| Objectives:A large number of studies have confirmed that mental and psychological factors have an important impact on the onset and development of constipation predominant irritable bowel syndrome(IBS-C).As a protective factor of mental health,the reduction of resilience will make people vulnerable to various physiological and mental states and produce a lot of psychological problems,so as to increase the stress reactivity of gastrointestinal tract and interfere with the normal function of the intestine.Through cross-sectional investigation,this study included the resilience of IBS-C patients as the main observation content and investigated the relationship between the resilience,severity of symptoms and quality of life in IBS-C patients.At the same time,under the guidance of motional theory of traditional Chinese medicine(TCM),it explored the distribution of TCM syndrome types of IBS-C and its correlation with resilience,so as to combine psychology with TCM syndrome types,and provide a theoretical basis for finding intervention measures to ease the symptoms and improve quality of life of IBS-C patients from psychological factors.Methods:The IBS-C patients participating in this study were from the outpatient department,inpatient department and endoscopy center of spleen and stomach department of Wangjing Hospital from June 2021 to February 2022.The questionnaire used in the project was designed to collect the general information,symptom severity,quality of life and the resilience of IBS-C patients.IBS symptom severity scale(IBS-SSS)was used to evaluate the disease grade of patients;IBS-QOL was used to evaluate the quality of life of patients;The brief Resilience Scale(BRS)and the Connor Davidson Resilience Scale(CD-RISC)were used to evaluate the resilience of patients.According to the diagnostic criteria of TCM syndrome types formulated in the Consensus of TCM Diagnosis and Treatment Experts on Irritable Bowel Syndrome(2017),the TCM syndrome classification of IBS-C patients was analyzed.All data were input into SPSS 20.0 software for statistical analysis.T-test,analysis of variance or nonparametric test were used for measurement data.Chi square test or rank sum test were used for counting data.Spearman or Pearson correlation analysis was used for the correlation between resilience,symptom score and quality of life.The related influencing factors were analyzed by single factor analysis,and the factors with statistical differences were analyzed by multi factor logistic regression.Results:1.A total of 120 patients with IBS-C were included in the subject,with a male to female ratio of approximately 1:1.6,and the range of age of it is 20 to 76 years,the mean age is 39.98 years.Body mass index(BMI)of the subject is 16.02 kg/m2 for the smallest and 29.05 kg/m2 for the largest.The marital status of these patients was predominantly married,the occupation was predominantly non-manual laborers,and the educational level was concentrated in undergraduate and college degrees,and monthly income was concentrated between 0 and 5,000 RMB.2.According to the statistical results of the IBS-SSS score,there were 19 cases(15.8%)of 120 IBS-C patients with the disease in remission(<75 points),64 cases(53.3%)with mild disease(75-175 points),32 cases(26.7%)with moderate disease(176-300 points),and 5 cases with severe disease(>300 points).The IBS-C patients whose IBS-QOL scores was in 0-25 were 3 cases(2.5%),in 26-50 were 14 cases(11.7%),in 51-75 were 95 cases(79.2%),and in75-100 were 8 cases(6.6%).3.120 patients with IBS-C had a mean total CD-RISC score of 64.11±15.94,a mean firmness score of 32.04 ± 9.11,a mean strength score of 22.17 ± 5.50,and a mean optimism score of 9.90±2.76.The BRS score was in low resilience(1.00-2.99)were 38 cases(31.7%),in normal resilience were 74 cases(61.6%),and in high resilience were 8 cases(6.7%).Low income(0～5000 yuan)and sleep disturbance could be the risk factors for the decrease of resilience in IBS-C patients.4.There was a significant negative correlation between IBS-SSS score and CDRISC score,BRS score in 120 IBS-C patients(rs=0.1302,P<0.0001;rs=0.1288,P<0.0001).And there was a significant positive correlation between IBS-QOL score and CD-RISC score,BRS score(rs=0.1097,P<0.0001;rs=0.2214,P<0.0001).Besides,CD-RISC score and BRS score were significantly different between remission period and attack period of IBS-SSS score(P<0.001,P<0.001).5.Among the 120 IBS-C patients,the TCM syndrome types were mainly distributed in 43 cases(35.8%)with liver stagnation and qi stagnation syndrome,and the others were 23 cases(19.2%)with yin deficiency and intestinal dryness syndrome,20 cases(16.7%)with lung and spleen qi deficiency syndrome,18 cases(15.0%)with spleen and kidney yang deficiency syndrome,and 16 cases(13.3%)with gastrointestinal heat accumulation syndrome.The CD-RISC score,BRS score and IBS-SSS score of IBS-C patients with five TCM syndrome types were significantly different(P<0.05),among which the CD-RISC score of patients with lung and spleen qi deficiency syndrome was significantly lower than those of patients with liver stagnation and qi stagnation syndrome,yin deficiency and intestinal dryness syndrome,spleen and kidney yang deficiency syndrome,and gastrointestinal heat accumulation syndrome(P<0.05).The BRS score of patients with liver stagnation and qi stagnation syndrome,spleen and kidney yang deficiency syndrome and lung and spleen qi deficiency syndrome were significantly lower than those of patients with yin deficiency and intestinal dryness syndrome and gastrointestinal heat accumulation syndrome,and the difference was statistically significant(P<0.001).The IBS-SSS scores were different between the five types,and the severity was from severe to mild in the order of lung and spleen qi deficiency syndrome>spleen and kidney yang deficiency syndrome>liver stagnation and qi stagnation syndrome>yin deficiency and intestinal dryness syndrome>gastrointestinal heat accumulation syndrome(P<0.05).There were differences in the course of disease among the five types,which of lung and spleen qi deficiency syndrome was significantly longer than that of the other types(P<0.001).The IBS-QOL score of patients among the five syndrome types had no significant difference(P>0.05).Conclusion:1.The resilience of IBS-C patients was significantly correlated with symptom severity and quality of life.IBS-C patients with symptoms in remission period showed higher quality of life and higher resilience,and IBS-C patients with severe symptoms showed lower quality of life and lower resilience.2.There were significant differences in symptom severity and resilience among IBS-C patients with different TCM syndrome types.The resilience scores of gastrointestinal heat accumulation syndrome,yin deficiency and intestinal dryness syndrome were significantly higher than those of liver stagnation and qi stagnation syndrome,spleen and kidney yang deficiency syndrome and especially lung and spleen qi deficiency syndrome.The symptom severity of patients with gastrointestinal heat accumulation syndrome was significantly lower than those of patients with lung and spleen qi deficiency syndrome,and the course of disease of lung and spleen qi deficiency syndrome was significantly longer than that of the other types. |
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