臺灣成年人腸激躁症與精神症狀的相關性研究

The Relationship between Irritable Bowel Syndrome and Psychiatric Symptoms in a Taiwanese Adult Population

目的：腸激躁症與焦慮、憂鬱、身體化疾病、恐慌症及畏懼疾病有所相關，然而腸激躁症與其他精神症狀的相關性研究並不多，而現有的研究並未以複迴歸分析作其他干擾因素的調整。因此本研究以台灣成年人為研究對象，使用簡式症狀量表來評估精神症狀，探討腸激躁症與精神症狀的相關性。方法：以某醫學中心健康檢查病房接受胃鏡及大腸鏡篩檢、腸激躁症問卷及簡式症狀量表者共2,558位為研究對象。腸激躁症係採Rome II診斷標準。簡式症狀量表-50包括身體化症狀、強迫性症狀、人際間敏感性、憂鬱、焦慮、敵意、畏懼、疑心、離群及其他附加症狀等十個向度；並以一般症狀指數及各向度分數評估精神症狀的嚴重程度。結果：在2,558位受檢者中，符合腸激躁症者共217位（8.5%）。單變項分析顯示有腸激躁症組比無腸激躁症組較年輕、較高比例的喝酒習慣及較高的三酸甘油酯值、一般症狀指數和十個精神症狀向度分數，另外有／無腸激躁症兩組間在教育程度（p<0.001）及婚姻狀況（p<0.01）有顯著的差異。多變項分析顯示經調整年齡、性別、婚姻狀態、肥胖、高血壓、糖尿病、喝酒、茶及咖啡、吸菸及運動習慣後，中學（勝算比1.958）及小學以下（勝算比3.978）的教育程度比大學教育程度者有較高腸激躁症的勝算比；隨著一般症狀指數的增加，腸激躁症發生的勝算比也增加（勝算比3.340）。另外以精神症狀之十個向度分別取代一般症狀指數做進一步分析，結果顯示隨著每個精神症狀向度分數增加，有腸激躁症的勝算比也隨之增加（勝算比1.975-2.917）。結論：不論從精神症狀的整體性或從各精神症狀向度來看，較低的教育程度及精神症狀皆與腸激躁症有統計學上顯著的相關性。因此，臨床上應注意腸激躁者精神相關症狀之評估，以早期診斷及適時介入治療，尤其是中、小學以下教育程度的個案，但仍有待一步確認。

Purpose: It has been suggested that psychiatric symptoms including anxiety, depression, somatization disorder, panic disorders and phobias are associated with irritable bowel syndrome (IBS). The effect of psychiatric symptoms on IBS has been inconsistent and previous studies had not been adjusted for other confounding factors. The aim of this study was to investigate the relationship between psychiatric symptoms and IBS in a Taiwanese population. Methods: A total of 2,558 subjects receiving health check-ups in a medical center were recruited. Each subject completed structured questionnaires including the Rome Ⅱ diagnostic questionnaire for IBS and the brief symptom rating scale (BSRS). The BSRS consists of 50 items measuring ten subscales including somatization, obsession, interpersonal sensitivity, depression, anxiety, hostility, phobia, paranoid ideation, psychoticism and addition. The scores for the global severity index (GSI) and ten subscales were assessed to determine the severity of psychiatric symptoms. Results: Two hundred and seventeen subjects (8.5%) fulfilled the Rome II diagnostic criteria for IBS. Univariate analysis showed that the subjects with IBS were younger, had a higher percentage of habitual drinking, a higher level of triglycerides and higher scores on both the GSI and its ten subscales than did the subjects without IBS. There were significant differences in level of education and marital status between subjects with and without IBS. Subjects with higher GSI scores (odds ratio: 3.340), a high-school education (odds ratio: 1.958), and an elementary-school education or less (odds ratio: 3.978) had a higher risk for IBS after adjusting for age, sex, marital status, obesity, hypertension, diabetes mellitus, alcohol, tea, or coffee consumption, smoking and exercise habits. In other models, individual subscales were substituted for GSI for further multivariate analyses. The risk of IBS increased as each subscale score increased (odds ratio: 1.975-2.917). Conclusions: A low education level was statistically significantly associated with IBS in a Taiwanese population as were multiple psychiatric symptoms. An integrative evaluation of psychiatric symptoms is recommended in patients with IBS.