Levenstein S, Prantera C, Varvo V, Scribano M L, Berto E, Spinella S, Lanari G
Gastroenterology Division, Nuovo Regina Margherita Hospital, Rome, Italy.
J Clin Gastroenterol. 1995 Sep;21(2):110-7. doi: 10.1097/00004836-199509000-00010.
To clarify whether and how psychologic factors might contribute to peptic ulcer, in this study we addressed the relations between psychologic characteristics and known biologic risk factors among ulcer patients. In 75 patients with recent-onset, symptomatic duodenal ulcer, an index of three potential psychologic risk factors (stressful life events, abnormal Minnesota Multiphasic Personality Inventory, mood disturbance) was examined in relation to historical risk factors (sex, age, seasonality, family history, smoking, alcohol use, coffee consumption, nonsteroidal antiinflammatory drug use), and to blood type, serum pepsinogen I, and Helicobacter pylori antibody titers. The more risk factors in a patient's history, the less likely he or she was to have psychopathology or stress (r = -0.45, p = 0.0007). The mean number of conventional risk factors was 2.7 in patients with all three psychologic risk factors and 4.4 in patients with none; conversely, the mean number of psychologic factors was 0.9 among patients with five or more biologic risk factors and 2.1 among patients with fewer than three risk factors. This negative association was strongest among patients with no previous ulcer history. The psychologic factors also tended to vary inversely with H. pylori antibody titers but not with blood type O or pepsinogen. Duodenal ulcer patients who are atypical in terms of their conventional risk factors are likely to be emotionally fragile, under stress, or both, especially at the time of their first ulcer symptoms. A clinician diagnosing an ulcer in an individual who does not match the usual patient profile should be on the lookout for psychologic factors.
为了阐明心理因素是否以及如何导致消化性溃疡，在本研究中，我们探讨了溃疡患者心理特征与已知生物学危险因素之间的关系。在75例近期发病、有症状的十二指肠溃疡患者中，研究了三种潜在心理危险因素（生活应激事件、明尼苏达多相人格调查表异常、情绪障碍）指标与既往危险因素（性别、年龄、季节性、家族史、吸烟、饮酒、咖啡摄入、非甾体抗炎药使用）以及血型、血清胃蛋白酶原I和幽门螺杆菌抗体滴度之间的关系。患者病史中的危险因素越多，其出现精神病理学或压力的可能性就越小（r = -0.45，p = 0.0007）。在具有所有三种心理危险因素的患者中，传统危险因素的平均数量为2.7，而在没有心理危险因素的患者中为4.4；相反，在具有五种或更多生物学危险因素的患者中，心理因素的平均数量为0.9，而在具有少于三种危险因素的患者中为2.1。这种负相关在没有溃疡病史的患者中最为明显。心理因素也往往与幽门螺杆菌抗体滴度呈负相关，但与O型血或胃蛋白酶原无关。在传统危险因素方面不典型的十二指肠溃疡患者可能情绪脆弱、处于压力之下，或两者兼而有之，尤其是在首次出现溃疡症状时。临床医生在诊断不符合常见患者特征的个体的溃疡时，应留意心理因素。
