傅騏遐
【摘 要】目的 分析痔瘡伴便秘患者臨床特征與血脂代謝紊亂之間的關(guān)系。方法 選取寧波市第一醫(yī)院2021年6月-2022年6月收治的156例痔瘡伴便秘患者作為觀察組,160例同齡健康志愿者作為對照組,比較兩組血脂代謝指標(biāo)[甘油三酯(TG)、總膽固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)],并分析不同性別、年齡段、便秘嚴(yán)重程度的痔瘡伴便秘患者血脂代謝紊亂狀況。結(jié)果 觀察組外周血TG、TC及LDL-C水平高于對照組,HDL-C水平低于對照組(P<0.05),觀察組不同性別患者外周血TG、TC、LDL-C及HDL-C水平比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05);觀察組20~39歲及40~59歲年齡段患者TG、TC、LDL-C及HDL-C水平比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05),而60~70歲年齡段患者TG、TC、LDL-C水平高于20~39歲及40~59歲年齡段患者,HDL-C水平低于20~39歲及40~59歲年齡段患者(P<0.05)。隨著便秘嚴(yán)重程度的不斷加重,觀察組患者TG、TC及LDL-C水平逐漸升高,HDL-C水平逐漸下降(P<0.05)。結(jié)論 痔瘡伴便秘者存在血脂代謝紊亂問題,且老年及重度便秘患者血脂代謝問題更為嚴(yán)重,在常規(guī)用藥改善痔瘡伴便秘患者臨床癥狀的同時(shí),還應(yīng)注意對患者血脂代謝異常進(jìn)行調(diào)控。
【關(guān)鍵詞】痔瘡;便秘;血脂代謝紊亂
中圖分類號(hào):R574.8 文獻(xiàn)標(biāo)識(shí)碼:A 文章編號(hào):1004-4949(2022)19-0122-04
Analysis of Clinical Characteristics and Lipid Metabolism Disorder in Patients with Hemorrhoids and Constipation
Fu Qi-xia
(Department of Anorectal, Ningbo University School of Medicine, Ningbo 315211, Zhejiang, China)
【Abstract】Objective To analyze the relationship between clinical features and lipid metabolism disorder in patients with hemorrhoids and constipation. Methods A total of 156 patients with hemorrhoids and constipation admitted to Ningbo First Hospital from June 2021 to June 2022 were selected as the observation group, and 160 healthy volunteers of the same age were selected as the control group. The blood lipid metabolism indexes [triglyceride (TG), total cholesterol (TC), high density lipoprotein(HDL-C), low density lipoprotein (LDL-C)] were compared between the two groups, and the blood lipid metabolism disorders of patients with hemorrhoids and constipation of different genders, age groups and severity of constipation were analyzed. Results The levels of TG, TC and LDL-C in peripheral blood of the observation group were higher than those of the control group, and the level of HDL-C was lower than that of the control group, and the differences were statistically significant (P<0.05). There were no significant differences in the levels of TG, TC, LDL-C and HDL-C in peripheral blood of patients with different genders in the observation group (P>0.05).There was no significant difference in the levels of TG, TC, LDL-C and HDL-C in patients aged 20-39 years and 40-59 years in the observation group (P>0.05), while the levels of TG, TC and LDL-C in patients aged 60-70 years were higher than those in patients aged 20-39 years and 40-59 years, the level of HDL-C in patients aged 20-39 years and 40-59 years was lower than that in patients aged 20-39 years, and the differences were statistically significant (P<0.05). With the aggravation of the severity of constipation, the levels of TG, TC and LDL-C in the observation group were gradually increased, while the levels of HDL-C were gradually decreased (P<0.05). Conclusion The disorder of lipid metabolism exists in patients with hemorrhoids and constipation, and the problem of lipid metabolism is more serious in the elderly and severe constipation patients. Attention should be paid to the regulation of abnormal lipid metabolism in patients with hemorrhoids and constipation while improving the clinical symptoms of patients with hemorrhoids and constipation with routine medication.
【Key words】Hemorrhoids; Constipation; Blood lipid metabolism disorders
痔痔(hemorrhoids)是肛腸科最常見的良性病變,可發(fā)生于任何年齡段,以排便后感到肛門有凸起的腫塊、便血、肛門疼痛、墜脹感為臨床表現(xiàn)。痔瘡合并便秘者并不少見,臨床往往通過攝入益生菌、調(diào)節(jié)飲食、輔助中藥等方式緩解便秘,進(jìn)而減輕痔瘡相關(guān)癥狀。研究發(fā)現(xiàn)[1],便秘是痔瘡發(fā)作的重要誘因,多數(shù)痔瘡患者同時(shí)伴有便秘癥狀。2003-2018年我國成年人慢性便秘發(fā)病率不斷增高[2],而慢性便秘者普遍存在血脂代謝異?,F(xiàn)象,便秘與腸道菌群失衡互為因果,可能誘導(dǎo)多種疾病的發(fā)生[3]。目前,關(guān)于痔瘡合并便秘者的血脂代謝情況的報(bào)道較少,本研究對不同臨床特征的痔瘡合并便秘者的血脂代謝情況進(jìn)行分析,旨在進(jìn)一步探討痔瘡伴便秘的相關(guān)作用機(jī)制,為臨床治療痔瘡伴便秘提供參考,現(xiàn)報(bào)道如下。
1.1 一般資料 選取2021年6月-2022年6月寧波市第一醫(yī)院收治的156例痔瘡伴便秘患者作為觀察組,160例同齡健康志愿者作為對照組。觀察組男80例,女76例;年齡20~70歲,平均年齡(34.15±10.15)歲;體質(zhì)量指數(shù)(BMI):17~26 kg/m2,平均BMI(22.15±3.14)kg/m2。對照組男88例,女72例;年齡18~68歲,平均年齡(33.78±16.14)歲;BMI:18~26 kg/m2,平均BMI(21.78±11.07)kg/m2。兩組性別、年齡、BMI比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05),研究可比。本研究經(jīng)我院醫(yī)學(xué)倫理委員會(huì)批準(zhǔn),所有患者均知情同意且簽署知情同意書。
1.2 納入與排除標(biāo)準(zhǔn)
1.2.1觀察組 納入標(biāo)準(zhǔn):患者符合《中國痔病診療指南》(2020年版)[4]中相關(guān)診斷標(biāo)準(zhǔn),結(jié)合臨床表現(xiàn)及??茩z查確診為痔瘡;具有排便困難、排便為干球糞、排便不盡感、需手法協(xié)助排便、每周排便<3次中任意兩項(xiàng)及以上,合并便秘癥狀;年齡≥18歲。排除標(biāo)準(zhǔn):合并重大內(nèi)科疾病或長期臥床者;合并糖尿病、高血壓、動(dòng)脈粥樣硬化病等其他影響脂質(zhì)代謝性疾病者;合并腸梗阻及惡性腫瘤者。
1.2.1對照組 納入標(biāo)準(zhǔn):身體健康且年齡性別與觀察組相仿者。排除標(biāo)準(zhǔn):合并肛腸疾病、糖尿病、高血壓、動(dòng)脈粥樣硬化等影響脂質(zhì)代謝疾病者。
1.3 方法 外周靜脈采血前禁食8~10 h,采集外周血空腹靜脈血5 ml,檢測甘油三酯(triglyceride,TG)、總膽固醇(Total cholesterol,TC)、高密度脂蛋白(High-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白(Low-density lipoprotein cholesterol,LDL-C)水平,檢測儀器為BS-480型全自動(dòng)生化分析儀(深圳邁瑞生物醫(yī)療電子股份有限公司)。
1.4 觀察指標(biāo) ①比較兩組血脂代謝水平,按照《中國成人血脂異常防治指南》[5]對血脂水平進(jìn)行判斷:TG≤1.7 mmol/L,TC<5.2 mmol/L,LDL-C≤3.12 mmol/L,HDL-C>1.04 mmol/L為正常范圍;②比較觀察組不同性別、不同年齡段(20~39歲、40~59歲、60~70歲)、不同便秘嚴(yán)重程度患者血脂代謝水平。按照Wexner系統(tǒng)[6]中相關(guān)標(biāo)準(zhǔn)判定便秘嚴(yán)重程度:輕度(Wexner得分8~14分)、中度(Wexner得分15~21分)、重度(Wexner得分22~30分),其中Wexner系統(tǒng)共有8個(gè)項(xiàng)目,分值為0~30分,分值與便秘嚴(yán)重程度呈正相關(guān)。
1.5 統(tǒng)計(jì)學(xué)方法 采用SPSS 19.0統(tǒng)計(jì)學(xué)軟件對本研究數(shù)據(jù)進(jìn)行處理。計(jì)量資料以(x-±s)表示,行t檢驗(yàn);計(jì)數(shù)資料以[n(%)]表示,行χ2檢驗(yàn);以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。
2.1 兩組血脂代謝水平比較 觀察組外周血TG、TC及LDL-C水平高于對照組,HDL-C水平低于對照組(P<0.05),見表1。
2.2 觀察組不同性別患者血脂代謝水平比較 觀察組不同性別患者外周血TG、TC、LDL-C及HDL-C水平比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05),見表2。
2.3 觀察組不同年齡段患者血脂代謝水平比較 觀察組20~39歲及40~59歲年齡段患者TG、TC、LDL-C及HDL-C水平比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05);60~70歲年齡段患者TG、TC、LDL-C水平高于20~39歲及40~59歲年齡段患者,HDL-C水平低于20~39歲及40~59歲年齡段患者(P<0.05),見表3。
2.4 觀察組不同便秘嚴(yán)重程度患者血脂代謝水平比較 隨著便秘嚴(yán)重程度的不斷加重,觀察組TG、TC及LDL-C水平逐漸升高,HDL-C水平逐漸下降(P<0.05),見表4。