焦虑与抑郁心理对溃疡性结肠炎患者神经内分泌免疫的影响研究

doi:10.12114/j.issn.1007-9572.2019.00.318

摘要/Abstract

摘要： 背景　溃疡性结肠炎（UC）是消化内科常见病，目前，该病病因和发病机制尚不十分明确，近年来，多项研究显示，精神心理因素可能也参与了UC的发病，但精神心理因素到底通过何种机制参与UC的发病，是值得探讨的问题。目的　探讨焦虑、抑郁心理对UC患者神经内分泌免疫的影响。方法　选取2013年1月—2018年11月在蚌埠医学院附属连云港市第二人民医院和蚌埠医学院第一附属医院消化内科就诊的门诊及住院UC患者198例为病例组，根据病情分期将其分为缓解期（A组）57例和活动期（B组）141例。B组根据病情严重程度分为轻度活动期（B1亚组）83例和中-重度活动期（B2亚组）58例。121例轻-中度活动期患者中合并焦虑和/或抑郁者62例，采用随机数字表法将其分为对照组31例和干预组31例，对照组予“美沙拉嗪肠溶片”治疗，干预组予“心理干预+氟哌噻吨美利曲辛片+美沙拉嗪肠溶片”治疗。另选取同期在两院体检健康者32例作为健康体检组。于纳入研究和治疗4周后采用汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）测定研究对象焦虑、抑郁情况，并采用酶联免疫吸附试验（ELISA）测定5羟色胺（5-HT）、白介素（IL）-6、IL-8、IL-2水平。结果　健康体检组、A组、B1亚组HAMA、HAMD评分及5-HT、IL-6、IL-8水平均分别低于病例组、B组、B2亚组，IL-2水平均分别高于病例组、B组、B2亚组（P<0.01）。Pearson相关分析结果显示，病例组HAMA评分、HAMD评分均与5-HT、IL-6、IL-8呈正相关，与IL-2呈负相关（P<0.001）。治疗4周后，干预组HAMA、HAMD评分及5-HT、IL-6、IL-8水平均低于对照组，IL-2水平高于对照组（P<0.05）；对照组和干预组治疗后HAMA、HAMD评分及5-HT、IL-6、IL-8水平均低于治疗前，IL-2水平均高于治疗前（P<0.05）。结论　焦虑、抑郁心理与UC发病密切相关，其可能通过影响神经内分泌免疫相关指标而参与UC的发病。

关键词: 结肠炎, 溃疡性；焦虑；抑郁；神经内分泌细胞；细胞因子类

Abstract: Background　Ulcerative colitis （UC） is a common disease in the Department of Gastroenterology.At present，the etiology and pathogenesis of UC are not very clear.In recent years，many studies have shown that psycho-psychological factors are involved in the occurrence of UC.Therefore，it is worth exploring the mechanism of psycho-psychological factors in the onset of UC.Objective　To investigate the effect of anxiety and depression on neuroendocrine immune network in patients with UC.Methods　A total of 198 outpatients and inpatients with UC in the Department of Gastroenterology of the Second People's Hospital of Lianyungang，Affiliated Hospital of Bengbu Medical College and the First Affiliated Hospital of Bengbu Medical College from January 2013 to November 2018 were divided into remission stage group （group A，57 cases） and active stage group （group B，141 cases）．Group B was divided into mild active stage （subgroup B1，83 cases） and moderate-severe active stage （subgroup B2，58 cases） according to the severity of the disease.Sixty-two patients with anxiety and/or depression among 121 patients with mild-moderate active stage were divided into control group（n=31） and intervention group（n=31） by random number table method.The control group was treated with mesalazine enteric-coated tablets and the intervention group was treated with psychological intervention+Flupentixol and Melitracen Tablets+mesalazine enteric-coated tablets.Thirty-two healthy persons were selected as the health examination group in the same period.The Hamilton Anxiety Scale （HAMA） and Hamilton Depression Scale （HAMD） were used to determine the anxiety and depression of the subjects after 4 weeks of treatment.The levels of serotonin（5-HT），interleukin（IL）-6，IL-8 and IL-2 were measured by enzyme-linked immunosorbent assay （ELISA）．Results　The scores of HAMA，HAMD and levels of 5-HT，IL-6 and IL-8 in healthy examination group，group A and subgroup B1 were lower than those in case group，group B and subgroup B2，and the levels of IL-2 were higher than those in case group，group B and subgroup B2，respectively （P<0.01）．Pearson correlation analysis showed that HAMA and HAMD score were positively correlated with 5-HT，IL-6，IL-8 and negatively correlated with IL-2 （P<0.001）．After 4 weeks of treatment，HAMA and HAMD scores，5-HT，IL-6 and IL-8 levels in the intervention group were lower than those in the control group，and IL-2 level was higher than that in the control group （P<0.05）；HAMA and HAMD scores，5-HT，IL-6 and IL-8 levels in the control group and the intervention group after treatment were lower than those before treatment，and IL-2 levels were higher than those before treatment （P<0.05）．Conclusion　Anxiety and depression are closely correlated to the pathogenesis of UC，which may participate in the pathogenesis of UC by affecting related indicators of neuroendocrine immune network.

Key words: Colitis, ulcerative；Anxiety；Depression；Neuroendocrine cells；Cytokines

赵昌东,赵红艳,柯希权,等. 焦虑与抑郁心理对溃疡性结肠炎患者神经内分泌免疫的影响研究[J]. 中国全科医学, 2020, 23(2): 234-239. DOI: 10.12114/j.issn.1007-9572.2019.00.318.
ZHAO Changdong,ZHAO Hongyan,KE Xiquan, et al. Effects of Anxiety and Depression on Neuroendocrine Immune Network in Patients with Ulcerative Colitis　[J]. Chinese General Practice, 2020, 23(2): 234-239. DOI: 10.12114/j.issn.1007-9572.2019.00.318.

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