Psychologic stress and disease activity in patients with inflammatory bowel disease: A multicenter cross-sectional study
Psychologic stress and disease activity in patients with inflammatory bowel disease: A multicenter cross-sectional study
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DOI：
10.1371/journal.pone.0233365
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发表时间：
2020-05-26
期刊：
影响因子：
3.7
通讯作者：
Takehara, Tetsuo
中科院分区：
文献类型：
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作者：
Araki, Manabu;Shinzaki, Shinichiro;Takehara, Tetsuo
背景与目的心理应激可影响炎症性肠病（IBD）的发病机制，但心理应激对IBD的确切作用尚不清楚。我们调查了IBD患者的心理应激与疾病活动的关系，特别是在精神状态和睡眠状况方面。方法采用多中心观察性研究，包括20家机构。采用医生调查表和患者问卷收集数据，探讨心理应激与临床参数的关系。使用流行病学研究中心抑郁量表（CES-D）评估精神状态，通过询问患者失眠症状的严重程度来评估睡眠状况。结果共纳入1078例IBD患者，其中克罗恩病患者303例，溃疡性结肠炎患者775例。75%的IBD患者认为心理压力引发了他们的疾病恶化（PSTE组），25%的患者没有（非PSTE组）。PSTE组临床活动性疾病患者的CES-D评分明显高于缓解期患者(中位数（四分位数范围）= 7 (4-9.5)vs. 5 (3-7), p < 0.0001)，但非PSTE组无此差异(5 （2-8)vs. 4 (3-7), p = 0.78）。女性性别和非心理应激因素引起的疾病加重是心理应激引发疾病加重的独立因素。此外，失眠患者的疾病活动性高于无失眠患者，尤其是在PSTE组。结论IBD患者的精神状态恶化与疾病活动度相关，尤其是那些认为自己的疾病因心理压力而加重的患者。
Background and aimsPsychologic stress can affect the pathogenesis of inflammatory bowel disease (IBD), but the precise contribution of psychologic stress to IBD remains unclear. We investigated the association of psychologic stress with disease activity in patients with IBD, especially in terms of mental state and sleep condition.MethodsThis was a multi-center observational study comprising 20 institutions. Data were collected using survey forms for doctors and questionnaires for patients, and the association of psychologic stress with clinical parameters was investigated. Mental state was evaluated using the Center for Epidemiologic Studies Depression (CES-D) scale, and sleep condition was evaluated by querying patients about the severity of insomnia symptoms.ResultsA total of 1078 IBD patients were enrolled, including 303 patients with Crohn's disease and 775 patients with ulcerative colitis. Seventy-five percent of IBD patients believed that psychologic stress triggered an exacerbation of their disease (PSTE group) and 25% did not (non-PSTE group). The CES-D scores were significantly higher for patients with clinically active disease than for those in remission in the PSTE group (median (interquartile range) = 7 (4-9.5) vs. 5 (3-7), p < .0001), but not in the non-PSTE group (5 (2-8) vs. 4 (3-7), p = 0.78). Female sex and disease exacerbation by factors other than psychologic stress were independent factors of psychologic stress-triggered disease exacerbation. Also, patients with insomnia had higher disease activity than those without insomnia, especially in the PSTE group.ConclusionsA worsened mental state correlates with disease activity in IBD patients, especially those who believe that their disease is exacerbated by psychologic stress.