Creed Francis, Tomenson Barbara, Guthrie Elspeth, Ratcliffe Joy, Fernandes Lakshmi, Read Nicholas, Palmer Steve, Thompson David G
Division of Psychiatry, University of Manchester, Manchester, UK.
J Psychosom Res. 2008 Jun;64(6):613-20. doi: 10.1016/j.jpsychores.2008.02.016.
This study aimed to assess the relationship between somatisation and outcome in patients with severe irritable bowel syndrome (IBS).
Two hundred fifty-seven patients with severe IBS included in a randomised controlled trial were assessed at baseline and divided into four quartiles on the basis of their somatisation score. The patients were randomised to receive the following over 3 months: brief interpersonal psychotherapy, 20 mg daily of the SSRI antidepressant paroxetine, or treatment as usual. Outcome 1 year after treatment was assessed using the Short Form-36 physical component summary (PCS) score and total costs for posttreatment year.
The patients in the quartile with the highest baseline somatisation score had the most severe IBS, the most concurrent psychiatric disorders, and the highest total costs for the year prior to baseline. At 1 year after the end of treatment, however, the patients with marked somatisation, who received psychotherapy or antidepressant, had improved health status compared to those who received usual care: mean (S.E.) PCS scores at 15 months were 36.6 (2.2), 35.5 (1.9), and 26.4 (2.7) for psychotherapy, antidepressant, and treatment-as-usual groups, respectively (adjusted P=.014). Corresponding data for total costs over the year following the trial, adjusted for baseline costs, were pound 1092 (487), pound 1394 (443), and pound 2949 (593) (adjusted P=.050).
Patients with severe IBS who have marked somatisation improve with treatment like other IBS patients and show a greater reduction of costs. Antidepressants and psychotherapy are cost-effective treatments in severe IBS accompanied by marked somatisation.
本研究旨在评估严重肠易激综合征（IBS）患者的躯体化与预后之间的关系。
对纳入一项随机对照试验的257例严重IBS患者在基线时进行评估，并根据其躯体化得分分为四个四分位数组。患者被随机分配接受以下治疗，为期3个月：简短人际心理治疗、每日20毫克的选择性5-羟色胺再摄取抑制剂（SSRI）抗抑郁药帕罗西汀或常规治疗。使用简明健康状况调查量表（SF-36）身体成分总结（PCS）得分和治疗后一年的总费用评估治疗1年后的预后。
基线躯体化得分最高的四分位数组患者的IBS最严重，并发精神疾病最多，且基线前一年的总费用最高。然而，在治疗结束1年后，接受心理治疗或抗抑郁药治疗的有明显躯体化的患者与接受常规治疗的患者相比，健康状况有所改善：心理治疗组、抗抑郁药组和常规治疗组在15个月时的平均（标准误）PCS得分分别为36.6（2.2）、35.5（1.9）和26.4（2.7）（校正P = 0.014）。试验后一年的总费用，经基线费用校正后的相应数据分别为1092英镑（487英镑）、1394英镑（443英镑）和2949英镑（593英镑）（校正P = 0.050）。
有明显躯体化的严重IBS患者与其他IBS患者一样，治疗后病情改善，且费用降低幅度更大。抗抑郁药和心理治疗是伴有明显躯体化的严重IBS的经济有效的治疗方法。
