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目的探讨非心源性胸痛患者(NCCP)的临床特点,调查NCCP患者的生活质量状况,了解NCCP与酸反流的关系及质子泵抑制剂(PPI)试验对NCCP病因诊断的价值。方法详细记载87例NCCP患者症状并评分后,给予7 d兰索拉唑治疗试验(兰索拉唑30 mg口服,2次/d),并在PPI试验前后均进行问卷调查,内容包括一般社会资料,症状评分表,简明健康状况调查表SF-36,焦虑量表(SAS),抑郁量表(SDS),所得分数与健康对照组进行比较。结果①NCCP最常见的病因是胃食管反流病,典型反流症状发生率为34.5%。②87例NCCP患者中酸相关性NCCP为56.3%(49/87),非酸相关性NCCP为43.7%(38/87)。PPI试验敏感性为91%,特异性为81%。③NCCP患者的生活质量在8个健康概念上除情绪角色功能外均明显比健康人差(P<0.01)。除躯体疼痛外,非酸相关性NCCP组在生理功能、生理职能、精神健康、总体健康、社会功能情感职能、活力6个维度,积分下降更为显著(P<0.05)。④NCCP患者焦虑、抑郁的发生率明显高于健康对照组(P<0.01),平均焦虑、抑郁程度高于对照组(P<0.01),非酸相关性NCCP组焦虑症和抑郁症的发生率明显高于酸相关性NCCP组(P<0.05)。结论NCCP最常见的病因是酸相关性食管疾病,NCCP患者伴有不同程度的精神障碍,PPI试验是临床诊断酸相关性NCCP的简便而实用的方法。
Objective To investigate the clinical features of non-cardiac chest pain (NCCP), investigate the quality of life of NCCP patients, understand the relationship between NCCP and acid reflux and the value of proton pump inhibitor (PPI) test in the diagnosis of NCCP. Methods The symptoms and scores of 87 patients with NCCP were recorded in detail. The lansoprazole 7-day treatment (lansoprazole 30 mg orally twice a day) was given and questionnaires were conducted before and after the PPI test. The questionnaire included general society SF-36, SAS, and SDS, and the scores were compared with healthy controls. Results ① The most common cause of NCCP was gastroesophageal reflux disease. The incidence of typical reflux symptoms was 34.5%. (2) Acid-related NCCP was 56.3% (49/87) in 87 patients with NCCP and 43.7% (38/87) in non-acid-related NCCP. PPI test sensitivity was 91%, specificity was 81%. ③ The quality of life of patients with NCCP was significantly worse than that of healthy people (P <0.01) except for the role of emotional role in the eight health concepts. In addition to somatic pain, non-acid-related NCCP group decreased more significantly in six dimensions of physiological function, physiological function, mental health, general health, emotional function of social function, and vitality (P <0.05). The incidence of anxiety and depression in NCCP patients was significantly higher than that in healthy controls (P <0.01). The average anxiety and depression were higher in NCCP patients than those in control group (P <0.01). The incidence of anxiety and depression were significantly higher in non-acid-related NCCP patients Higher than acid-related NCCP group (P <0.05). Conclusion The most common cause of NCCP is acid-related esophageal disease. NCCP patients with varying degrees of mental disorders, PPI test is a simple and practical method for the clinical diagnosis of acid-related NCCP.