Cioli V M, Gagliardi G, Pescatori M
Coloproctology Unit, Parioli Clinic, Rome, Italy.
Int J Colorectal Dis. 2015 Aug;30(8):1123-9. doi: 10.1007/s00384-015-2245-3. Epub 2015 May 15.
Psychological stress is known to affect the immunologic system and the inflammatory response. The aim of this study was to assess the presence of psychological stress, anxiety, and depression in patients with anal fistula.
Consecutive patients with anal fistula, hemorrhoids, and normal volunteers were studied prospectively. Stressful life events were recorded and subjects were asked to complete the state-trait anxiety inventory (STAI), a depression scale, and three different reactive graphic tests (RGT).
Seventy-eight fistula patients, 73 patients with grade III-IV hemorrhoids, and 37 normal volunteers were enrolled. Of the fistula patients, 65 (83 %) reported one or more stressful events in the year prior to diagnosis, compared to 16 (22 %) of the hemorrhoid patients (P = 0.001). There were no significant differences in the percentage of subjects with abnormal trait anxiety (i.e., proneness for anxiety) and depression scores between fistula patients, hemorrhoid patients, and controls. Fistula patients had significantly higher (i.e., better) scores compared to hemorrhoid patients in two of three RGT and significantly lower (i.e., worse) scores in all three RGT compared to healthy volunteers. Of 37 patients followed up for a median of 28 months (range 19-41 months) after surgery, 8 (21.6 %) had persistent or recurrent sepsis. There was no significant difference in depression, STAI, and RGT scores between patients with sepsis and patients whose fistula healed.
Our results suggest that an altered emotional state plays an important role in the pathogenesis of anal fistula and underline the importance of psychological screening in patients with anorectal disorders.
已知心理应激会影响免疫系统和炎症反应。本研究的目的是评估肛瘘患者心理应激、焦虑和抑郁的情况。
对连续性的肛瘘患者、痔疮患者和正常志愿者进行前瞻性研究。记录应激性生活事件，并要求受试者完成状态-特质焦虑量表（STAI）、抑郁量表和三种不同的反应性图形测试（RGT）。
纳入了78例肛瘘患者、73例III-IV级痔疮患者和37名正常志愿者。在肛瘘患者中，65例（83%）报告在诊断前一年发生了一次或多次应激事件，相比之下，痔疮患者中有16例（22%）报告有此类事件（P = 0.001）。肛瘘患者、痔疮患者和对照组之间，特质焦虑异常（即焦虑倾向）和抑郁评分异常的受试者百分比无显著差异。在三项RGT中的两项测试中，肛瘘患者的得分显著高于（即更好）痔疮患者，而在所有三项RGT中，肛瘘患者的得分显著低于（即更差）健康志愿者。在37例术后中位随访28个月（范围19 - 41个月）的患者中，8例（21.6%）出现了持续性或复发性脓毒症。脓毒症患者和肛瘘愈合患者之间的抑郁、STAI和RGT评分无显著差异。
我们的结果表明，情绪状态改变在肛瘘发病机制中起重要作用，并强调了对肛肠疾病患者进行心理筛查的重要性。
