Bargellini A, Barbieri A, Rovesti S, Vivoli R, Roncaglia R, Borella P
Dipartimento di Scienze Igienistiche, Microbiologiche e Biostatistiche, Via Campi 287, I-41100 Modena, Italy.
Occup Environ Med. 2000 Jul;57(7):453-7. doi: 10.1136/oem.57.7.453.
To evaluate in a group of physicians the relation between burnout, demographic or job characteristics, anxiety, and immune variables.
Seventy one physicians of all grades were recruited among different departments to a cross sectional survey. The Maslach burnout inventory, scales of emotional exhaustion, depersonalisation, and personal accomplishment, the trait scale of anxiety inventory (STAI-Y2), and a questionnaire on personal and professional characteristics were administered. The immune profile included quantitative (number (%) of lymphocytes and subsets) and functional (natural killer cytotoxicity) measures.
With a model of stepwise multiple regression analysis, emotional exhaustion was significantly affected by both personal (marital, sex) and job characteristics (qualification, working activity), whereas only patient contact explained a portion of variation in depersonalisation. Furthermore, trait anxiety was found to predict the Maslach burnout inventory scores. After correction for potential confounders, physicians who scored high levels of personal accomplishment showed significantly higher numbers of total lymphocytes, T cells (CD3), T helper cells (CD4), and T suppressor cells (CD8) than those who scored low levels. No other correlation was found between burnout and immune variables.
In our group of relatively young physicians a high degree of personal accomplishment was associated with an increase in the number of peripheral lymphocytes, particularly T subsets. The meaning of this is not clear, although it could be speculated that to evaluate oneself positively, particularly with regard to work with patients in the health services, might help to stimulate the immune system. By contrast, there is no evidence that to work hard, to feel tired from work, and to have a cynical reaction towards patient care is related to immunosuppression.
在一组医生中评估职业倦怠、人口统计学或工作特征、焦虑与免疫变量之间的关系。
从不同科室招募了71名各级医生进行横断面调查。采用了马氏职业倦怠量表，包括情感耗竭、去人格化和个人成就感量表，焦虑量表特质分量表（STAI-Y2），以及一份关于个人和职业特征的问卷。免疫指标包括定量指标（淋巴细胞及其亚群的数量（%））和功能指标（自然杀伤细胞细胞毒性）。
通过逐步多元回归分析模型，情感耗竭受到个人因素（婚姻状况、性别）和工作特征（资质、工作活动）的显著影响，而去人格化的部分变异仅由与患者接触这一因素解释。此外，特质焦虑被发现可预测马氏职业倦怠量表得分。在对潜在混杂因素进行校正后，个人成就感得分高的医生与得分低的医生相比，其总淋巴细胞、T细胞（CD3）、辅助性T细胞（CD4）和抑制性T细胞（CD8）的数量显著更多。未发现职业倦怠与免疫变量之间的其他相关性。
在我们这组相对年轻的医生中，高度的个人成就感与外周淋巴细胞数量增加有关，尤其是T细胞亚群。尽管可以推测，积极评价自己，特别是在医疗服务中与患者打交道方面，可能有助于刺激免疫系统，但这一现象的意义尚不清楚。相比之下，没有证据表明努力工作、工作疲劳以及对患者护理持愤世嫉俗的态度与免疫抑制有关。
