Exploration Of The Mechanism Of Functional Dyspepsia And Clinical Study Of Combination Of Traditional Chinese And Western Medicine And Cognitive Behavioral Therapy

Objective: To explore the relationship between sleep quality,emotional symptoms and the severity of clinical symptoms of functional dyspepsia(FD).To explore the characteristics of resting brain function changes in patients with functional dyspepsia and its relationship with the severity of the disease.To compare the efficacy of Shugan Jieyu Capsule,a Chinese medicine,and mirtazapine,an antidepressant,in the treatment of functional dyspepsia.To explore the effect of cognitive behavioral therapy combined with network communication on emotional and digestive function of patients with functional dyspepsia,to guide clinical practice and provide reference and basis.Method: The subjects were FD patients who met the Rome III criteria for functional dyspepsia.The healthy control group was healthy volunteers.FD patients were divided into control group and experimental group according to random number method.The following methods were used for evaluation and intervention: Sleep disorders were assessed by Pittsburgh Sleep Quality Index(PSQI)in 115 adults with FD symptoms and 61 healthy volunteers.Mental health status was assessed by Symptom Checklist 90(SCL-90).The severity of FD was assessed by Dyspepsia Symptom Scale.Demographic variables were assessed by t-test and single factor.Analysis of variance,such as body weight,height and body mass index.Sleep disorder parameters and psychological factors in FD patients and healthy controls were also assessed by t-test.Spearman correlation analysis was used to evaluate the correlation between PSQI total score and FD symptom severity score.To explore the risk factors of dyspepsia,single factor analysis was used.Independent risk factors for indigestion were determined by Logistic regression with reverse elimination.Using the method of local consistency data analysis in resting functional magnetic resonance imaging(fMRI),10 FD patients and 10 healthy controls matched with sex,age and years of education were selected and scanned with fMRI respectively.ReHo images of case group and control group were compared by double-sample t-test.ReHo mean values of different brain areas were correlated with the total score of functional gastropathy clinical assessment scale.To analyze and observe the clinical severity and the characteristics of differentiated brain activity.116 FD patients were randomly divided into two groups.The control group was treated with Domperidone,a digestive medicine.The experimental group was treated with Shugan Jieyu Capsule and mirtazapine,an antidepressant,on the basis of the control group.The clinical symptoms and patient’s condition of functional dyspepsia were evaluated at 3 and 12 months after treatment.The effects of mood state,bile reflux and gastric emptying time.134 patients with functional dyspepsia in general hospitals were randomly divided into control group and experimental group.All patients with functional dyspepsia took drugs regularly under the guidance of digestive physicians.The experimental group received regular cognitive behavioral therapy and regular mobile terminal network communication at the same time.Before intervention,1 month after intervention and 2 months after intervention,90 symptom checklist 90,clinical scale of dyspepsia,gastric emptying time and other digestive function related indicators were assessed and evaluated.Result: The scores of PSQI and nine dimensions of SCL-90 symptoms in FD patients were significantly higher than those in the control group(P < 0.05).Multivariate logistic regression analysis showed that low BMI,low education and sleep disorders were independently associated with FD and FD subgroups.Hostility and terror anxiety are independent risk factors for FD.Further analysis showed that hostility was an independent risk factor for abdominal pain in FD subgroup.The ReHo values of left middle occipital gyrus,left middle frontal gyrus,left superior frontal gyrus,right anterior cuneiform lobe and right cingulate gyrus in the case group gradually increased with the increase of functional gastropathy clinical assessment scale scores;the areas of left talus fissure,right superior marginal gyrus and left anterior central gyrus gradually decreased with the increase of functional gastropathy clinical assessment scale scores,with statistical significance(P < 0.05).In the treatment group of Shugan Jieyu Capsule combined with mirtazapine,the clinical symptoms of dyspepsia,laboratory indicators of digestive function and emotional symptoms were significantly improved in the third and twelfth months,which were better than those in the control group,with statistical significance(P < 0.05).Compliance of the experimental group was significantly better than that of the control group(P < 0.05);after 2 months of treatment,the scores of the psychological scale of the experimental group were lower than those of the control group(P < 0.05);after 2 months,the digestive functi on related indexes such as clinical scale of dyspepsia and gastric emptying time of the two groups were significantly improved compared with those before intervention(P < 0.05);the indexes of dyspepsia of the experimental group and the control group were significantly improved(P < 0.There was significant improvement(P < 0.05).Conclusion: 1.The severity of FD clinical symptoms is related to sleep disorders and negative emotions.Treatment for sleep and psychological factors may help to reduce FD symptoms.2.The changes of spontaneous activity in the prefrontal lobe,cingulate gyrus,marginal system and part of occipital and parietal lobes in patients with functional gastropathy may be closely related to the severity of functional gastropathy.3.The curative effect of Shugan Jieyu Capsule combined with mirtazapine in the treatment of functional dyspepsia is obvious.After treatment,the clinical symptoms of patients are obviously improved,bile reflux is reduced,gastric emptying speed is improved,and the overall therapeutic effect is ideal.4.Cognitive behavioral therapy can improve emotional problems,treatment compliance and digestive function in patients with functional dyspepsia.