忧郁和焦虑会缩短IBD突发时间


  【24drs.com】根据在线发表于1月25日临床胃肠病学和肝病学期刊的Kaplan-Meier分析,忧郁和焦虑会使某些患者的发炎性肠道疾病(inflammatory bowel disease,IBD)发作和复发频率加快。
  
  英国约克大学健康科学系Antonina Mikocka-Walus博士等人表示,应建议在标准IBD照护纳入常见的精神障碍筛检,并于需要时转介进行心理/精神科治疗。
  
  虽然一直以来即认为IBD和忧郁及焦虑有关,研究作者报告指出,忧郁和焦虑与IBD疾病活性之关联有所争论,迄今尚未建立因果关系。
  
  最近的文献调查中,Mikocka-Walus博士等人发现,12篇前瞻研究中,有7篇提出忧郁和焦虑与IBD突发有正相关,另5篇则否。对这些研究之间的矛盾,他们归因于研究设计差异,例如观察期间、样本数与筛选,评估焦虑、忧郁、与IBD严重度的方法。
  
  因此,研究者进行了一篇前瞻研究,使用Swiss IBD Cohort描绘出这两个生理情况与IBD之间的暂时性倾向。参与的研究对象,在研究开始前至少4个月诊断有IBD,参与期间为2006-2015年。
  
  在纳入研究时和之后每年进行临床检查、使用克隆氏症活性指数(Crohn's Disease Activity Index)和修改版Truelove & Witts严重度指数(Modified Truelove and Witts Severity Index)评估IBD,患者们也完成有14个问题的医院焦虑和忧郁量表(Hospital Anxiety and Depression Scale),以7分作为焦虑/忧郁症状的临界点。
  
  纳入研究的2,007名患者中,56%患有克隆氏症(CD),其它则是患有溃疡性结肠症(UC)或未定型结肠炎;开始时的平均年龄为40.5岁、48.3%是白人、平均患病期间为7.2年。
  
  在开始时,20.2%研究对象的忧郁症分数超过临界点、37.5%研究对象的焦虑症分数超过临界点;两性之间的忧郁盛行率约略相当(男性200人[20.6%]vs女性205人[19.8%];P = .635),但是女性的焦虑症比率较高(女性448人[43.2%]vs男性304人[31.3%];P < .001)。
  
  在开始时,克隆氏症活性指数分数、焦虑或忧郁之间并无显著关联(分别是P = .221与P = .266),修改版Truelove & Witts严重度指数分数和焦虑或忧郁之间也是(分别是P = .167和P = .288)。
  
  不过,在有发生忧郁或焦虑的研究对象中,IBD的临床复发比没有忧郁或焦虑者更快,与性别无关。
  
  Kaplan-Meier曲线发现,随著时间,相较于焦虑和IBD复发之间,忧郁和IBD临床复发有较强烈之关联(所有IBD, P = .000001; CD, P = .0007; UC, P = .005)。虽然在整体样本中有观察到焦虑和IBD复发之关联(P = .0014),只有CD的患者也有(P = .031),但是在UC患者则无(P = .066)。
  
  焦虑和忧郁也与IBD的特定表现有关。忧郁和CD患者的廔管、手术和使用类固醇有统计上的显著关联,和UC患者与CD患者的突发有关。焦虑则是和CD患者与UC患者的突发有关,和UC患者的类固醇使用有关;焦虑和忧郁都和CD患者的生物制剂使用有关。
  
  焦虑和IBD复发的关联性比忧郁弱,研究者推测,忧郁患者的冷漠情况可能会导致不遵守IBD治疗, 而焦虑则可能会更容易发作,例如,当一个人找不到厕所时。
  
  研究作者们提到一些研究限制,包括采用自我评估焦虑和忧郁、以及各次追踪之间的时间长度。
  
  英国Leeds大学Leeds生物医学暨临床科学研究中心Alexander C. Ford医师与英国圣詹姆斯大学医院Leeds胃肠研究中心David J. Gracie医师在在线发表于2月9日临床胃肠病学和肝病学期刊致编辑者的信中写道,之前的研究只有使用横断面研究设计检视这个议题,意谓著无法建立因果关系,因此,此次的研究发现既新且重要,为脑部与肠道的相互影响提供支持,而这可能会影响IBD的自然史。
  
  不过,他们指出,Mikocka-Walus等人的研究无法分辨「忧郁和焦虑与IBD突发之间的病理关联」与「情绪不佳者之胃肠道症状恶化的可能性增加」。
  
  Gracie医师和Ford医师同意研究作者的建议,在标准IBD照护纳入心理/精神科筛检,他们写道,不论这关联的原因为何,对于IBD未来的处置策略有着重要影响。它提出一个范例,不再仅限于专注在减少这些患者之发炎负担的治疗。
  
  资料来源:http://www.24drs.com/
  
  Native link:Depression and Anxiety Can Shorten Time to IBD Flare

Depression and Anxiety Can Shorten Time to IBD Flare

By Ricki Lewis, PhD
Medscape Medical News

Depression and anxiety can precede and shorten the time to recurrence of inflammatory bowel disease (IBD) in some patients, according to a Kaplan-Meier analysis published online January 25 in Clinical Gastroenterology and Hepatology.

"It thus seems prudent to recommend that screening for common mental disorders and referring for psychological/psychiatric treatment should be included in standard IBD care," Antonina Mikocka-Walus, PhD, from the Department of Health Sciences, University of York, United Kingdom, and colleagues write.

Although IBD has long been associated with depression and anxiety, "the relationship of depression and anxiety with disease activity in IBD has been controversial, with no causal link established to date," the study authors report.

In a recent survey of the literature, Dr Mikocka-Walus and colleagues found that 7 of 12 prospective studies positively associated depression and anxiety with IBD flare-ups, while 5 did not. They attribute the inconsistency between the studies to differences in study designs, such as observation period, sample size and selection, and methods of assessing anxiety, depression, and IBD severity.

The investigators therefore conducted a prospective study using the Swiss IBD Cohort to paint a temporal portrait of the associations between the two psychiatric conditions and IBD. Patients participated between 2006 and 2015 and were diagnosed with IBD at least 4 months before the study began.

Clinical exams to assess IBD at enrollment and annually thereafter used the Crohn's Disease Activity Index and the Modified Truelove and Witts Severity Index. Patients took the 14-question Hospital Anxiety and Depression Scale, with a score of 7 being the cutoff for anxiety/depression symptoms.

Of the 2007 patients included in the study, 56% had Crohn disease (CD), and the remainder had ulcerative colitis (UC) or indeterminate colitis. Median age at baseline was 40.5 years, 48.3% were males, and median disease duration was 7.2 years.

At baseline, 20.2% of the participants exceeded the cutoff for the depression score, and 37.5% had an anxiety score above cutoff. The prevalence of depression was about equal between the sexes (200 [20.6%] males vs 205 [19.8%] females; P = .635), but females were more likely to experience anxiety (448 [43.2%] female vs 304 [31.3%] male; P < .001).

At baseline there was no significant association among Crohn's Disease Activity Index score, anxiety, or depression (P = .221 and P = .266, respectively) or between the Modified Truelove and Witts Severity Index score and anxiety or depression (P = .167 and P = .288, respectively).

However, in participants experiencing depression or anxiety, clinical recurrence of IBD occurred sooner than among participants without depression or anxiety. Sex was not a factor.

The Kaplan-Meier curves revealed a stronger association between depression and clinical recurrence of IBD over time (all IBD, P = .000001; CD, P = .0007; UC, P = .005) than between anxiety and recurrence. Although the association between anxiety and IBD recurrence over time was observable in the whole sample (P = .0014), as well as in only the participants with CD (P = .031), this was not so for participants with UC (P = .066).

Depression and anxiety also tracked with specific manifestations of IBD. Depression alone had a statistically significant association with fistula, surgery, and steroid use in patients with CD and with flares in patients with UC and with CD. Anxiety alone was associated with flares in CD and UC and steroid use in UC. Anxiety and depression were both associated with use of biologics in CD.

The association between anxiety and IBD recurrence was weaker than that for depression. The researchers speculate that apathy in patients with depression may cause noncompliance with IBD treatment, whereas anxiety may be more episodic, such as when a person cannot find a bathroom.

The study authors acknowledge that limitations of the study include self-assessment of anxiety and depression and the length of time between follow-ups.

"Previous studies have only examined this issue using a cross-sectional design, meaning that causality cannot be established, so the findings are therefore novel and important, and provide support for the existence of brain-gut interactions, which may affect the natural history of IBD," write David J. Gracie, MD, from the Leeds Gastroenterology Institute, St. James’s University Hospital, United Kingdom, and Alexander C. Ford, MD, from the Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, United Kingdom, in a letter to the editor published online February 9 in Clinical Gastroenterology and Hepatology.

However, they add that the study by Dr Mikocka-Walus and colleagues could not distinguish a pathological connection between depression and anxiety and IBD flares from an increased likelihood of reporting worsening gastrointestinal symptoms among individuals with impaired mood.

Dr Gracie and Dr Ford agree with the study authors in recommending inclusion of psychological/psychiatric screening in standard IBD care. "Whatever the reason for this association, it has important implications for future management strategies in IBD. It suggests that a paradigm shift away from therapies focused solely on reducing the inflammatory burden is needed in a subset of patients," they write.

This study was supported by the Swiss National Science Foundation. The authors and correspondents have disclosed no relevant financial relationships.

Clin Gastroenterol Hepatol. Published online January 25, 2016.

    
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