intestinal electric activity showed no significant difference between the groups. Compare with patients in the normal group, patients in the sympathetic 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 vagal group showed higher CSS score than the other two groups. Maybe depressed emotion is prominent. Multiple regression analysis showed that anxiety/depression emotion, ANS function state can significantly affect the quality of life.

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  • 收稿日期:2022-10-18
  • 最后修改日期:2023-03-03
  • 录用日期:2023-04-17
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