Maunder Robert G, Levenstein Susan
Department of Psychiatry, Mount Sinai Hospital, 600 University Ave., Toronto, Canada, M5G 1X5.
Curr Mol Med. 2008 Jun;8(4):247-52. doi: 10.2174/156652408784533832.
It is unclear whether psychological stress contributes to the inflammatory process in the inflammatory bowel diseases (IBD), ulcerative colitis (UC) and Crohn's disease (CD). This review assesses the epidemiological evidence regarding a causal link between stress and gut inflammation in IBD.
A Medline search identified prospective studies of the effects of stress on subsequent disease activity and randomized controlled studies of the effects of psychological interventions on disease course in IBD. Controlled retrospective studies were included in the review of aspects of the stress-inflammatory relationship for which few prospective studies are available (e.g. the link between stress and disease onset). Studies were assessed qualitatively.
Among 9 longitudinal studies of stress or depression and disease course, a significant stress-inflammation relationship has been found when UC and CD are studied independently (4 of 4 studies positive) but studies of mixed samples of CD and UC have mostly had negative results (1 of 5 studies positive). Evidence of a contribution of stress to disease onset is very weak. The results of 5 studies of psychological interventions in IBD have been negative or modestly supportive of benefit. Confidence in therapeutic benefits of psychological interventions results is limited by methodological weaknesses in these studies.
There is consistent evidence for a contribution of psychological factors to IBD disease course, especially stress in UC and depressive symptoms in CD. More rigorous tests of psychological interventions in IBD are needed.
心理压力是否会导致炎症性肠病（IBD）、溃疡性结肠炎（UC）和克罗恩病（CD）的炎症过程尚不清楚。本综述评估了关于压力与IBD肠道炎症之间因果关系的流行病学证据。
通过医学文献数据库检索，确定了关于压力对后续疾病活动影响的前瞻性研究以及关于心理干预对IBD疾病进程影响的随机对照研究。对于压力与炎症关系中前瞻性研究较少的方面（如压力与疾病发作之间的联系），纳入了对照回顾性研究。对研究进行定性评估。
在9项关于压力或抑郁与疾病进程的纵向研究中，单独研究UC和CD时发现了显著的压力与炎症关系（4项研究中有4项呈阳性），但对CD和UC混合样本的研究大多得出阴性结果（5项研究中有1项呈阳性）。压力对疾病发作影响的证据非常薄弱。5项关于IBD心理干预的研究结果为阴性或仅适度支持有益效果。这些研究中的方法学缺陷限制了对心理干预治疗效果的信心。
有一致的证据表明心理因素对IBD疾病进程有影响，特别是UC中的压力和CD中的抑郁症状。需要对IBD的心理干预进行更严格的测试。
