Exploring the relationship between stress/distress reduction, inflammatory markers and relapse in relapsing remitting Inflammatory Bowel Disease (IBD)

探索复发缓解型炎症性肠病 (IBD) 中压力/痛苦减轻、炎症标志物与复发之间的关系

• 批准号: 2605094
• 金额: --
• 依托单位: King's College London
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2605094
• 关键词: Exploring; relationship; between; stress; distress

Inflammatory bowel disease (IBD) is a chronic, autoimmune, inflammatory condition. Biomedical models stipulate that inflammation levels and disease complications correlate with abdominal pain (Basso et al., 2015; Docherty et al., 2011); however, psychoneuroimmunological frameworks are helpful to conceptualise IBD symptomatology. IBD patients demonstrate dysregulated endocrine and immunological responses (Mackner et al., 2010; Pellissier et al., 2010). Additionally, in IBD it appears that there are bidirectional relationships between symptoms and psychological function (Sweeney et al,. 2018). The brain-gut axis provides a physiological framework for these relationships (Bonaz & Bernstein, 2013). A recent systematic review has demonstrated the bidirectional relationship between psychological factors and disease progression (Fairbrass et al., 2021); although it did not investigate biological markers of disease activity. Cross-sectional studies have identified associations between pro-inflammatory cytokines and depression, but there is a limited understanding of the directionality of inflammation and depressive symptoms in IBD (Moulton et al., 2019).Studies have suggested that hypothalamic-pituitary-adrenal (HPA) axis activity is correlated with the progression of IBD (Sun et al., 2019). Moreover, HPA axis hyperactivity is a consistent biological marker of depression (Gold et al., 2015; Iob et al., 2020; Pariante & Lightman, 2008; Stetler et al., 2013), therefore it is plausible that the depression symptoms in IBD patients may contribute to HPA axis hyperactivity. However, many studies investigating the area are underpowered and demonstrate conflicting results. The literature needs to establish standard ways of measuring key biomarkers and requires larger sample sizes.The primary supervisor, Prof Rona Moss-Morris, has done extensive research in IBD populations, including a randomised-controlled trial of a transdiagnostic online cognitive-behavioural therapy intervention. She and her team have developed an online CBT program, COMPASS, tailored to treat illness-related distress in the context of long-term conditions. COMPASS is delivered over 3 months, and RCT data demonstrate its effectiveness at reducing anxiety and depression in people with IBD However, to date there has been no investigations regarding the effectiveness of COMPASS (and other CBT interventions) at influencing critical disease biomarkers via psychoneuroimmunological pathways.Moreover, the second supervisor Dr Valeria Mondelli is a lead researcher in the field of psychoneuroimmunology and has investigated the relationship between inflammatory biomarkers, such as cortisol and peripheral immune biomarkers, with key disease factors such as treatment response (Mondelli et al., 2015; Enache et al., 2021), environmental stressors (Zajkowska et al., 2021), disease symptoms (McLaughlin et al., 2021) and severity of psychological symptoms (Murri et al., 2016; Sforzini et al., 2019).Dr Joanna Hudson has been added as a third supervisor. Alongside Prof Rona Moss-Morris, she was instrumental in the development of COMPASS.The aim of the thesis is to investigate the relationship between psychosocial factors, inflammatory biomarkers and reductions in illness-related distress following an online CBT investigation.Firstly, a systematic review will establish what is currently known about the relationships between mental and physical health outcomes and inflammatory biomarkers in IBD and clarify gaps in the literature.The second aim is to investigate cross-sectionally the associations between the identified inflammatory biomarkers and key psychosocial and clinical variables.The third aim is to investigate reductions in distress following an online CBT intervention (COMPASS) in IBD patients and to explore if reductions in distress are associated with reductions in inflammatory markers related to disease flares at post-intervention and 1year follow up.

炎症性肠病(IBD)是一种慢性、自身免疫性炎症性疾病。生物医学模型规定炎症水平和疾病并发症与腹痛相关(Basso等人，2015；Docherty等人，2011)；然而，心理神经免疫框架有助于概念化IBD症状学。IBD患者表现出失调的内分泌和免疫反应(Mackner等人，2010年；Pellissier等人，2010年)。此外，在IBD中，症状和心理功能之间似乎存在双向关系(Sweeney等人，。2018年)。脑-肠轴为这些关系提供了一个生理框架(Bonaz&Bernstein，2013)。最近的一项系统综述证明了心理因素和疾病进展之间的双向关系(Fairbrass等人，2021年)；尽管它没有研究疾病活动的生物标记物。横断面研究已经确定了促炎细胞因子和抑郁之间的关系，但对IBD中炎症和抑郁症状的方向性了解有限(Moulton等人，2019年)。研究表明，下丘脑-垂体-肾上腺(HPA)轴的活动与IBD的进展有关(Sun等人，2019年)。此外，HPA轴多动是抑郁症的一致生物学标志(Gold等人，2015；IOB等人，2020；Pariante&Lightman，2008；Stetler等人，2013)，因此IBD患者的抑郁症状可能与HPA轴多动有关。然而，许多调查该地区的研究力度不足，并证明了相互矛盾的结果。这些文献需要建立衡量关键生物标志物的标准方法，并需要更大的样本量。首席主管罗娜·莫斯-莫里斯教授在IBD人群中进行了广泛的研究，包括一项跨诊断在线认知行为治疗干预的随机对照试验。她和她的团队开发了一个在线CBT程序，COMPASS，专为在长期条件下治疗与疾病相关的痛苦而量身定做。COMPASS在3个月内交付，RCT数据显示其在降低IBD患者焦虑和抑郁方面的有效性。然而，到目前为止，还没有关于COMPASS(和其他CBT干预措施)通过心理神经免疫途径影响危重疾病生物标记物的有效性的研究。此外，第二主管瓦莱里亚·蒙代利博士是心理神经免疫学领域的首席研究员，并调查了炎症生物标记物，如皮质醇和外周免疫生物标记物与关键疾病因素，如治疗反应的关系(Mondelli等，2015；环境压力源(Zajkowska等人，2021年)、疾病症状(McLaughlin等人，2021年)和心理症状的严重性(Murri等人，2016；Sforzini等人，2019年)。Joanna Hudson博士已被增加为第三名主管。与罗娜·莫斯-莫里斯教授一起，她对COMPAS的发展起到了重要作用。本论文的目的是调查心理社会因素、炎性生物标记物和在线CBT调查后疾病相关痛苦的减少之间的关系。首先，一项系统的综述将确定目前已知的IBD患者的心理和身体健康结果与炎性生物标志物之间的关系，并澄清文献中的空白。第二个目标是横断面调查已识别的炎性生物标志物与关键的心理社会和临床变量之间的关联。第三个目标是调查IBD患者在线CBT干预(COMPASS)后痛苦的减少，并探索干预后和1年随访时与疾病爆发相关的炎性标志物的减少是否相关。