探讨质子泵抑制剂（PPI）治疗期间焦虑对胃食管反流病（GERD）疗效的影响。

本研究为前瞻性队列研究。收集2018年1月至2021年12月新疆维吾尔自治区人民医院经胃镜明确诊断为GERD并需接受PPI治疗的患者503例。主要终点事件为经质子泵抑制剂(PPI)治疗有效，随访时间4周，通过门诊、电话、医院病历资料等方式进行随访，对纳入的患者进行密切随访，统计终点事件发生情况、以及各项指标的检测情况。按照患者是否焦虑分为2组，其中焦虑组患者179例，无焦虑组患者49例。绘制Kaplan-Meier生存曲线明确不同焦虑状态下经PPI治疗后有效率的差异，并运用单因素Cox回归模型及多因素Cox回归模型分别明确焦虑与有效率的联系，与此同时运用趋势性检验，明确不同程度焦虑对有效率影响的异同。

本研究最终纳入GERD患者425例。4周随访结束后，425例GERD患者中297例（69.88%）患者经PPI治疗有效，128例（30.12%）患者无效；其中在246例合并焦虑患者中，有160例（65.04%）患者经PPI治疗有效，86例（34.96%）患者无效。179例未合并焦虑的患者中有137例（76.54%）患者经治疗有效，有42例（23.46%）患者无效；未合并焦虑的患者具有更高缓解率。单因素及多因素Cox回归分析，结果提示无论是单因素分析（HR=1.05，95%CI： 1.02~1.07； P<0.05）还是多因素分析（HR=1.05，95%CI： 1.02~1.07； P<0.05），焦虑均为降低PPI疗效的危险因素；进行趋势性检验发现，随着焦虑程度的增加，PPI治疗后的有效率明显下降（P for trend<0.05）。

焦虑是难治性胃食管反流病的一个危险因素。焦虑状态降低了PPIs对GERD症状的治疗效果。因此，需要注意检测具有GERD症状的患者的焦虑状态，以适当地治疗患者并优化治疗结果。

To explore the effect of anxiety during proton pump inhibitor (PPI) treatment on the curative effect of gastroesophageal reflux disease (GERD).

This study was a prospective cohort study. From January 2018 to December 2021, 503 patients who were diagnosed as GERD by gastroscopy and needed PPI treatment were collected. The main end point was effective treatment with proton pump inhibitor (PPI), and the follow-up time was 4 weeks. The patients were followed up by outpatient service, telephone and hospital medical records, and the occurrence of end point events and the detection of various indicators were counted. Patients were divided into two groups according to whether they were anxious or not, including 179 patients in anxiety group and 49 patients in non-anxiety group. Draw Kaplan-Meier survival curve to clarify the difference of effective rate after PPI treatment in different anxiety States, and use single-factor Cox regression model and multi-factor Cox regression model to clarify the relationship between anxiety and effective rate respectively, and at the same time use trend test to clarify the similarities and differences of different levels of anxiety on effective rate.

425 patients with GERD were finally included in this study. After 4-week follow-up, among 425 patients with GERD, 297 (69.88%) were effective after PPI treatment, and 128 (30.12%) were ineffective. Among 246 patients with anxiety, 160 patients (65.04%) were effective after PPI treatment, and 86 patients (34.96%) were ineffective. Among 179 patients without anxiety, 137 (76.54%) were effective after treatment, and 42 (23.46%) were ineffective. Patients without anxiety have a higher remission rate. The results of univariate and multivariate Cox regression analysis showed that no matter univariate analysis (HR=1.05,95%CI: 1.02-1.07; P<0.05) or multivariate analysis (HR=1.05,95%CI: 1.02-1.07; P<0.05), anxiety is a risk factor for reducing the curative effect of PPI; The trend test showed that with the increase of anxiety, the effective rate after PPI treatment decreased significantly (P for trend<0.05).

Anxiety is a risk factor for refractory gastroesophageal reflux disease. Anxiety reduces the therapeutic effect of PPIs on GERD symptoms. Therefore, it is necessary to pay attention to detect the anxiety state of patients with GERD symptoms in order to treat patients appropriately and optimize the treatment results.