摘要
目的通过人格及精神障碍评估问卷了解医院就诊肠易激综合征（IBS）患者精神障碍的共病状况。方法顺序纳入2008年11月至2010年3月北京大学第三医院消化科门诊就诊、符合罗马Ⅲ标准的IBS患者83例，由经过培训的人员通过人格诊断问卷4（PDQ-4）、复合型国际诊断交谈（CIDI）表进行人格障碍、躯体形式障碍及其他精神障碍诊断。结果83例IBS患者中男43例，女40例，年龄（38±14）岁。其中便秘型20例（24．1％）、腹泻型31例（37．3％）、混合型15例（18．1％）、未分型17例（20．5％）。（1）62例（74．7％）患者被检出1型或多型人格障碍，性别差异无统计学意义，其中以强迫和回避为特征的焦虑·抑制类（C组）人格障碍最多（58例，69．9％）。存在人格障碍者躯体形式障碍检出率为46．8％（29／62），高于无人格障碍者[19．0％（4／21），P=0．025]。（2）IBS患者的CIDI-3．0精神障碍终生患病率44．6％（37例），显著高于对照组，性别差异无统计学意义。焦虑与心境障碍是最多见的精神障碍共病类型，分别为21例（25．3％）和19例（22．9％）。物质滥用和依赖、间歇性暴发障碍分别检出9例（10．8％）和7例（8．4％）。腹泻型IBS患者精神障碍共病率最高（58．1％，18／31），但不同IBS亚组之间精神障碍检出率差异无统计学意义。（3）IBS患者中33例（39．8％）存在躯体形式障碍，性别差异无统计学意义。各亚组间躯体形式障碍检出率差异无统计学意义。焦虑障碍同时合并躯体形式障碍者为61．9％（13／21），显著高于无焦虑障碍者[32．3％（20／62），P=0．016]。结论综合医院消化科就诊的IBS患者精神障碍共病较为常见，尤其是焦虑障碍和心境障碍。存在人格偏离及焦虑障碍的IBS患者更容易出现躯体形式障碍，消化专业医师应对此有充分认识并予以恰当治疗建议。
Objective To assess the prevalence of psychiatric comorbidities in patients referred for irritable bowel syndrome （ IBS ） with questionnaires for mental disorders. Methods A total of 83 IBS patients at our hospital were enrolled and assessed with the Personality Diagnostic Questionnaire for DSM-Ⅳ, version 4 （PDQ-4） and Composite International Diagnostic Interview, version 3.0 and 2.1 （ CIDI-3.0 ＆ CIDI-2. 1 ） by trained interviewers. Such items as personality dysfunction, mental disorder and somatization disorder were examined. Results The male-female ratio was 1.08/1. Their mean age was （38 ±14） years old, Among them, 20 patients （24. 1%） were predominant, 15 （18. 1%） mixed and 17 （20.5%） constipation-predominant, 31 （ 37.3% ） diarrheaunclassified type. （ 1 ） Sixty-two （ 74. 7% ） patients scored positive for any personality dysfunction. There was no significant gender difference. The cluster C （anxious-fearful） personality disorder was most commonly found in IBS patients （n = 58, 69. 9% ）. The prevalence of somatoform disorders plus personality dysfuntion was 46. 8% （29/62）. It was significantly higher than those without personality dysfunction [ 19. 0% （4/21）, P = 0. 0251. （2） Thirty-seven patients （44. 6% ） had a lifetime CIDI-3.0 diagnosis. It was significantly higher than that in the general population. There was no gender difference. Anxiety and mood disorders were the most common types of psychiatric comorbidities [ n = 21 （25.3%） and n = 19 （22. 9% ） respectively ]. The lifetime prevalence of alcohol or nicotine abuse and（or） dependence and intermittent explosive disorder were 10. 8% （n = 9） and 8. 4% （n = 7）. Psychiatric comorbidities were most commonly found in diarrhea-predominant patients （58. 1% ）. But there was no significant difference among the subgroups. （3） Thirty-three patients （39. 8% ） had somatoform disorders. Neither gender nor subgroup difference was observed. The IBS patients with anxiety disorders presented significantly more somatoform disorders than the remainders [ 61.9% （13/21） vs 32. 3% （20/62）, P =0. 016]. Conclusion Such psychiatric comorbidities as anxiety disorders and mood disorders are common in patients referred for IBS. The patients with personality dysfunction and（or） anxiety were more likely to suffer somatoform disorders. A gastroenterologist should grasp a thorough knowledge and make appropriate therapeutic recommendations for those patients.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2011年第27期1886-1890,共5页
National Medical Journal of China
基金
国家高技术研究发展计划"863"计划专题
作者简介
通信作者：段丽萍，Email：duanlp@bjmu．edu．cn
