Vidal Angela, Gómez-Gil Esther, Sans Miquel, Portella Maria J, Salamero Manel, Piqué Josep M, Panés Julián
Department of Clinical Psychology, Hospital Clínic de Barcelona, Institute Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
Am J Gastroenterol. 2006 Apr;101(4):775-81. doi: 10.1111/j.1572-0241.2006.00476.x. Epub 2006 Feb 22.
The impact of life events in recurrence of inflammatory bowel disease (IBD) is unclear. We sought to determine whether stressful life events or the emotional impact of these events are associated with IBD relapses, hypothesizing that the exposure of life events among patients with inactive disease will increase the risk of subsequent relapses.
In this prospective study, 163 patients with inactive IBD, who had had at least one relapse in a 2-yr period before entry into the study, were enrolled. The Spanish version of the Social Readjustment Rating Scale (SRRS) (measuring life events), a measure of the emotional impact of these life events, and an IBD activity index were completed monthly up to the end of the study (maximum 11 months) or up to a relapse. Biological factors associated with an increased risk of relapse were identified in patients who relapsed.
Fifty-one patients relapsed (32.9%), 104 remained in remission, and 8 dropped out. Multivariate Cox regression analysis with time dependent variables showed that the number of life events was not associated with the rate of relapse after adjustment for significant covariates on the subsequent month (hazard ratio = 0.88, 95% CI = 0.68-1.13, p = 0.33) or in the time-lagged analysis. The emotional impact of stressful events was also not associated with the risk of relapse. When patients who suffered a biological risk factor for relapsing were excluded in subsequent statistical analyses, similar results were obtained.
Our results suggest that stressful life events do not trigger exacerbations in patients suffering from IBD.
生活事件对炎症性肠病（IBD）复发的影响尚不清楚。我们试图确定应激性生活事件或这些事件的情感影响是否与IBD复发相关，假设处于疾病缓解期的患者经历生活事件会增加随后复发的风险。
在这项前瞻性研究中，纳入了163例IBD缓解期患者，这些患者在进入研究前的2年期间至少有过一次复发。每月完成西班牙文版的社会再适应评定量表（SRRS）（测量生活事件）、这些生活事件的情感影响量表以及IBD活动指数，直至研究结束（最长11个月）或直至复发。在复发的患者中确定与复发风险增加相关的生物学因素。
51例患者复发（32.9%），104例仍处于缓解期，8例退出研究。对时间依赖性变量进行多变量Cox回归分析显示，在对随后一个月的显著协变量进行调整后（风险比=0.88，95%可信区间=0.68-1.13，p=0.33）或在时间滞后分析中，生活事件的数量与复发率无关。应激事件的情感影响也与复发风险无关。在随后的统计分析中排除有复发生物学风险因素的患者后，得到了类似的结果。
我们的结果表明，应激性生活事件不会引发IBD患者病情加重。
