G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California.
G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California.
Clin Gastroenterol Hepatol. 2023 Mar;21(3):741-749.e3. doi: 10.1016/j.cgh.2022.07.025. Epub 2022 Aug 8.
BACKGROUND & AIMS: Although perceived stress (PS) has been associated with symptomatic flares in inflammatory bowel disease, clinical and physiological measures associated with perceived stress and flare are not known. The aim of this study was to identify physiological factors associated with perceived stress in ulcerative colitis (UC) subjects, and their relationship with flare.
Patients with UC in clinical remission (Simple Colitis Clinical Activity Index [SCCAI] score <5) underwent clinical and behavioral assessments, morning salivary cortisol measurements, autonomic nervous system activity testing (heart rate variability, electrodermal activity) at baseline with patient-reported SCCAI every 2 weeks over 1 to 2 years and fecal calprotectin at time of flare. Clinical flares (SCCAI ≥5) and biochemical flares (SCCAI ≥5 with fecal calprotectin ≥250 μg/g) were evaluated.
One hundred ten patients with UC were enrolled, with mean follow-up of 65.6 weeks. Patients with UC with higher and lower PS were determined. Although the high PS group had 3.6 times higher odds of a clinical flare than the low PS group, no significant differences in biochemical flares were observed between the low and high PS groups. The high vs low PS group differed in tonic sympathetic arousal as indexed by significantly greater baseline electrodermal activity (4.3 vs 3.4 microsiemens; P = .026) in the high PS group, but not in terms of heart rate variability and morning cortisol levels. Increased fecal calprotectin was associated with cardioautonomic measures, suggesting lower parasympathetic activity.
Increased PS assessed at baseline is associated with tonic sympathetic arousal and greater odds of clinical flares in patients with UC.
尽管感知压力（PS）与炎症性肠病的症状性发作有关，但与感知压力和发作相关的临床和生理指标尚不清楚。本研究的目的是确定与溃疡性结肠炎（UC）患者感知压力相关的生理因素，并研究其与发作的关系。
处于临床缓解期（简单结肠炎临床活动指数[SCCAI]评分<5）的 UC 患者接受临床和行为评估、清晨唾液皮质醇测量、自主神经系统活动测试（心率变异性、皮肤电活动），基线时患者报告 SCCAI 每 2 周评估一次，持续 1 至 2 年，并在发作时评估粪便钙卫蛋白。评估临床发作（SCCAI≥5）和生化发作（SCCAI≥5 且粪便钙卫蛋白≥250μg/g）。
共纳入 110 例 UC 患者，平均随访 65.6 周。确定了感知压力较高和较低的 UC 患者。尽管高 PS 组发生临床发作的可能性是低 PS 组的 3.6 倍，但低 PS 组和高 PS 组之间在生化发作方面没有显著差异。高 PS 组与低 PS 组在基础电皮肤活动（4.3 与 3.4 微西门子；P=0.026）方面存在显著差异，表明张力性交感神经兴奋更高，而在心率变异性和清晨皮质醇水平方面无差异。粪便钙卫蛋白升高与心脏自主神经测量有关，表明副交感神经活动较低。
基线时评估的 PS 增加与 UC 患者的张力性交感神经兴奋和临床发作的可能性增加相关。
