正念减压法对老年人糖皮质激素抵抗的缓冲作用：一项随机对照试验。
Mindfulness-Based Stress Reduction Buffers Glucocorticoid Resistance Among Older Adults: A Randomized Controlled Trial.
机构信息
From the University of Pittsburgh (Lindsay, Stern, Greco, Walsh, Wright, Marsland); Carnegie Mellon University (Creswell, Dutcher, Lipitz), Pittsburgh, Pennsylvania; and Virginia Commonwealth University (Brown), Richmond, Virginia.
出版信息
Psychosom Med. 2021;83(6):641-649. doi: 10.1097/PSY.0000000000000928.
OBJECTIVE
Mindfulness interventions have been effective for improving a range of health outcomes; however, pathways underlying these effects remain unclear. Inflammatory processes may play a role, possibly through increased resistance of immune cells to the anti-inflammatory effects of glucocorticoids (i.e., glucocorticoid resistance, or GCR). Here, we conducted an initial examination of whether mindfulness training mitigates GCR among lonely older adults.
METHODS
Lonely older adults (65-85 years; n = 190) were randomly assigned to an 8-week Mindfulness-Based Stress Reduction (MBSR) or a matched Health Enhancement Program (HEP). Whole blood drawn before and after the intervention and at 3-month follow-up was incubated with endotoxin and varying concentrations of dexamethasone, and interleukin-6 production was assessed using enzyme-linked immunosorbent assay. GCR was assessed as the concentration of dexamethasone required to decrease the stimulated interleukin-6 response by 50% (half maximal inhibitory concentration), with higher concentrations indicating greater GCR. Mixed-effects linear models tested time (pre, post, follow-up) by condition (MBSR versus HEP) effects.
RESULTS
There was no overall time by condition effect on GCR across all time points. However, a significant time by condition effect was observed from preintervention to postintervention (d = 0.29), such that MBSR buffered increases in GCR observed in the HEP group. Although MBSR showed small, nonsignificant reductions in GCR from preintervention to 3-month follow-up, group differences were not maintained at the 3-month follow-up (d = 0.10).
CONCLUSIONS
Results suggest that MBSR may protect against declines in the sensitivity of immune cells to the anti-inflammatory effects of glucocorticoids among at-risk lonely older adults and show value in studying this biological mechanism in future trials.Trial Registration: Clinical Trials identifier NCT02888600.
目的
正念干预已被证明能有效改善多种健康结果；然而，这些效果的潜在机制尚不清楚。炎症过程可能发挥了作用，其机制可能是免疫细胞对糖皮质激素的抗炎作用的抵抗力增加（即，糖皮质激素抵抗，或 GCR）。在这里，我们初步研究了正念训练是否能减轻孤独的老年人群中的 GCR。
方法
将孤独的老年成年人（65-85 岁；n=190）随机分配到 8 周的正念减压疗法（MBSR）或匹配的健康增强计划（HEP）中。干预前后和 3 个月随访时采集全血，与内毒素和不同浓度的地塞米松孵育，并用酶联免疫吸附试验评估白细胞介素-6 的产生。GCR 评估为抑制 50%刺激的白细胞介素-6 反应所需的地塞米松浓度（半最大抑制浓度），浓度越高表示 GCR 越大。混合效应线性模型检验了时间（干预前、干预后、随访）与条件（MBSR 与 HEP）的作用。
结果
在所有时间点，GCR 均无总体时间与条件的交互作用。然而，从干预前到干预后（d=0.29），MBSR 对 HEP 组观察到的 GCR 增加有显著的缓冲作用。尽管 MBSR 从干预前到 3 个月随访时，GCR 有小的、无统计学意义的降低，但在 3 个月随访时，组间差异不再维持（d=0.10）。
结论
结果表明，MBSR 可能有助于预防高危孤独的老年人群中免疫细胞对糖皮质激素抗炎作用的敏感性下降，并在未来的试验中研究这种生物学机制具有价值。
试验注册
临床试验标识符 NCT02888600。
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