Mittermaier Christian, Dejaco Clemens, Waldhoer Thomas, Oefferlbauer-Ernst Anna, Miehsler Wolfgang, Beier Markus, Tillinger Wolfgang, Gangl Alfred, Moser Gabriele
Department of Medicine IV, Division of Gastroenterology and Hepatology, University Hospital of Vienna, Vienna, Austria.
Psychosom Med. 2004 Jan-Feb;66(1):79-84. doi: 10.1097/01.psy.0000106907.24881.f2.
There is evidence of an interaction between psychological factors and activity of inflammatory bowel disease (IBD). We examined the influence of depressive mood and associated anxiety on the course of IBD over a period of 18 months in a cohort of patients after an episode of active disease.
In this prospective, longitudinal, observational study, 60 patients (37 women and 23 men) with clinically inactive IBD (Crohn disease, n = 47, 78%; ulcerative colitis, n = 13, 22%) were enrolled after a flare of disease. Psychological status, health-related quality of life (HRQOL), and disease activity were evaluated at baseline and then every 3 months for a period of 18 months by means of clinical and biological parameters, the Beck Depression Inventory (BDI), the Spielberger State-Trait Anxiety Inventory, the Inflammatory Bowel Disease Questionnaire, the Perceived Stress Questionnaire, and the Rating Form of Inflammatory Bowel Disease Patients Concerns.
At baseline, depression (BDI > or = 13 points) was found in 17 of 60 (28%) patients. Thirty-two patients (59%) experienced at least one relapse during the 18 months of follow-up. Regression analysis showed a significant correlation between BDI scores at baseline and the total number of relapses after 12 (p <.01) and 18 months (p <.01) of follow-up. Furthermore, depression scores at baseline correlated with the time until the first recurrence of the disease (p <.05). Anxiety and low HRQOL were also related with more frequent relapses during follow-up (p <.05 and p <.01, respectively).
Psychological factors such as a depressive mood associated with anxiety and impaired HRQOL may exert a negative influence on the course of IBD. Therefore, assessment and management of psychological distress should be included in clinical treatment of patients with IBD.
有证据表明心理因素与炎症性肠病（IBD）的活动之间存在相互作用。我们在一组活动性疾病发作后的患者队列中，研究了抑郁情绪及相关焦虑在18个月期间对IBD病程的影响。
在这项前瞻性、纵向、观察性研究中，60例临床缓解期的IBD患者（37例女性和23例男性）（克罗恩病，n = 47，78%；溃疡性结肠炎，n = 13，22%）在疾病发作后入组。通过临床和生物学参数、贝克抑郁量表（BDI）、斯皮尔伯格状态-特质焦虑量表、炎症性肠病问卷、感知压力问卷以及炎症性肠病患者关注评定表，在基线时以及随后的18个月内每3个月评估一次心理状态、健康相关生活质量（HRQOL）和疾病活动度。
基线时，60例患者中有17例（28%）存在抑郁（BDI≥13分）。32例患者（59%）在18个月的随访期间经历了至少一次复发。回归分析显示，基线时的BDI评分与随访12个月（p<.01）和18个月（p<.01）后的复发总数之间存在显著相关性。此外，基线时的抑郁评分与疾病首次复发的时间相关（p<.05）。焦虑和低HRQOL也与随访期间更频繁的复发相关（分别为p<.05和p<.01）。
诸如与焦虑相关的抑郁情绪以及受损的HRQOL等心理因素可能对IBD的病程产生负面影响。因此，在IBD患者的临床治疗中应包括对心理困扰的评估和管理。
