一项心理干预通过减轻抑郁症状来降低炎症标志物：一项随机对照试验的二次分析
A psychological intervention reduces inflammatory markers by alleviating depressive symptoms: secondary analysis of a randomized controlled trial.
作者信息
Thornton Lisa M, Andersen Barbara L, Schuler Tammy A, Carson William E
机构信息
Department of Psychology, Ohio State University, 159 Psychology Building, 1835 Neil Avenue, Columbus, OH 43210, USA.
出版信息
Psychosom Med. 2009 Sep;71(7):715-24. doi: 10.1097/PSY.0b013e3181b0545c. Epub 2009 Jul 21.
OBJECTIVES
To test experimentally whether a psychological intervention reduces depression-related symptoms and markers of inflammation among cancer patients and to test one mechanism for the intervention effects. Depression and inflammation are common among cancer patients. Data suggest that inflammation can contribute to depressive symptoms, although the converse remains untested.
METHODS
As part of a randomized clinical trial, newly diagnosed breast cancer patients (n = 45) with clinically significant depressive symptoms were evaluated and randomized to psychological intervention with assessment or assessment only study arms. The intervention spanned 12 months, with assessments at baseline, 4, 8, and 12 months. Mixed-effects modeling tested the hypothesis that the intervention reduced self-reported depressive symptoms (Center for Epidemiological Studies Depression scale, Profile of Mood States Depression and Fatigue subscales, and Medical Outcomes Study-Short Form 36 Bodily Pain subscale) and immune cell numbers that are elevated in the presence of inflammation (white blood cell count, neutrophil count, and helper/suppressor ratio). Mediation analyses tested whether change in depressive symptoms, pain, or fatigue predicted change in white blood cell count, neutrophil count, or the helper/suppressor ratio.
RESULTS
The intervention reduced significantly depressive symptoms, pain, fatigue, and inflammation markers. Moreover, the intervention effect on inflammation was mediated by its effect on depressive symptoms.
CONCLUSIONS
This is the first experiment to test whether psychological treatment effective in reducing depressive symptoms would also reduce indicators of inflammation. Data show that the intervention reduced directly depressive symptoms and reduced indirectly inflammation. Psychological treatment may treat effectively depressive symptoms, pain, and fatigue among cancer patients.
目的
通过实验测试心理干预是否能减轻癌症患者与抑郁相关的症状及炎症标志物，并测试干预效果的一种机制。抑郁和炎症在癌症患者中很常见。数据表明炎症可能导致抑郁症状，尽管反之尚未得到验证。
方法
作为一项随机临床试验的一部分，对新诊断出患有具有临床意义抑郁症状的乳腺癌患者（n = 45）进行评估，并随机分为接受心理干预加评估或仅接受评估的研究组。干预为期12个月，在基线、4个月、8个月和12个月时进行评估。混合效应模型检验了以下假设：该干预能减轻自我报告的抑郁症状（流行病学研究中心抑郁量表、情绪状态剖面图抑郁和疲劳分量表以及医学结局研究简表36身体疼痛分量表）以及在炎症存在时升高的免疫细胞数量（白细胞计数、中性粒细胞计数和辅助/抑制细胞比例）。中介分析检验了抑郁症状、疼痛或疲劳的变化是否能预测白细胞计数、中性粒细胞计数或辅助/抑制细胞比例的变化。
结果
该干预显著减轻了抑郁症状、疼痛、疲劳和炎症标志物。此外，干预对炎症的影响是通过其对抑郁症状的影响介导的。
结论
这是首个测试有效减轻抑郁症状的心理治疗是否也能减轻炎症指标的实验。数据表明该干预直接减轻了抑郁症状，并间接减轻了炎症。心理治疗可能有效治疗癌症患者的抑郁症状、疼痛和疲劳。
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