Relationship between stress exposure and irritable bowel syndrome and functional constipation in college students
-
摘要: 目的 分析大学生压力暴露与肠易激综合征和功能性便秘之间的关系。方法 于2019年9月在武汉某高校共纳入大学生2820例，就个人健康状况、消化道症状和学生生活压力3个方面进行问卷调查，其中生活压力使用学生生活压力调查表(SLSI)评估。结果 2820例受试者的年龄为17~24岁，有72例(2.6%)被诊断为肠易激综合征，45例(1.6%)被诊断为功能性便秘。和对照组相比，肠易激综合征学生的挫折、冲突、压力、变化、自我评价、生理、情绪和行为8个维度的得分显著升高，差异有统计学意义(P < 0.05)。而功能性便秘学生仅冲突、压力和情绪3个维度得分升高，差异有统计学意义(P < 0.05)。结论 不同的压力源及对压力源的反应在两个疾病中分别有不同的意义，在大学生管理中，需关注压力暴露对肠易激综合征及功能性便秘的影响。Abstract: Objective The purpose of this study was to analyze the association between stress exposure and irritable bowel syndrome(IBS) and functional constipation in college students.Methods A total of 2820 college students were enrolled from a Wuhan university in September 2019 to conduct a questionnaire survey on personal health status, gastrointestinal symptoms, and students' life pressure. The life pressure was assessed by student-life stress inventory.Results The age of enrolled students ranged from 17 to 24. There were 72(2.6%) patients diagnosed with IBS and 45(1.6%) patients diagnosed with functional constipation. Compared with the control group, the scores of 8 dimensions including frustration, conflict, stress, change, self-evaluation, physiology, emotion and behavior of IBS students, were significantly increased, with statistical significance(P < 0.05). However, only three dimensions of conflict, stress, and emotion increased in students with functional constipation(P < 0.05).Conclusion Different stressors and reactions to stressors have different meanings in the two diseases. In managing college students, it is necessary to pay attention to the influence of stress exposure on IBS and functional constipation.
-
-
表 1 受试者的基本特征
例(%)，X±S 基本特征 对照组(n=2581) IBS(n=72) FC(n=45) P 年龄/岁 18.1±0.7 18.2±0.6 18.2±0.7 0.91 性别 男 2030(78.7) 54(75.0) 25(55.6) < 0.05 女 551(21.3) 18(25.0) 20(44.4) 过敏情况 过敏 666(25.8) 23(31.9) 13(28.9) 0.46 不过敏 1915(74.2) 49(68.1) 32(71.1) 吸烟情况 吸烟 11(0.4) 1(1.4) 0 0.49 已经戒烟 7(0.3) 0 0 不吸烟 2563(99.3) 71(98.6) 45(100.0) 饮酒情况 饮酒 41(1.6) 0 1(2.2) 0.91 已经戒酒 7(0.3) 0 0 从不饮酒 2533(98.1) 72(100.0) 44(97.8) 锻炼情况 锻炼 1496(58.0) 35(48.6) 24(53.3) 0.24 不锻炼 1085(42.0) 37(51.4) 21(46.7) 睡眠状态 睡眠好 1381(53.5) 25(34.7) 15(33.4) < 0.05 一般 1126(43.6) 32(44.4) 24(53.3) 差 72(2.8) 12(16.7) 5(11.1) 差且需要借助安眠药 2(0.1) 3(4.2) 1(2.2) 
下载: 导出CSV
表 2 SLSI评分的比较
分，M(Q3-Q1) 项目 对照组(n=2581) IBS(n=72) FC(n=45) P P1 P2 压力源 挫折 9.0(4.4) 12.0(4.4) 11.0(5.5) < 0.05 < 0.05 0.04 冲突 4.0(3.0) 5.0(3.0) 5.0(2.6) < 0.05 < 0.05 < 0.05 压力 8.0(3.7) 8.0(3.5) 9.0(2.6) < 0.05 < 0.05 < 0.05 变化 5.0(3.0) 6.0(2.2) 6.0(1.1) < 0.05 < 0.05 0.19 自我评价 12.0(4.4) 13.0(6.3) 13.0(5.2) 0.56 0.23 0.44 总压力 37.0(14.1) 44.0(12.6) 43.0(8.5) < 0.05 < 0.05 < 0.05 对压力源的反应 生理 9.0(7.4) 12.0(11.5) 12.0(6.7) < 0.05 < 0.05 0.06 情绪 5.0(3.7) 8.0(3.3) 6.0(3.7) < 0.05 < 0.05 < 0.05 行为 4.0(5.2) 6.5(5.2) 4.0(3.3) < 0.05 < 0.05 0.35 认知评价 6.0(2.2) 6.0(3.0) 6.0(1.9) 0.33 0.07 0.14 总反应 23.0(14.8) 32.0(19.8) 29.0(14.1) < 0.05 < 0.05 < 0.05 SLSI总评分 98.0(41.5) 120.5(37.0) 114.0(26.3) < 0.05 < 0.05 < 0.05 注：P1是IBS和对照组的比较；P2是FC和对照组的比较。
下载: 导出CSV
表 3 IBS、FC与SLSI总分之间的二元logistic回归分析
项目 β SE Wald χ2 OR 95%CI P IBS 模型1 0.014 0.004 15.194 1.015 1.007~1.022 < 0.05 模型2 0.014 0.004 14.495 1.014 1.007~1.022 < 0.05 FC 模型1 0.009 0.005 3.233 1.009 0.999~1.018 0.07 模型2 0.009 0.005 3.148 1.009 0.999~1.018 0.08
下载: 导出CSV
表 4 IBS、FC危险因素的多维度二元logistic回归分析
因素 IBS OR(95%CI) P FC OR(95%CI) P 挫折 模型1 1.683(1.234~2.295) < 0.05 1.455(0.978~2.164) 0.06 模型2 1.662(1.216~2.273) < 0.05 1.485(0.990~2.228) 0.06 冲突 模型1 1.546(1.221~1.957) < 0.05 1.442(1.069~1.943) < 0.05 模型2 1.533(1.209~1.944) < 0.05 1.439(1.058~1.958) < 0.05 压力 模型1 1.338(1.037~1.726) < 0.05 1.468(1.067~2.020) < 0.05 模型2 1.313(1.016~1.689) < 0.05 1.433(1.036~1.983) < 0.05 变化 模型1 1.383(1.082~1.767) < 0.05 1.181(0.862~1.617) 0.30 模型2 1.379(1.076~1.766) < 0.05 1.164(0.846~1.601) 0.35 自我评价 模型1 1.451(1.089~1.932) < 0.05 1.050(0.730~1.509) 0.79 模型2 1.451(1.089~1.935) < 0.05 1.072(0.741~1.550) 0.71 生理 模型1 1.883(1.320~2.687) < 0.05 1.341(0.830~2.168) 0.23 模型2 1.869(1.308~2.671) < 0.05 1.348(0.829~2.191) 0.23 情绪 模型1 1.498(1.190~1.886) < 0.05 1.542(1.157~2.054) < 0.05 模型2 1.478(1.172~1.864) < 0.05 1.543(1.152~2.067) < 0.05 行为 模型1 1.822(1.319~2.515) < 0.05 0.983(0.604~1.599) 0.94 模型2 1.784(1.291~2.464) < 0.05 0.962(0.589~1.570) 0.88 认知评价 模型1 1.064(0.858~1.320) 0.57 1.260(0.948~1.673) 0.11 模型2 1.085(0.872~1.352) 0.46 1.306(0.974~1.750) 0.07
下载: 导出CSV
-
[1] Barberio B, Judge C, Savarino EV. Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2021, 6(8): 638-648. doi: 10.1016/S2468-1253(21)00111-4
[2] Dong YY. Prevalence of irritable bowel syndrome in Chinese college and university students assessed using Rome Ⅲ criteria[J]. World J Gastroenterol, 2010, 16(33): 4221. doi: 10.3748/wjg.v16.i33.4221
[3] Yang W, Yang X, Cai X. The Prevalence of Irritable Bowel Syndrome Among Chinese University Students: A Systematic Review and Meta-Analysis[J]. Front Public Health, 2022, 10: 864721. doi: 10.3389/fpubh.2022.864721
[4] Chen Z, Peng Y, Shi Q. Prevalence and Risk Factors of Functional Constipation According to the Rome Criteria in China: A Systematic Review and Meta-Analysis[J]. Front Med(Lausanne), 2022, 9: 815156.
[5] Saha L. Irritable bowel syndrome: Pathogenesis, diagnosis, treatment, and evidence-based medicine[J]. World J Gastroenterol, 2014, 20(22): 6759. doi: 10.3748/wjg.v20.i22.6759
[6] Rao SSC, Rattanakovit K, Patcharatrakul T. Diagnosis and management of chronic constipation in adults[J]. Nat Rev Gastroenterol Hepatol, 2016, 13(5): 295-305. doi: 10.1038/nrgastro.2016.53
[7] 任光圆. 某高校学生生活应激状态变化研究[J]. 中国学校卫生, 2004, 25(4): 454-455. doi: 10.3969/j.issn.1000-9817.2004.04.032
[8] Chen HH, Hung CH, Kao AW. Exploring Quality of Life, Stress, and Risk Factors Associated with Irritable Bowel Syndrome for Female University Students in Taiwan[J]. Int J Environ Res Public Health, 2021, 18(8): 3888. doi: 10.3390/ijerph18083888
[9] Lim YJ, Rosita J, Chieng JY. The Prevalence and Symptoms Characteristic of Functional Constipation Using Rome Ⅲ Diagnostic Criteria among Tertiary Education Students[J]. PLoS One, 2016, 11(12): e0167243. doi: 10.1371/journal.pone.0167243
[10] Gadzella BM, Baloglu M, Masten WG. Evaluation of the Student Life-stress Inventory-Revised[J]. J Instructional Psychol, 2012, 39: 82
[11] Gadzella BM. Student-Life Stress Inventory: Identification of and Reactions to Stressors[J]. Psychol Rep, 1994, 74(2): 395-402. doi: 10.2466/pr0.1994.74.2.395
[12] Schmulson MJ, Drossman DA. What Is New in Rome Ⅳ[J]. J Neurogastroenterol Motil, 2017, 23(2): 151-163. doi: 10.5056/jnm16214
[13] 吴善玉, 赵红姬. 大学生生活应激与心理健康的相关性研究[J]. 教育与职业, 2009, 610(6): 95-96. doi: 10.3969/j.issn.1004-3985.2009.06.040
[14] Nehra V, Bruce BK, Rath-harvey DM. Psychological disorders in patients with evacuation disorders and constipation in a tertiary practice[J]. Am J Gastroenterol, 2000, 95(7): 1755-1758. doi: 10.1111/j.1572-0241.2000.02184.x
[15] Kim JY, Lim MH. Psychological factors to predict chronic diarrhea and constipation in Korean high school students[J]. Medicine, 2021, 100(27): e26442. doi: 10.1097/MD.0000000000026442
[16] Yaribeygi H, Panahi Y, Sahraei H, et al. The impact of stress on body function: A review[J]. EXCLI J, 2017, 16: 1057-1072.
[17] Lee HH, Choi YY, Choi MG. The Efficacy of Hypnotherapy in the Treatment of Irritable Bowel Syndrome: A Systematic Review and Meta-analysis[J]. J Neurogastroenterol Motility, 2014, 20(2): 152-162. doi: 10.5056/jnm.2014.20.2.152
[18] Lindfors P, Unge P, Arvidsson P. Effects of Gut-Directed Hypnotherapy on IBS in Different Clinical Settings-Results From Two Randomized, Controlled Trials[J]. Am J Gastroenterol, 2012, 107(2): 276-285. doi: 10.1038/ajg.2011.340
[19] Donnet AS, Hasan SS, Whorwell PJ. Hypnotherapy for irritable bowel syndrome: patient expectations and perceptions[J]. Therap Adv Gastroenterol, 2022, 15: 175628482210742.
[20] Halland M, Talley NJ. New treatments for IBS[J]. Nature Rev Gastroenterol Hepatol, 2013, 10(1): 13-23. doi: 10.1038/nrgastro.2012.207
[21] Pascoe MC, Hetrick SE, Parker AG. The impact of stress on students in secondary school and higher education[J]. Int J Adolesc Youth, 2020, 25(1): 104-112. doi: 10.1080/02673843.2019.1596823
[22] Yousefi A, Kardarian B, Mojtaba Hashemi S. The relation between anxiety and functional constipation: A multicenter study in Iranian medical interns[J]. Trends Med, 2020, 20(2): 2-8.
-