在 6.5 年的纵向随访中，疾病活动度和心理健康对炎症性肠病预后的相对贡献。
Relative Contribution of Disease Activity and Psychological Health to Prognosis of Inflammatory Bowel Disease During 6.5 Years of Longitudinal Follow-Up.
机构信息
Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom.
Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom.
出版信息
Gastroenterology. 2022 Jul;163(1):190-203.e5. doi: 10.1053/j.gastro.2022.03.014. Epub 2022 Mar 23.
BACKGROUND & AIMS: Symptoms of common mental disorders, such as anxiety or depression, are common in inflammatory bowel disease (IBD) and may affect prognosis. However, unlike clinical or biochemical markers of disease activity, psychological health is not a recommended therapeutic target. We assessed relative contribution of poor psychological health and clinical or biochemical activity to prognosis.
METHODS
Demographic features, IBD subtype, treatments, and anxiety and depression scores were recorded at baseline for 760 adults, with clinical activity determined using validated scoring systems. Fecal calprotectin was analyzed in 379 (49.9%) patients (≥250 μg/g used to define biochemical activity). Glucocorticosteroid prescription or flare, escalation, hospitalization, intestinal resection, or death were assessed during 6.5 years of follow-up. Occurrence was compared using multivariate Cox regression across 4 patient groups according to presence of disease remission or activity, with or without symptoms of a common mental disorder, at baseline.
RESULTS
In total, 718 (94.5%) participants provided data. Compared with clinical remission without symptoms of a common mental disorder at baseline, need for glucocorticosteroid prescription or flare (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.58-3.54), escalation (HR, 1.65; 95% CI, 1.14--2.40), and death (HR, 4.99; 95% CI, 1.80-13.88) were significantly higher in those with clinical activity and symptoms of a common mental disorder. Rates in those with clinical remission and symptoms of a common mental disorder at baseline or those with clinical activity without symptoms of a common mental disorder were not significantly higher. Similarly, with biochemical activity and symptoms of a common mental disorder, rates of glucocorticosteroid prescription or flare (HR, 2.48; 95% CI, 1.38-4.46), escalation (HR, 2.97; 95% CI, 1.74-5.06), hospitalization (HR, 3.10; 95% CI, 1.43-6.68), and death (HR, 6.26; 95% CI, 2.23-17.56) were significantly higher.
CONCLUSIONS
Psychological factors are important determinants of poor prognostic outcomes in IBD and should be considered as a therapeutic target.
背景与目的
焦虑或抑郁等常见精神障碍的症状在炎症性肠病（IBD）中很常见，可能影响预后。然而，与疾病活动的临床或生化标志物不同，心理健康不是推荐的治疗靶点。我们评估了不良心理健康状况与临床或生化活动对预后的相对贡献。
方法
为 760 名成年人记录了人口统计学特征、IBD 亚型、治疗方法以及焦虑和抑郁评分，使用验证评分系统确定临床活动。在 379 名（49.9%）患者中分析粪便钙卫蛋白（≥250μg/g 用于定义生化活动）。在 6.5 年的随访期间评估皮质类固醇处方或发作、升级、住院、肠切除术或死亡情况。使用多变量 Cox 回归在 4 组患者中根据基线时存在或不存在疾病缓解或活动以及是否存在常见精神障碍症状进行比较。
结果
共 718 名（94.5%）参与者提供了数据。与基线时无常见精神障碍症状的临床缓解相比，需要皮质类固醇处方或发作（风险比[HR]，2.36；95%置信区间[CI]，1.58-3.54）、升级（HR，1.65；95% CI，1.14-2.40）和死亡（HR，4.99；95% CI，1.80-13.88）的风险明显更高在那些有临床活动和常见精神障碍症状的患者中。在基线时具有临床缓解和常见精神障碍症状的患者，或具有临床活动但无常见精神障碍症状的患者，其发生率并未显著升高。同样，在具有生化活动和常见精神障碍症状的患者中，皮质类固醇处方或发作（HR，2.48；95% CI，1.38-4.46）、升级（HR，2.97；95% CI，1.74-5.06）、住院（HR，3.10；95% CI，1.43-6.68）和死亡（HR，6.26；95% CI，2.23-17.56）的发生率也明显更高。
结论
心理因素是 IBD 不良预后的重要决定因素，应作为治疗靶点。
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