J Gastroenterology:功能性消化不良患者患有胃肠道感染后体重会明显减轻

2022-03-06 MedSci原创 MedSci原创

功能性消化不良(FD)又称消化不良,是指具有上腹痛、上腹胀、早饱、嗳气、食欲不振、恶心、呕吐等不适症状,经检查排除引起上述症状的器质性疾病的一组临床综合征。

      功能性消化不良 (FD) 是一种常见的胃肠道 (GI) 疾病,会对患者的生活质量造成相当大的影响,对社会造成重大经济负担。罗马 IV 指南将FD定义为源自胃肠道的影响日常生活的症,例如餐后饱胀、早饱、上腹痛和上腹灼痛,而没有潜在的器质性疾病。罗马 IV 标准将FD区分了两个亚组:餐后窘迫综合征 (PDS),其特征是早饱,餐后饱胀是最主要的症状,以及上腹痛综合征 (EPS),其特征是上腹痛或与摄入食物无关的烧灼感。有研究证实急性胃肠炎和幽门螺杆菌(HP) 感染是功能性胃肠道疾病(如 FD 和肠易激综合征)的潜在危险因素,急性胃肠炎后 FD 的持续症状称为感染后 FD (PI-FD),也有研究指出 HP 根除治疗后 FD 症状的显着改善,因此指南建议将 HP 根除作为 HP 阳性 FD 患者的一线治疗方案。然而,作为潜在危险因素的 GI 感染和 HP 与 FD 的关系在很大程度上仍不清楚。本项研究旨在评估感染后 FD (PI-FD) 和 HP 状态与临床特征和体重减轻的关系。

 

      研究人员对接受治疗的连续 FD 患者纳入本项研究,并收集统计了患者的症状频率和严重程度,并进行评估。根据严重程度评分将患者确定为 PDS、EPS 或两种疾病共有的重叠组。此外,还确定了 PI 历史记录和 HP 的感染状态。

 

      在 459 名 FD 患者的队列中,36% 的患者被表征为患有 PDS,9% 的患者患有 EPS,55% 的患者出现重叠。分别有 20% 和 14% 的患者报告 PI 发作和阳性 HP 状态,亚组之间没有显着差异(分别为p=0.31 和p=0.40)。研究结果PDS 患者体重减轻为 63%,EPS 患者体重减轻为 36%,重叠患者体重减轻为 56%(p=0.011)。只有早饱严重程度与 PDS ( r=0.31, p  < 0.0001) 和重叠组 ( r=0.38, p < 0.0001)中更严重的体重减轻相关 。PI-FD 患者更有可能经历体重减轻(OR 2.27,p=0.0013)。HP 状态与体重减轻没有显着相关性(p=0.90)。

图:不同患者体重减轻的情况

 

      本项研究证实FD 症状的 PI 发作是这部分患者出现体重减轻的危险因素,但与 PDS、EPS 或重叠亚组的症状模式无关。HP 感染患者不太可能经历严重的体重减轻。

 

 

原始出处:

Jolien Schol. Et al. Postinfectious onset in functional dyspepsia is a risk factor for weight loss. Journal of Gastroenterology.2022.

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    2022-09-22 许安
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