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目的 探讨FD患者的躯体化症状以及联合抗躯体化症状治疗对其生活质量的影响.方法 纳入219例FD患者,完成患者健康问卷躯体症状群量表15项(PHQ-15)和Nepean消化不良指数(NDI)评分,分析两者之间的关系.对采用常规PPI和(或)促动力药治疗后4周疗效差及PHQ-15＞4分的131例FD患者,服用兰索拉唑、莫沙必利联合氟哌噻吨美利曲辛(抗躯体化症状治疗)4周,而后观察疗效,分析治疗前后躯体化症状及NDI的变化.采用t检验、卡方检验、Spearman相关分析和线性回归进行统计学分析.结果 219例FD患者的PHQ-15总评分为(5.7±3.4)分,NDI总评分为(42.0±10.4)分,两者呈正相关(r=0.493,P＜0.05).胃痛、头痛、胸痛、头晕、气促、感到疲乏或精力不足、睡眠困难、口干等与NDI总评分呈正相关(r=0.262,0.230,0.241,0.243,0.352,0.385,0.266,0.281;P均＜0.05).胸痛、胃痛、气促、头晕、感到疲乏或精力不足是NDI的影响因素(t=2.340,2.488,5.278,2.167,2.443;P均＜0.05).131例采用联合抗躯体化症状治疗的FD患者中,6例因不良反应而未完成治疗,故最终125例被纳入分析.治疗前和治疗后4周,125例FD患者的PHQ-15总评分分别为(7.3±3.2)分和(2.9±2.2)分,差异有统计学意义(t=12.653,P＜0.01).胃痛、头痛、胸痛、头晕、气促、感到疲乏或精力不足、睡眠困难、口干在患者治疗前后的不同被扰程度(无影响、略有影响和有较大影响)中比较差异均有统计学意义(x2=39.231,6.796,6.693,15.520,6.698,51.572,44.390,16.506;P均＜0.05).治疗前NDI总评分为(44.3±11.7)分,治疗后为(29.2±6.9)分,差异有统计学意义(t=12.503,P＜0.01).结论 FD患者的躯体化症状如胸痛、胃痛、气促、头晕、感到疲乏或精力不足等影响其生活质量.对于常规治疗效果差的FD患者,通过联合抗躯体化症状治疗可能提高其生活质量.

Objective To explore somatic symptoms of patients with functional dyspepsia (FD) and effects of combined anti somatisation therapy on the quality of life in patients with FD.Methods Two hundred and nineteen patients with FD were enrolled.Patient Health Questionnaire-15 (PHQ-15) and Nepean Dyspepsia Index (NDI) were completed,and the relation between them was analyzed.Lansoprazole,mosapride and flupentixol melitracen (the anti-somatisation medication) were taken for four weeks by 131 FD patients who had poor response to four-week conventional treatment with proton pump inhibitors (PPI) and/or prokinetic medication and who got more than 4 scores in PHQ 15.And then therapeutic effects were observed and the changes of NDI before and after treatment were analyzed.The t test,chi-square test,Spearman's correlation and linear regression were performed for statistical analysis.Results The total PHQ-15 and NDI score of 219 patients with FD were 5.7±3.4 and 42.0± 10.4,and there was positive correlation between them (r=0.493,P＜0.05).Stomach pain,headache,chest pain,dizziness,shortness of breath,fatigue,sleeping disorder,thirst and so on were positively correlated with totalNDIscore (r=0.262,0.230,0.241,0.243,0.352,0.385,0.266,0.281,all P＜0.05).Chest pain,stomach pain,shortness of breath,dizziness and fatigue were the influence factors of NDI (t=2.340,2.488,5.278,2.167,2.443,all P＜0.05).Among 131 patients with FD who received anti somatisation combination therapy,six patients did not complete the therapy because of the side effects,and finally 125 patients were enrolled and analyzed.Before and four weeks after the treatment,the total PHQ-15 scores of 125 patients with FD were 7.3±3.2 and 2.9±2.2,respectively; and the difference was statistically significant (t =12.653,P＜0.01).There were significant differences in the influence of stomach pain,headache,chest pain,dizziness,shortness of breath,fatigue,sleeping disorder and thirst before and after the treatment (not bothered at all,bothered a little,bothered a lot) (x2=39.231,6.796,6.693,15.520,6.698,51.572,44.390 and 16.506,all P＜0.05).The total NDI score before and after the treatment were 44.3 ± 11.7 and 29.2 ± 6.9,and the difference was statistically significant (t=12.503,P＜0.01).Conclusions The quality of life in patients with FD is affected by somatic symptoms such as chest pain,stomach pain,shortness of breath,dizziness,fatigue and so on.For FD patients with poor response to conventional treatment,the quality of life could be improved by the combination of anti-somatisation therapy and the conventional therapy.