Maunder Robert G, Greenberg Gordon R, Hunter Jonathan J, Lancee William J, Steinhart A Hillary, Silverberg Mark S
Department of Psychiatry, Mount Sinai Hospital, Toronto, Canada.
Am J Gastroenterol. 2006 Nov;101(11):2546-51. doi: 10.1111/j.1572-0241.2006.00798.x. Epub 2006 Oct 4.
Studies of psychological factors in ulcerative colitis (UC) have produced inconsistent findings. This study sought to determine whether perinuclear antineutrophil cytoplasmic antibody (pANCA) demarcates subtypes which differ with respect to psychobiological interactions.
In 148 outpatients with UC, the strength of the relationship between current UC disease activity and psychological distress was assessed. pANCA was determined by ELISA and immunofluorescence, disease activity was determined by symptoms, physical examination, and endoscopy using the St. Mark's index, and depressive symptoms and health anxiety were measured with self-report scales. Pearson correlations between disease activity and depressive symptoms and between disease activity and health anxiety were calculated.
In 74 pANCA negative subjects, the relationship between disease activity and measures of psychological distress was significant for disease activity-depression (partial correlation = 0.48, p < 0.001) and for disease activity-health anxiety (partial correlation = 0.64, p < 0.001), whereas in 74 pANCA positive subjects, no relationships were found (disease activity-depression: partial correlation = 0.18, p= 0.14; disease activity-health anxiety: partial correlation = 0.20, p= 0.09). The differences in the strength of correlation between pANCA positive and pANCA negative subjects were statistically significant for both disease activity-depression (z = 2.0, p= 0.02) and activity-health anxiety (z = 3.3, p < 0.001).
pANCA status demarcates psychobiologically distinct subtypes of UC, such that the absence of pANCA is associated with greater psychobiological interaction. These findings have implications for clinical care and understanding the pathophysiology of intestinal inflammation.
关于溃疡性结肠炎（UC）心理因素的研究结果并不一致。本研究旨在确定核周抗中性粒细胞胞浆抗体（pANCA）是否区分了在心理生物学相互作用方面存在差异的亚型。
对148例UC门诊患者，评估当前UC疾病活动度与心理困扰之间的关系强度。通过酶联免疫吸附测定（ELISA）和免疫荧光法测定pANCA，使用圣马克指数通过症状、体格检查和内镜检查确定疾病活动度，并用自我报告量表测量抑郁症状和健康焦虑。计算疾病活动度与抑郁症状之间以及疾病活动度与健康焦虑之间的Pearson相关性。
在74例pANCA阴性受试者中，疾病活动度与心理困扰指标之间的关系在疾病活动度-抑郁方面显著（偏相关系数=0.48，p<0.001），在疾病活动度-健康焦虑方面也显著（偏相关系数=0.64，p<0.001）；而在74例pANCA阳性受试者中，未发现相关性（疾病活动度-抑郁：偏相关系数=0.18，p=0.14；疾病活动度-健康焦虑：偏相关系数=0.20，p=0.09）。pANCA阳性和pANCA阴性受试者之间相关性强度的差异在疾病活动度-抑郁（z=2.0，p=0.02）和疾病活动度-健康焦虑（z=3.3，p<0.001）方面均具有统计学意义。
pANCA状态区分了UC在心理生物学上不同的亚型，使得pANCA的缺失与更强的心理生物学相互作用相关。这些发现对临床护理和理解肠道炎症的病理生理学具有启示意义。
