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陆军某部官兵创伤后应激障碍患病情况及其与功能性胃肠病的关系
作者:王倩 姚欣 靳海峰 孙蓉 于佳 智佳 王春华 郭丽丽 
单位:067000  河北承德  承德医学院研究生学院(王倩) 101100  北京  首都医科大学附属北京友谊医院新华医院消化内科(姚欣) 050082  石家庄  解放军白求恩国际和平医院消化内科(靳海峰、孙蓉、于佳、智佳、王春华、郭丽丽) 
关键词:创伤后应激障碍 功能性胃肠病 军人 创伤性事件 压力性事件 
分类号:R57;R749.5
出版年,卷(期):页码:2018,43(2):172-180
摘要:

[摘要 目的  探讨陆军某部官兵创伤后应激障碍(PTSD)患病情况及其与功能性胃肠病(FGIDs)的关系。方法  应用创伤后应激障碍症状自评量表(PCL-C)诊断PTSD,应用罗马 FGIDs调查问卷进行FGIDs的分类和诊断。采用创伤史筛查问卷及压力性事件调查问卷研究PTSD与创伤性及压力性事件的关系。分析PTSDFGIDs的重叠情况及二者的相关性。结果  927例调查对象中,诊断为PTSD33例,总体患病率3.56%;诊断为FGIDs435例,总体患病率为46.93%。诊断为PTSD33例中28例合并FGIDsFGIDs患病率为84.85%(28/33),明显高于非PTSD(45.53%P<0.05)。同时,FGIDsPTSD患病率高于非FGIDs(6.43% vs. 1.02%P<0.05)PTSD官兵最常见的FGIDs是周期性呕吐综合征(CVS33.33%)、非特异性功能性肠病(24.24%)、功能性腹胀(18.18%)和功能性直肠肛门痛(18.18%)。多因素分析发现,PTSDCVS(OR=9.118)、功能性直肠肛门痛(OR=3.373)、功能性腹胀(OR=4.772)、肠易激综合征(OR=3.438)、反刍综合征(OR=16.033)、功能性呕吐(OR=10.329)和功能性吞咽困难(OR=9.891)的危险因素(P<0.05)。多因素logistic回归分析显示,CVS(OR=4.063)、创伤性事件个数(OR=1.159)和压力性事件个数(OR=1.401)是军人PTSD患病的危险因素(P<0.05)结论 PTSDFGIDs互为患病的危险因素,PTSD在多种FGIDs中的患病率存在较大差异。CVSPTSD官兵最常见的FGIDs,也是PTSD患病的危险因素,其原因及机制值得深入研究。

[Abstract]  Objective  To determine the prevalence of post traumatic stress disorder (PTSD) in the army officers and soldiers (AOSs), and identify its relationship with functional gastrointestinal disorders (FGIDs). Methods  PTSD and FGIDs were diagnosed based on the PTSD checklist--civilian (PCL-C) and Rome Modular Questionnaire respectively, the overlaps of PTSD and FGIDs and their correlation were diagnosed. The correlation of PTSD with traumatic and stressful events was investigated using Trauma History and Stressful Event Screening Questionnaire. The coexistence and relationship of PTSD and FGIDs were analyzed. Results  Of 927 AOSs, 33 were diagnosed with PTSD. The prevalence of PTSD was 3.56%. FGIDs were identified in 435 subjects and the incidence of FGIDs was 46.93%. Among 33 AOSs with PTSD, 28 were diagnosed as having FGIDs and the prevalence of FGIDs was 84.85%, which was significantly higher than that of non-PTSD group (45.53%, P<0.05). Moreover, the FGIDs group had a higher prevalence of PTSD, compared with the non-FGID group (6.43% vs. 1.02%, P<0.05). Cyclic vomiting syndrome (CVS, 33.33%), unspecified functional bowel disorder (24.24%), functional bloating (18.18%) and functional anorectal pain (18.18%) were the four most frequent FGIDs in PTSD AOSs. Multiple regression analysis showed PTSD was the risk factor for CVS (OR=9.118), functional anorectal pain (OR=3.373), functional bloating (OR=4.772), irritable bowel syndrome (OR=3.438), rumination syndrome (OR=16.033), functional vomiting (OR=10.329), functional dysphagia (OR=9.891)(P<0.05). CVS (OR=4.063), the number of traumatic (OR=1.159) and stress events (OR=1.401) were the risk factors for PTSD in AOSs (P<0.05). Conclusions  PTSD and FGID interact as risk factor each other. The prevalence of PTSD differs significantly in different FGIDs. CVS is the most frequent FGID in PTSD AOSs and risk factor for PTSD, which deserves more concerns.

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