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目的:探讨心理因素在难治性IBS发病中的作用和抗抑郁药对IBS的疗效。方法:分别对92例经常规治疗无效的IBS患者和66名健康成人进行汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和症状自评量表(SCL)-90心理测评,对IBS患者的主要症状进行评分以了解其心理状态,并对IBS患者的主要症状(腹部不适、疼痛和排便异常等)进行分级。在常规治疗的基础上予lBS患者抗抑郁药文拉法新,疗程均为6周,治疗前后分别进行上述量表评分和主要症状分级。结果:lBS患者的HAMD、HAMA、HAD评分均高于健康对照组(P<0.001),接受抗抑郁药文拉法新治疗2周、4周及6周,各量表评分均显著低于治疗前,主要症状分级亦明显降低,4周及6周相比较为接近,治愈率分别为46.3%和49.6%,总有效率分别为82.7%和94.2%。结论:心理因素在lBS的发病中起重要作用。难治性lBS患者普遍存在抑郁、焦虑等情绪障碍;应用抗抑郁药治疗能显著改善难治性lBS患者的症状。文法法新2周后起效,(4周末及6周末接近提示)疗效延续、稳定。
Objective: To explore the role of psychological factors in the pathogenesis of refractory IBS and the effect of antidepressants on IBS. Methods: Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Scale (HAMA) and Symptom Checklist 90 (SCL) -90 psychological evaluation were performed in 92 patients with IBS and 66 healthy adults who were ineffective in conventional treatment. IBS The patient’s main symptoms were scored to understand their psychological status, and the main symptoms of IBS patients (abdominal discomfort, pain and defecation abnormalities, etc.) were graded. On the basis of routine treatment of lBS patients with antidepressant venlafaxine, treatment were 6 weeks, before and after treatment were scored above the scale and classification of the main symptoms. Results: The scores of HAMD, HAMA and HAD in lBS patients were significantly higher than those in healthy controls (P <0.001). The scales of two scales, four weeks and six weeks after anti-depressant therapy were significantly lower than those of the treatment Before, the main symptoms were significantly lower grade, 4 and 6 weeks are relatively close, the cure rates were 46.3% and 49.6%, the total effective rate was 82.7% and 94.2%. Conclusion: Psychological factors play an important role in the pathogenesis of lBS. Refractory lBS prevalence of depression, anxiety and other mood disorders; antidepressants treatment can significantly improve the symptoms of refractory lBS patients. New grammar law 2 weeks after the onset, (4 weekend and 6 weekend approaching tips) efficacy continued, stable.