Duan Shihao, Yang Yi, Cao Yubin, Chen Pingrun, Liang Chang, Zhang Yan
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Front Psychiatry. 2023 Jul 21;14:1029467. doi: 10.3389/fpsyt.2023.1029467. eCollection 2023.
Anxiety and depression symptoms are very common in patients with inflammatory bowel disease (IBD). We aimed to explore the impact of anxiety and depression on the efficacy of medications, as well as IBD-related poor outcomes.
This was a prospective longitudinal observational study. Hospital Anxiety and Depression Scale was used to assess anxiety and depression symptoms. Logistic regression analyses were used to assess the association between anxiety/depression and the response to different medications. Kaplan-Meier survival analysis and Cox regression model were applied to analyze the relationship between anxiety/depression and IBD-related poor outcomes, which were defined as urgent IBD-related hospitalization, IBD-related surgery, or death.
A total of 325 IBD patients were enrolled, 118 of whom were treated with corticosteroids, 88 with azathioprine/6-mercaptopurine (AZA/6-MP), and 147 with anti-TNF agents. Anxiety/depression symptoms were found to be significantly related to steroid resistance, but independent of AZA/6-MP and anti-TNF agents nonresponse. There was a significant association between anxiety/depression symptoms and IBD-related poor outcomes. Coexisting with anxiety/depression symptoms was an independent influencing factor of steroid resistance and IBD-related poor outcomes.
IBD patients with anxiety/depression symptoms were at a higher risk of developing steroid resistance and IBD-related poor outcomes. Future studies are needed to explore whether interventions for anxiety and depression will improve their response to medications and change their prognosis.
焦虑和抑郁症状在炎症性肠病（IBD）患者中非常常见。我们旨在探讨焦虑和抑郁对药物疗效以及IBD相关不良结局的影响。
这是一项前瞻性纵向观察研究。采用医院焦虑抑郁量表评估焦虑和抑郁症状。使用逻辑回归分析评估焦虑/抑郁与不同药物反应之间的关联。应用Kaplan-Meier生存分析和Cox回归模型分析焦虑/抑郁与IBD相关不良结局之间的关系，IBD相关不良结局定义为IBD相关紧急住院、IBD相关手术或死亡。
共纳入325例IBD患者，其中118例接受皮质类固醇治疗，88例接受硫唑嘌呤/6-巯基嘌呤（AZA/6-MP）治疗，147例接受抗TNF药物治疗。发现焦虑/抑郁症状与类固醇抵抗显著相关，但与AZA/6-MP和抗TNF药物无反应无关。焦虑/抑郁症状与IBD相关不良结局之间存在显著关联。焦虑/抑郁症状共存是类固醇抵抗和IBD相关不良结局的独立影响因素。
有焦虑/抑郁症状的IBD患者发生类固醇抵抗和IBD相关不良结局的风险更高。未来需要研究探讨对焦虑和抑郁的干预是否会改善他们对药物的反应并改变其预后。
