【作者】 韩永春；

【导师】 林越汉；

【作者基本信息】 福建中医学院 ， 中医内科学， 2008， 硕士

【摘要】 目的:1.通过对非糜烂性反流病(non-erosive reflux disease,NERD)的证型做小样本调查,初步了解本地区NERD患者中医证型的分布特点,同时根据调查结果,进一步对常见证型进行深入探讨。2.通过对NERD患者焦虑和/或抑郁状态评分调查,探讨精神心理因素与NERD常见证型发病的相关性。3.为NERD的中西医结合治疗开拓新的思路和方法。方法:自2006年2月～2008年1月,对就诊于福建省人民医院和福建省立医院消化内科门诊、住院和福建省消化内镜中心的具有典型的烧心感和反流症状(如胸骨后疼痛、反酸或反食)患者,予反流性疾病问卷(reflux diagnostic questionnaire,RDQ,又称耐信量表)评定症状总分≥12分,行电子胃镜检查,排除有食管粘膜损害或Barrett食管表现的患者,筛选出非糜烂性反流病(NERD)患者,行证候学调查,并予分析、归纳,应用国际通用的焦虑自评量表(Self-rating anxiety scale,SAS)、抑郁自评量表(Self-rating depression scale,SDS)对所有入选患者进行焦虑和/或抑郁状态心理测评,并统计总积分,观察临床非糜烂性反流病患者常见中医证型与焦虑和/或抑郁的关系。结果:1.本课题共收集176例NERD患者,主要归纳为4个常见证型,其中肝胃郁热证56例占总例数32.2%,肝胃不和证48例占总例数27.2%,痰气郁阻证37例占总例数20.9%,脾胃虚弱证27例占总例数15.2%,其它证型8例占总例数4.5%。由此可见,NERD患者中肝胃郁热证最多,肝胃不和证其次。2.NERD 4个常见证型肝胃郁热证、肝胃不和证与痰气郁阻证、脾胃虚弱证RDQ积分比较,前2个证型分别明显高于后2个证型RDQ积分,存在显著性差异,P＜0.05;肝胃郁热证与肝胃不和证比较、痰气郁阻证与脾胃虚弱证比较无显著性差异,P＞0.05,提示肝胃郁热证与肝胃不和证临床症状较严重。3.NERD 4个常见证型肝胃郁热证、肝胃不和证与痰气郁阻证、脾胃虚弱证SAS表和/或SDS表积分比较,前2个证型分别明显高于后2个证型,存在显著性差异,P＜0.05:肝胃郁热证与肝胃不和证比较、痰气郁阻证与脾胃虚弱证比较无显著性差异,P＞0.05,提示肝胃郁热证与肝胃不和证伴有抑郁和/或焦虑状态较严重。4.NERD患者RDQ积分与SAS表和/或SDS表积分呈显著正相关性。5.非糜烂性反流病4个常见证型的患者均有不同程度的精神心理因素,肝胃郁热、肝胃不和的焦虑和/或抑郁状态评分明显高于其他各型。结论:1.本地区NERD患者中医证型以肝胃郁热证、肝胃不和证、痰气郁阻证和脾胃虚弱证为主,特别是前2个证型。2.精神心理因素在NERD的发病中起重要作用。3.NERD患者症状严重程度与其焦虑和/或抑郁状态严重程度呈正相关性。4.肝之疏泄功能失常在NERD的发病中是十分重要的一环。更多还原

【Abstract】 Objective:1.Through the sample survey of the NERD’s chinese syndromes to understand this area sufferers’distribution feature.according to the investigation result at the same time, further carry on the deep discussion to often chinese syndromes.2.Through grading and investigating to NERD patient’s anxious and/or depressed state,To probe the relationship between psychological factor and chinese syndromes types of non-erosive reflux disease 3.Open up new thinking and method for the therapy of combining traditional Chinese and Western medicine of NERD.Method:Since February,2006 to January,2008,to go to a doctor on hospital,and Endoscope of ministry have typical cooking feeling and reflux symptom digest,Pain,sour instead of behind the brestbone or against food) The patiens mark Reflux diagnostic questionnare(RDQ)scal,the total points of symptom are greater than 12 points,then using gastrocopy,get rid of oesophageal mucous membrane damage or Barrett patient whose esophagus display,We choosed non-erosive reflux diseas(NERD)patients,Basing on Chinese medicine diagnostic standard to evaluate,employing internatioanlly agreed anxiety commenting scales(Self-rating anxiety scale,SAS),the depressed scale(Self-rating depression scale,SDS) commenting.It is until allthe patients more selected for anxiety and Depressed state psychology test and assess,count total scores,to observe the relationship between different chinese syndro-mes and psychological factor.Results:1.176 cases of non-erosive reflux disease were classified according to svndrome differentiation.Mainly four syndrome types of non-erosive reflux disease,stagnated heat of liver stomach accounted for 32.2%as 56 patiens,disorder of liver stomach accounted for 27.2%as 48 patiens,phlegmqi stagnation accounted for 20.9%as 37 patiens,27 patiens of asthenia spleen and stomach accounted for 15.2%,other syndrome types 8 account for 4.5%. Therefore NERD patients stagnated heat of liver stomach to take the most,disorder of liver stomach secondly.2.Four syndrome types of non-erosive reflux disease,stagnated heat of liver stomach of total mark of RDQ form,disorder of liver stomach,asthenia spleen and stomach with card and phlegmqi stagnation,the first 2 card type total mark of RDQ form are obviously higher than the last 2 card type total mark of RDQ form,there are significant differences,P＜0.05,has comparativity,There is no significant difference between stagnated heat of liver stomach,disorder of liver stomach and phlegmqi stagnation,asthenia spleen and stomach,P＞0.05,It is not relatively serious to brief on stagnated heat of liver stomach and disorder of liver stomach with the clinical symptom of the card.3.Four syndrome types of NERD often stagnated heat of liver stomach,disorder of liver stomach and phlegmqi stagnation,asthenia spleen and stomach form and/or SDS form integration,SAS of card,compare while being strongly fragrant with card,the first 2 card types are obviously higher than the last 2 card types separately,there are significance differences,P＜0.05;stagnated heat of liver stomach,disorder of liver stomach,phlegmqi stagnation have a significance difference compared with asthenia spleen and stomach,while being strongly fragrant,P＞0.05,it is not relatively serious to brief on the stagnated heat of liver stomach and disorder of liver stomach with the depressed and/or anxious state.4.Total mark of NERD symptom(RDQ) Present prominent positive correlation with SDS, SAS.5.Four syndrome types of NERD have a psychological factor in various degree often,the stagnated heat of liver stomach,disorder of liver stomach with anxiety / states depressed grade last a other various obviously.Conelusion:1.The chinese syndromes of this area NERD patient relies mainly on the fact that stagnated heat of liver stomach,disorder of liver stomach and phlegrnqi stagnation,asthenia spleen and stomach,especially the first 2 card types.2,psychological factor plays an important role among morbidity of NERD.3.NERD patient presents relevance in the hope of being improved instead of the state severity of anxious and/or depressed state in symptom severity.4.The stagnation of liver plays important role in the pathogenesis of non-erosive reflux disease.更多还原