Chan Annie-Oo, Cheng Cecilia, Hui Wai-Mo, Hu Wayne-H-C, Wong Nina-Y-H, Lam K-F, Wong Wai-Man, Lai Kam-Chuen, Lam Shiu-Kum, Wong Benjamin-C-Y
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
World J Gastroenterol. 2005 Sep 14;11(34):5362-6. doi: 10.3748/wjg.v11.i34.5362.
To investigate coping mechanisms, constipation symptoms and anorectal physiology in 80 constipated subjects and 18 controls.
Constipation was diagnosed by Rome II criteria. Coping ability and anxiety/depression were assessed by validated questionnaires. Transit time and balloon distension test were performed.
34.5% patients were classified as slow transit type of constipation. The total colonic transit time (56 h vs 10 h, P<0.0001) and rectal sensation including urge sensation (79 mL vs 63 mL, P = 0.019) and maximum tolerable volume (110 mL vs 95 mL, P = 0.03) differed in patients and controls. Constipated subjects had significantly higher anxiety and depression scores and lower SF-36 scores in all categories. They also demonstrated higher scores of 'monitoring' coping strategy (14+/-6 vs 9+/-3, P = 0.001), which correlated with the rectal distension sensation (P = 0.005), urge sensation (P=0.002), and maximum tolerable volume (P = 0.035). The less use of blunting strategy predicted slow transit constipation in both univariate (P = 0.01) and multivariate analysis (P = 0.03).
Defective or ineffective use of coping strategies may be an important etiology in functional constipation and subsequently reflected in abnormal anorectal physiology.
研究80例便秘患者和18例对照者的应对机制、便秘症状及肛肠生理情况。
采用罗马II标准诊断便秘。通过有效问卷评估应对能力及焦虑/抑郁情况。进行传输时间和气囊扩张试验。
34.5%的患者被归类为慢传输型便秘。患者与对照者的全结肠传输时间（56小时对10小时，P<0.0001）以及直肠感觉包括便意感觉（79毫升对63毫升，P = 0.019）和最大耐受量（110毫升对95毫升，P = 0.03）存在差异。便秘患者在所有类别中的焦虑和抑郁评分显著更高，而SF-36评分更低。他们还表现出更高的“监控”应对策略得分（14±6对9±3，P = 0.001），这与直肠扩张感觉（P = 0.005）、便意感觉（P = 0.002）和最大耐受量（P = 0.035）相关。在单因素分析（P = 0.01）和多因素分析（P = 0.03）中，较少使用钝化策略均预示着慢传输型便秘。
应对策略使用不当或无效可能是功能性便秘的重要病因，并随后反映在异常肛肠生理中。
