發(fā)布時間：2018-05-26 04:56

  本文選題：原發(fā)性膽汁反流性胃炎 + 膽囊排空功能　； 參考：《青島大學》2017年碩士論文

【摘要】：目的研究原發(fā)性膽汁反流性胃炎患者膽囊排空功能與心理精神因素在發(fā)病機制中的作用及心理精神因素對膽囊排空功能的影響,為原發(fā)性膽汁反流性胃炎臨床治療提供新理論依據(jù),同時探究膽囊排空的特點,探討幽門螺桿菌感染與膽汁反流關系。方法標本取自來我院內鏡室行內鏡檢查的患者,采用胃鏡檢查和胃粘膜組織活檢共同診斷的方法,選取原發(fā)性膽汁反流性胃炎患者31例,和19例慢性非萎縮性胃炎患者作對照。所有受試者均填寫一般情況登記表,采用軀體化癥狀自評量表評估心理精神因素,在B超下分別進行空腹以及脂餐后的膽囊排空試驗,記錄膽囊最大長徑、前后徑、橫徑和膽囊壁變化,統(tǒng)計軀體化癥狀自評量表得分以及空腹和餐后膽囊體積大小并計算排空率。結果原發(fā)性膽汁反流性胃炎患者常見的癥狀為腹脹(64.5%)、腹痛(64.5%)、噯氣(67.7%)、燒心(61.3%)、反酸(51.6%),同時可伴早飽感(35.5%)、惡心(38.7%)、食欲不振(25.8%)、失眠(41.9%)等癥狀,與慢性非萎縮性胃炎臨床表現(xiàn)差異無統(tǒng)計學意義(P0.05),原發(fā)性膽汁反流性胃炎臨床癥狀無特異性;原發(fā)性膽汁反流性胃炎組中存在心理精神因素比例(71.8%)明顯高于對照組(42.1%),膽囊排空率(35.31±18.53)%也明顯低于對照組(51.99±11.80)%(均P0.05),且試驗組中存在心理精神因素組的膽囊排空率(29.51±13.65)%,也明顯低于不存在心理精神因素組(51.97±21.43)%,P0.05,心理精神因素(SSS評分)與膽囊排空率呈負相關(r=-0.76,p0.05);超聲檢測下最大長徑變化、最大前后徑變化和最大橫徑變化均與膽囊排空率呈負相關(r=-0.746、-0.382、-0.538),且橫徑變化對膽囊排空率影響(B=-18.77)最為顯著,而膽囊壁變化與膽囊排空率之間無相關性(P0.05);反流組HP感染率與非反流組HP感染率差異有統(tǒng)計學意義,反流組HP感染明顯低于非反流組(X~2=5.632,P0.05)。結論原發(fā)性膽汁反流性胃炎臨床癥狀無特異性,常見的有腹痛、腹脹、反酸、燒心、噯氣,同時可伴有早飽、惡心、食欲不振、失眠等;原發(fā)性膽汁反流性胃炎患者存在顯著心理精神因素的影響,膽囊排空率顯著降低,心理精神因素可顯著影響膽囊排空功能,可能是通過中樞神經(jīng)系統(tǒng)、自主神經(jīng)系統(tǒng)和各種胃腸肽共同調控造成的,在臨床治療中應適當給予患者心理精神方面的干預,加強調節(jié)胃腸道及膽囊功能,有望研制新型藥物調節(jié)自主神經(jīng)系統(tǒng);原發(fā)性膽汁反流性胃炎的幽門螺桿菌感染率較低,膽汁反流能夠抑制幽門螺桿菌生長繁殖;超聲測定膽囊體積變化時最大橫徑變化對膽囊體積變化影響最顯著,而膽囊壁厚度的變化與膽囊體積變化無相關性,可能僅存在動力因素。
[Abstract]:Objective to study the effect of gallbladder emptying and psychological factors on the pathogenesis of primary bile reflux gastritis and the effect of psycho mental factors on the gallbladder emptying function, to provide a new theoretical basis for the clinical treatment of primary bile reflux gastritis, and to explore the characteristics of gallbladder emptying, and to explore the infection of Helicobacter pylori and to explore the infection of Helicobacter pylori. Method specimens were selected from the endoscopy room of our hospital. By gastroscopy and gastric mucosal biopsy, 31 patients with primary bile reflux gastritis were selected and 19 patients with chronic non atrophic gastritis were compared. All subjects filled in the general registration form and used the body. The psychological and mental factors were evaluated by the self rating scale, and the gallbladder emptying test was carried out on the empty stomach and after the fat meal. The maximum length of the gallbladder, the front and back diameter, the transverse diameter and the change of the gallbladder wall were recorded. The scores of the somatic symptom self rating scale, the volume of the gallbladder and the postprandial gallbladder and the rate of emptying were calculated. The result of primary bile reflux was the result. The common symptoms of gastritis were abdominal distention (64.5%), belching (67.7%), heart burning (61.3%), acid reacid (51.6%), accompanied by early satiety (35.5%), nausea (38.7%), anorexia (25.8%), insomnia (41.9%) and other symptoms, with no statistical difference from chronic atrophic gastritis (P0.05), the clinical symptoms of primary bile reflux gastritis. The proportion of mental and mental factors in the primary bile reflux gastritis group (71.8%) was significantly higher than that in the control group (42.1%), and the gallbladder emptying rate (35.31 + 18.53)% was significantly lower than that of the control group (51.99 + 11.80)% (all P0.05), and the gallbladder emptying rate (29.51 + 13.65)% in the group of psycho psychic factors in the experimental group was also significantly lower than that of the non existence heart. The group (51.97 + 21.43)%, P0.05, psycho psychic factor (SSS score) had a negative correlation with the gallbladder emptying rate (r=-0.76, P0.05), and the maximum length and diameter change under ultrasonic examination, the maximum change of front and back diameter and the maximum transverse diameter were all negatively correlated with the gallbladder emptying rate (r= -0.746, -0.382, -0.538), and the change of transverse diameter on the gallbladder emptying rate (B=-18.77). There was no correlation between the gallbladder wall change and the gallbladder emptying rate (P0.05), and the HP infection rate and the HP infection rate in the reflux group were significantly lower than that in the non reflux group, and the HP infection in the reflux group was significantly lower than that of the non reflux group (X~2=5.632, P0.05). It can be accompanied by early satiety, nausea, nausea, loss of appetite, insomnia, and so on. There are significant psychological and mental factors in the patients with primary bile reflux gastritis, the gallbladder emptying rate is significantly reduced, psycho psychic factors can significantly affect the gallbladder emptying function, which may be through the central nervous system, the autonomic nervous system and various gastrointestinal peptides. In clinical treatment, the psychological and mental intervention should be properly given to the patients to regulate the function of the gastrointestinal tract and the gallbladder, and a new drug regulating autonomic nervous system is expected to be developed. The rate of Helicobacter pylori infection in primary bile reflux gastritis is low, and bile reflux can inhibit the growth and reproduction of Helicobacter pylori; The change of the maximum diameter of the gallbladder has the most significant influence on the change of the gallbladder volume, while the change of the thickness of the gallbladder is not related to the change of the gallbladder volume, and there may be only a dynamic factor.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R573.3

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本文編號：1936023