Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.
Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany; Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany.
Brain Behav Immun. 2021 Jan;91:202-211. doi: 10.1016/j.bbi.2020.09.028. Epub 2020 Sep 28.
Inflammation has been related to several somatic and psychological disorders and may moderate effects of psychological interventions. In the PSY-HEART trial patients benefitted from preoperative psychological interventions before undergoing coronary artery bypass graft surgery (CABG) and, if necessary, concomitant valvular surgery, compared to standard medical care. In this study we examined whether patients' baseline inflammatory status moderated the intervention effects.
In a prospective three-arm randomized clinical trial with 6-months follow-up, 124 patients scheduled for CABG surgery alone or concomitant with valvular surgery were randomized to (i) standard medical care only (SMC) or two preoperative psychological interventions: (ii) CBT-based optimizing expectations (EXPECT) and an (iii) an active control group focusing on emotional support (SUPPORT). Available baseline CRP- (n = 79), IL-6- (n = 78), IL-8- (n = 78) and TNF-alpha-(n = 80) parameters were considered as potential moderators (CRP as a categorical and continuous moderator). Linear mixed model analyses were calculated to test whether baseline inflammatory levels moderated intervention effects on disability, mental and physical quality of life at 6 months after surgery.
IL-8 moderated intervention effects on patients' disability and categorical CRP moderated intervention effects on mental quality of life. Follow-up tests indicated that EXPECT (and in part SUPPORT) led to lower postoperative disability and higher mental quality of life compared to SMC in patients with low baseline inflammatory markers. EXPECT indicated higher mental quality of life compared to SUPPORT in the high CRP subgroup. Patients in the SMC group had higher mental quality of life in the high CRP subgroup compared to the low CRP subgroup.
Especially for patients with a lower inflammatory baseline status preoperative psychological interventions might be helpful to optimize long-term CABG surgery outcomes.
炎症与多种躯体和心理障碍有关，并且可能会调节心理干预的效果。在 PSY-HEART 试验中，与标准医疗护理相比，接受冠状动脉旁路移植术（CABG）和/或同时进行瓣膜手术的患者在术前接受心理干预后受益。在这项研究中，我们检验了患者的基线炎症状态是否调节了干预效果。
在一项前瞻性的三臂随机临床试验中，对 124 名计划单独进行 CABG 手术或同时进行瓣膜手术的患者进行了 6 个月的随访，将他们随机分为（i）仅接受标准医疗护理（SMC）或（ii）两种术前心理干预：基于认知行为疗法的期望优化（EXPECT）和（iii）以情感支持为重点的主动对照组（SUPPORT）。考虑到基线 CRP（n=79）、IL-6（n=78）、IL-8（n=78）和 TNF-α（n=80）的参数作为潜在的调节剂（CRP 作为分类和连续调节剂）。使用线性混合模型分析来检验基线炎症水平是否调节了干预对术后 6 个月残疾、心理健康和身体质量的影响。
IL-8 调节了干预对患者残疾的影响，而分类 CRP 调节了干预对心理健康的影响。随访测试表明，与 SMC 相比，在基线炎症标志物较低的患者中，EXPECT（部分 SUPPORT）导致术后残疾程度降低和心理健康质量升高。在 CRP 较高的亚组中，EXPECT 比 SUPPORT 更能提高心理健康质量。与 CRP 较低的亚组相比，SMC 组的患者在 CRP 较高的亚组中具有更高的心理健康质量。
对于基线炎症状态较低的患者，术前心理干预可能有助于优化 CABG 手术的长期结局。
