Stepanishcheva L A, Sarsenbaeva A S, Fattakhova N V
Eksp Klin Gastroenterol. 2014(11):14-8.
To study the psycho-emotional status and prevalence of the coronary heart disease (CHD) and the idiopathic hypertensia (IH) at patients with the peptic ulcer of a stomach (PUS) and at patients with a peptic ulcer of a duodenum is (YaB DPK).
Examination of 226 patients with an exacerbation of a peptic ulcer was conducted. Patients were distributed in 3 groups of observation depending on localization of ulcerative process. At all surveyed questioning was carried out, data on heriditary burdeness, smoking, alcohol intake, existence of somatopathies were specified, clinic-morphological implications of a peptic ulcer were studied.
Feeling of alarm was present at 109 (48.2%) patients with a peptic ulcer, from them at 92 (40.7%) the subclinical level of alarm is noted, and at 17 (7.5%) clinically expressed form is taped. At 39.3% of the examined patients the depression is defined, from them two thirds of patients had the subclinical level of a depression, and 13 people suffered from clinically expressed depression form. Communication of recurrence with a stress was noted at 86.0% of patients, professionally caused stress--at 44.4%. In our research at the time of the beginning of a disease prevalence of an ischemic heart disease among patients with an ulcer of a duodenum (DPK) made 18.2%. In group of patients with the combined localization of ulcerative defect in a stomach and in DPK which already had an ischemic heart disease before emergence of the second ulcerative defect there were 26.6% that statistically significantly doesn't differ. However that by the time of emergence of the combined lesion this category of patients made already 73.4% is indicative. In case of DPK ulcer prevalence of an ischemic heart disease increased from the moment of the beginning of a disease until carrying out research twice (to 36.4%), but patients with the combined ultserozny lesion nevertheless distinguished both larger initial prevalence of an ischemic heart disease, and more expressed its gain. At the time of the beginning of a disease of GB met in a group of persons with the isolated ulcerative defect authentically more often (36.4% against 18.7% in group of patients with the combined localization of an ulcer). At the time of carrying out research prevalence of GB among patients with DPK ulcer (47.7%) whereas in group of the combined lesion of a stomach and DPK of GB without ischemic heart disease there was only every fourth patient remained significant by 2,7 times (DI 1.2-6.3). The combination of associated diseases of an ischemic heart disease and GB at patients with the advent of an ulcer at the same time in a stomach and DPK practically always met at the persons abusing alcohol and tobacco smoking that in general enlarges risk of development of an ulcer of the second localization by 7,6 times
At the peptic ulcer (PU) of any localization the previous stress conducting quite often to formation of alarm and a depression conducts to also education a stress--the induced conditions, for example, of an arterial hypertonia, and later--to an ischemic heart disease. As specific to every second patient with the combined form of a peptic ulcer of a stomach and a duodenum it is possible to consider a polisintropiya from such the comorbidity diseases as coronary heart disease and an idiopathic hypertensia. The combination of these associated diseases to alcohol intake and tobacco smoking progressively enlarges risk of development of a peptic ulcer of the combined localization by 7,6 times in comparison with the isolated duodenum canker.
To define influence of the comorbidity diseases and risk.
研究胃溃疡(PUS)患者和十二指肠溃疡(YaB DPK)患者的心理情绪状态以及冠心病(CHD)和特发性高血压(IH)的患病率。
对226例消化性溃疡急性发作患者进行了检查。根据溃疡病变的部位,将患者分为3组进行观察。对所有受调查者进行了询问,明确了遗传负担、吸烟、饮酒、躯体疾病的存在情况,研究了消化性溃疡的临床形态学特征。
109例(48.2%)消化性溃疡患者存在焦虑情绪,其中92例(40.7%)为亚临床焦虑水平,17例(7.5%)为临床显性焦虑形式。39.3%的受检患者存在抑郁,其中三分之二的患者为亚临床抑郁水平,13例患者患有临床显性抑郁形式。86.0%的患者发现复发与压力有关,职业性压力导致的复发占44.4%。在我们的研究中,十二指肠溃疡(DPK)患者在疾病初发时缺血性心脏病的患病率为18.2%。在胃和DPK溃疡合并定位且在第二个溃疡病变出现前已有缺血性心脏病的患者组中,这一比例为26.6%,统计学上无显著差异。然而,到合并病变出现时,这类患者已占73.4%,这一点很有指示性。在疾病初发时,单纯溃疡病变组中真正更常出现GB(36.4%,而溃疡合并定位患者组为18.7%)。在进行研究时,DPK溃疡患者中GB的患病率为47.7%,而在胃和DPK合并病变且无缺血性心脏病的患者组中,每四名患者中只有一名出现GB,差异有统计学意义,为2.7倍(DI 1.2 - 6.3)。缺血性心脏病和GB的合并疾病在胃和DPK同时出现溃疡的患者中几乎总是同时存在,这些患者通常酗酒和吸烟,这总体上使第二个定位溃疡的发生风险增加7.6倍。
在任何部位的消化性溃疡(PU)中,先前常导致焦虑和抑郁形成的压力也会导致应激诱导状态的形成,例如动脉高血压,随后导致缺血性心脏病。对于胃和十二指肠溃疡合并形式的每第二名患者,可以认为存在来自冠心病和特发性高血压等合并疾病的多系统病变。与单纯十二指肠溃疡相比,这些合并疾病与饮酒和吸烟的结合使合并定位消化性溃疡的发生风险增加7.6倍。
确定合并疾病的影响和风险。