症状活动是否可以解释肠易激综合征和炎症性肠病患者的心理差异？一项多中心横断面研究的结果。
Does symptom activity explain psychological differences in patients with irritable bowel syndrome and inflammatory bowel disease? Results from a multi-center cross-sectional study.
机构信息
Institute of Psychology, Heidelberg University, Hauptstraße 47-51, D-69117 Heidelberg, Germany; Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.
Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany; Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Hebelstrasse 2, CH-4031 Basel, Switzerland; Faculty of Medicine, University of Basel, Klingelbergstrasse 61, CH-4056 Basel, Switzerland.
出版信息
J Psychosom Res. 2019 Nov;126:109836. doi: 10.1016/j.jpsychores.2019.109836. Epub 2019 Sep 13.
OBJECTIVE
Irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBD) have similar symptoms and are affected by psychological factors via gut-brain-interactions. However, previous studies on IBS and IBD showed inconsistent results regarding psychological factors, potentially because they failed to consider the impact of symptom activity. The aim of this study was 1) to compare psychological distress and psychological risk factors among patients with IBS, IBD and healthy controls (HC), and 2) to assess the impact of symptom activity.
METHODS
A controlled cross-sectional study was conducted. Patients with IBS and IBD were recruited in several primary, secondary, and tertiary medical care units between 02 and 12/2017 in Germany. Overall, 381 matched participants (127/group, 63% female) were included. For the second analyses, patients with IBD were distinguished in patients with active (n = 93) and non-active (n = 34) symptoms. Psychological distress (somatization, depression, anxiety, and illness anxiety) and risk factors (adverse childhood experiences, attachment style, and mentalizing capacity) were measured.
RESULTS
Patients with IBS showed higher psychological distress and more psychological risk factors than patients with IBD and HC. However, patients with IBD and active symptoms showed similar psychological distress than patients with IBS, except for lower illness anxiety (p < .001, η = 0.069).
CONCLUSION
With the exception of higher illness anxiety in IBS patients, differences in psychological factors between patients with IBS and IBD were more strongly associated with symptom activity than with the underlying diagnosis. Therefore, this study challenges previous concepts of distinguishing functional and organic gastrointestinal diseases, but highlights the role of symptom activity and illness anxiety.
TRIAL REGISTRATION
DRKS00011685.
目的
肠易激综合征（IBS）和炎症性肠病（IBD）具有相似的症状，并通过肠-脑相互作用受到心理因素的影响。然而，先前关于 IBS 和 IBD 的研究在心理因素方面显示出不一致的结果，这可能是因为它们没有考虑到症状活动的影响。本研究的目的是：1）比较 IBS、IBD 和健康对照组（HC）患者之间的心理困扰和心理危险因素，2）评估症状活动的影响。
方法
本研究采用对照性横断面研究设计。于 2017 年 02 月至 12 月期间在德国的多个初级、二级和三级医疗保健单位招募 IBS 和 IBD 患者。共纳入 381 名匹配的参与者（每组 127 名，63%为女性）。对于第二次分析，将 IBD 患者分为症状活跃（n=93）和非活跃（n=34）两组。评估心理困扰（躯体化、抑郁、焦虑和疾病焦虑）和危险因素（不良童年经历、依恋风格和心理化能力）。
结果
与 IBD 患者和 HC 相比，IBS 患者表现出更高的心理困扰和更多的心理危险因素。然而，IBD 且症状活跃的患者与 IBS 患者的心理困扰相似，除了疾病焦虑较低（p<0.001，η²=0.069）。
结论
除了 IBS 患者更高的疾病焦虑外，IBS 和 IBD 患者之间心理因素的差异与症状活动的相关性强于与潜在诊断的相关性。因此，本研究挑战了先前关于区分功能性和器质性胃肠道疾病的概念，但强调了症状活动和疾病焦虑的作用。
试验注册
DRKS00011685。
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