健康与遗传心理学研究室知识库

进食障碍（eating disorder，ED）患者常存在消化道症状，不少患者在确诊前会去消化内科门诊就诊，甚至可能出现因长时间在消化内科治疗而延误进食障碍诊疗的状况。此外，在消化内科门诊工作中，会遇到一些功能性胃肠病 （functional gastrointestinal disorders，FGIDs）的患者，病情反复发作、迁延不 愈，这背后是否隐藏着未被发现的进食障碍风险？本研究旨在调查消化内科门诊患者的进食障碍风险，探讨影响该风险的因素，并结合具体案例的实际情况，为筛查进食障碍风险提供参考。

研究一采用横断面研究，在2021年11月至2023年5月期间，选择解放军 63820 部队医院消化内科门诊平均年龄为30.87岁的200名患者（18-50岁且排 除病因明确的急性患者）为研究对象（男女比例为 1：1）。被试填写进食障碍 检查自评问卷 6.0（EDE-Q）、成人功能性胃肠病罗马IV诊断性问卷和中文版抑郁、焦虑、压力量表-21（DASS-21）。根据收集数据进行统计学分析，评估患者的进食障碍风险，并探讨性别、年龄、负面情绪和功能性胃肠病对该风险的影响。

研究一结果发现，9.5%的被试有进食障碍患病风险,女被试进食障碍的患病风险为16%，显著高于男性被试（3%），75%具有进食障碍风险的女性被试年龄在30岁以下，负面情绪会增加进食障碍风险, OR=1.072（95%CI：1.033- 1.112）；存在功能性胃肠病风险的患者有105 人（男 52、女 53），其中存在进 食障碍风险的人数为15人。与非功能性胃肠病相比，功能性胃肠病患者存在更高的进食障碍风险，Z=2.45，p<0.01。

研究二采用个案研究法，跟踪了5个有进食障碍风险的门诊个案。根据研究一的调查情况，调整患者的处置方案。针对进食障碍风险，建议患者前往心理科进一步诊疗。1-12月后，回访患者病情变化，其中2名患者经过饮食习惯调整、药物治疗或心理咨询等治疗后症状缓解，另有2名病情好转。余下1例 患者未改善饮食习惯，也未接受心理咨询，2 后回访时进食障碍风险和消化道症状仍存在。

基于以上两个研究，本文得出以下结论：1、消化内科8-50 周岁的门诊患者（排除病因明确的急性患者）存在较高的进食障碍风险，进食障碍的风险率为 9.5%，其中男性患者为 3%，女性患者为 16%。2、与 31-50 岁患者相比，消内科门诊患者中 18-30岁以下的女性患者的进食障碍风险较高。3、负面情绪、功能性胃肠病会增加消化内科门诊患者的进食障碍风险。4、暴食是消化内科门诊患者中有进食障碍风险的个体的共性。

Patients with eating disorders (EDs) generally experience gastrointestinal symptoms, leading many to seek treatment at the Gastroenterology Clinic before diagnosis. Some may even face delayed diagnosis and treatment of ED due to prolonged treatment in this department. Moreover, individuals with functional gastrointestinal disorders (FGIDs), characterised by recurrent symptoms and a protracted course, may also seek consultation at the Gastroenterology Clinic. Are there undiscovered patients at risk of ED among them? Accordingly, the present study investigated the risk of ED in patients from the Gastroenterology Clinic, explored the influence factors of this risk and considered the actual situation of specific cases to provide a potential reference for screening the risk of ED.

In Part I of a cross-sectional study, 200 patients with an average age of 30.87 years (male-female ratio of 1:1) were selected from the Gastroenterology Clinic of Chinese People’s Liberation Army No.63820 Hospital from November 2021 to May 2023. These subjects completed the Eating Disorder Examination-Questionnaire 6.0 (EDEQ), Rome IV Diagnostic Questionnaire for functional gastrointestinal disorders in Adults and the Depression Anxiety Stress Scales-21 (DASS-21) in Chinese. The collected data were subjected to statistical analysis to evaluate the risk of ED in patients and explore the impact of gender, age, negative emotions and FGIDs on the risk of this disorder.

The results of the Part I study showed that 9.5% of the studied subjects had a risk of ED, with a risk of 16% for female subjects, significantly higher than that of male subjects (3%). Seventy-five percent of female subjects with ED risk were under the age of 30. Negative emotions increased the risk of ED (OR = 1.072, 95% CI: 1.033-1.112). There were 105 patients (52 males and 53 females) at risk of FGIDs, of which 15 cases were at risk of ED. Furthermore, compared to patients without FGIDs, patients with FGIDs had a higher risk (Z = 2.45, p < 0.01).

In Part II of the study, a case study tracked 5 outpatient cases at risk of ED. Treatment plans were adjusted based on the investigation results of Part I. Patients with ED risk were advised to seek further diagnosis and treatment from the Psychological Department. Follow-ups were conducted 1-12 months later. Two patients resolved symptoms after adjusting dietary habits, medication or psychological counselling, and 2 patients showed improvement. One patient, who did not adjust dietary habits or receive psychological counselling, still had ED risk and gastrointestinal symptoms at the follow-up 2 months later.

Based on the two parts of research, this article concludes the following: 1. Patients in the Gastroenterology Clinic have a higher risk of ED, with a risk rate of 9.5% after excluding acute cases with definite causes, 3% for male patients and 16% for female patients. 2. Compared with patients aged 31-50 years, Female patients under 30 in the Gastroenterology Clinic have a higher risk of ED. 3. Negative emotions or FGIDs can increase the risk of ED in Gastroenterology Clinic patients. 4. Overeating is a common risk factor among individuals at risk of ED in the Gastroenterology Clinic.