溃疡性结肠炎伴抑郁、焦虑的相关因素及中医证候相关性研究
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摘要
目的:本研究旨在探讨溃疡性结肠炎(ulcerative colitis UC)患者伴抑郁、焦虑的相关因素以及与中医证候之间的相关性。方法:运用流行病学的方法,收集溃疡性结肠炎患者的基本信息及相关中医证候信息,并进行抑郁、焦虑自评量表测试,将所得资料进行统计分析,找出流行病学资料、影响发病的相关因素和中医证候学规律及其与抑郁、焦虑的相关性。结果:1.将患者抑郁、焦虑自评量表评分与国内常模比较,提示UC与抑郁、焦虑显著相关。2.经χ~2检验及Logistic回归分析,得出女性、性格内向、工作生活压力大、情志刺激为UC伴抑郁发病的危险因素;女性、性格内向、工作生活压力大、年龄在40-49岁之间为UC伴焦虑发病的危险因素。3.应用直线回归,症状积分分别与SDS量表、SAS量表评分比较,两组变量间高度正相关。4.经χ~2检验及Logistic回归分析,UC伴抑郁、焦虑与中医证候分布之间的差异有统计学意义。肝郁脾虚证、脾胃虚弱证与UC伴抑郁的发病有关;湿热内蕴证与UC伴焦虑的发病有关。结论:1.UC与抑郁、焦虑明显相关。2.随着UC症状积分的增大,患者抑郁、焦虑的程度越重。3.女性、性格内向、工作生活压力大、受到情志刺激的UC患者易患抑郁;女性、性格内向、工作生活压力大、年龄在40-49岁之间的UC患者易患焦虑。4.中医证候分型为肝郁脾虚证、脾胃虚弱证的UC患者易患抑郁。中医证候分型为湿热内蕴证的UC患者易患焦虑。
Objective:This study aims at exploring the interrelation between ulcerative colitis and depression and anxiety, and finding out the regularity among common syndromes of ulcerative colitis in TCM. Methods: Using the method of epidemiological survey, basic data and clinical informations of patients with ulcerative colitis were collected, additionally, the patients were asked to assess their severity of depression and anxiety and also fill in questionnaire; and finally all the above data and information were processed and analyzed to find out epidemiological data, potential pathogenic factors and interrelation between syndrome and depression and/or anxiety. Result: 1. The study has shown the incidence of ulcerative colitis is closely interralated with depression and anxiety.2 .With the methods ofχ2 test and Logistic regression analysis, the study suggested that some factors such as female , introverted personality and stress can be considered as potential factors leading to ulcerative colitis , the patients at ages between 40-49 in particular. 3. The study showed significant differences in statistics between the patients accompanied by depression and anxiety, and their common syndromes .4.The patients accompanied with depression were often manifested as the syndrome of‘stagnation of the liver with deficiency of the spleen’, or‘deficiency of the spleen and stomach; whilst the patients accompanied by anxiety were mostly marked by the syndrome of‘internal accumulation of dampness and heat’. Conclusion: 1. Pathogenically, ulcerative colitis is obviously interralated with depression and anxiety.2. Clinically, along with the development and deterioration of ulcerative colitis, depression and anxiety became more and more serious. 3. In the patients with ulcerative colitis, depression often occurred in cases of female, introverted personality, and stress due to work and life; while anxiety was mostly seen in cases of female, introverted personality, severe stress caused by work and life, ages at 40-49 in particular. 4. The patient accompanied with depression mostly showed in the syndrome of‘stagnation of the liver and deficiency of spleen’or‘deficiency of the spleen and stomach’; while the patients accompanied by anxiety were often seen in the syndrome of‘internal accumulation of dampness and heat’.
Objective:This study aims at exploring the interrelation between ulcerative colitis and depression and anxiety, and finding out the regularity among common syndromes of ulcerative colitis in TCM. Methods: Using the method of epidemiological survey, basic data and clinical informations of patients with ulcerative colitis were collected, additionally, the patients were asked to assess their severity of depression and anxiety and also fill in questionnaire; and finally all the above data and information were processed and analyzed to find out epidemiological data, potential pathogenic factors and interrelation between syndrome and depression and/or anxiety. Result: 1. The study has shown the incidence of ulcerative colitis is closely interralated with depression and anxiety.2 .With the methods ofχ2 test and Logistic regression analysis, the study suggested that some factors such as female , introverted personality and stress can be considered as potential factors leading to ulcerative colitis , the patients at ages between 40-49 in particular. 3. The study showed significant differences in statistics between the patients accompanied by depression and anxiety, and their common syndromes .4.The patients accompanied with depression were often manifested as the syndrome of‘stagnation of the liver with deficiency of the spleen’, or‘deficiency of the spleen and stomach; whilst the patients accompanied by anxiety were mostly marked by the syndrome of‘internal accumulation of dampness and heat’. Conclusion: 1. Pathogenically, ulcerative colitis is obviously interralated with depression and anxiety.2. Clinically, along with the development and deterioration of ulcerative colitis, depression and anxiety became more and more serious. 3. In the patients with ulcerative colitis, depression often occurred in cases of female, introverted personality, and stress due to work and life; while anxiety was mostly seen in cases of female, introverted personality, severe stress caused by work and life, ages at 40-49 in particular. 4. The patient accompanied with depression mostly showed in the syndrome of‘stagnation of the liver and deficiency of spleen’or‘deficiency of the spleen and stomach’; while the patients accompanied by anxiety were often seen in the syndrome of‘internal accumulation of dampness and heat’.
引文
[1]欧阳钦,Rakesh Tandon, KL Goh,等.亚太地区炎症性肠病处理共识意见(一)[J].胃肠病学,2006,11(4):233-238.
[2]中华医学会消化病学分会炎症性肠病协作组.对我国炎症性肠病诊断治疗规范的共识意见[J].胃肠病学,2007, 12(8): 488-495.
[3]江学良,崔慧斐.溃疡性结肠炎治疗的新思路[J].世界华人消化杂志2007;15:319-322
[4]中华医学会消化病学分会.对炎症性肠肠病诊断治疗规范的建议[J].中华消化杂志,2001,6:56～59.
[5]郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社:2002.
[6]王春芳.抑郁自评表对1340例正常人评定分[J].中国精神疾病杂志,1996;12(5):267.
[7]吴文源.焦虑自评量表SAS[J].上海精神医学,1990;(2):44.
[8]张声生.溃疡性结肠炎中医诊疗共识意见[J].中华中医药杂志,2010,(06):891-895.
[9]胡兰.论《内经》情志活动与形体物质的辨证关系[J]实用中医杂志,2005,21(2):891-895.
[10] BrownCH. Acute emotional crises and ulcerative colitis. Report of seven cases[J].Am JDigDis,1963,8: 525-536.
[11]郑洪斌.溃疡性结肠炎全球发病情况比较[J].中华消化杂志.2001,4,23,4:242-243.
[12]张成林,储兴,林周,薛飞.溃疡性结肠炎患者的心理健康状况及个性特征[J].中国行为医学科学2001; 10: 32-33.
[13]顾华英,温盛霖,梁艳娉.溃疡性结肠炎患者的个性特征及心理状态研究[J].新医学2006; 37: 731-732.
[14]程文芳,施瑞华.溃疡性结肠炎患者心理特征的研究[J].胃肠病学和肝病学杂志2007; 16: 437-439.
[15]罗秋华,邹天然,陈掌珠,孙学礼.心理社会因素在溃疡性结肠炎中的作用[J].世界华人消化杂志, 2008,(05) .
[16] SewitchMJ,AbrahamowiczM,Bitton A,et al.Psychological distress,social support, and disease activity in patientswith inflammatory bowel disease[J].Am JGastroenterol 2001,96(5):1470-1479.
[17] Levenstein S, PranteraC,VarvoV,et al.Psychological stress and disease activity in ulcerative colitis : a multidimensional cross-sectional-study[J].Am JGastroenterol1994, 89(8): 1219-1225
[18] Mawdsley J E,RamPton D S.psychological stress in IBD:new insights into Pathogenic and therapeutic implications.[J].Gut,2005,54:1481-1491.
[19] MarriSR,Buchman AL.The education and employment status of Patients with inflammatory bowel diseases[J].Inflamm Bowel Dis 2005;11:117-177
[20] Pizzi LT,Weston CM,Goldfarb NI,Moretti D,CobbN,Howell JB,Infantolino A,Dimarino AJ,Cohen S.Impact of chronic conditions on quality of life in Patients with inflammatory bowel disease[J].Inflamm Bowel Dis 2006;12:47-52
[21] Mawdsley J E,Jenkins D G,Macey M G,et al.Nature killer cell numbers are increased by stress and decreased by hypnotherapy in patients with ulcerative colitis[J].Gut,2005,54(SupplⅡ):A23.
[22] Mawdsley J E,Rampton D S.Psychological stress in IBD:new insights into pathogenic and the rapeutic implications[J].Gut,2005,54(10):1481-1491.
[23]江学良,崔慧斐.中国溃疡性结肠炎10218例的特点[J].世界华人消化杂志, 2001,(08) .869-873.
[24]路玉良.中风痰热证病因模型的构建和临床研究[D].山东中医药大学, 2010 .
[25]陈志伟,邵雅斐,李雄.慢性疲劳与心理因素的关系初探[J].江西中医药, 2006,(04) . 17-18
[26]罗兴伟,蔡太生.个体心理模式对慢性疾病预后的探讨[J].医学与哲学(人文社会医学版), 2006,(08) .
[27] Mechanic D. Adolesscent health and illness behaviour: review of the literature and a new hypothesis for study of stress. J Hum stress,1983,94:13.
[28]杨巧芳.《内经》情志致病理论研究[D].北京中医药大学, 2009
[29]张淑芳.心身疾病及心理治疗初探[J].陕西中医学院学报,1992,15(4)8~9
[30]冯丽.血液病患者社会心理特征与中医证候的相关研究[D].广州中医药大学.
[31]蒋清华.四逆散合连理汤加减治疗肝郁脾虚型慢性非特异性溃疡性结肠炎的临床观察[J].湖南中医学院学报, 1999,(02) .
[32]王如茂,胡开生.痛泻要方合四逆散加味治疗肝郁脾虚型溃疡性结肠炎58例[J].中医杂志, 2008,(05) .
[33]卢健,范颖,马骥,王丽娜,林蔗茹,徐丹.四逆散及不同配伍干预溃疡性结肠炎的研究[J].中国实验方剂学杂志, 2010,(16) .
[34]谷松.加味四逆散治疗溃疡性结肠炎肝郁大鼠模型机制的研究[D].北京中医药大学, 2003 .
[35]覃朗.四逆散抗抑郁机制研究[J].当代医学, 2010,(14) .
[1]欧阳钦,Rakesh Tandon, KL Goh,等.亚太地区炎症性肠病处理共识意见(一)[J].胃肠病学,2006,11(4):233-238.
[2]中华医学会消化病学分会炎症性肠病协作组.对我国炎症性肠病诊断治疗规范的共识意见[J].胃肠病学,2007, 12(8): 488-495.
[3]江学良,崔慧斐.溃疡性结肠炎治疗的新思路[J].世界华人消化杂志2007;15:319-322
[4] Mawdsley J E,RamPton D S.psychological stress in IBD:new insights into Pathogenic and therapeutic implications.[J].Gut,2005,54:1481-1491.
[5] MarriSR,Buchman AL.The education and employment status of Patients with inflammatory bowel diseases[J].Inflamm Bowel Dis 2005;11:117-177
[6] Pizzi LT,Weston CM,Goldfarb NI,Moretti D,CobbN,Howell JB,Infantolino A,Dimarino AJ,Cohen S.Impact of chronic conditions on quality of life in Patientswith inflammatory bowel disease[J].Inflamm Bowel Dis 2006;12:47-52
[7] Mawdsley J E,Jenkins D G,Macey M G,et al.Nature killer cell numbers are increased by stress and decreased by hypnotherapy in patients with ulcerative colitis[J].Gut,2005,54(SupplⅡ):A23.
[8] Mawdsley J E,Rampton D S.Psychological stress in IBD:new insights into pathogenic and the rapeutic implications[J].Gut,2005,54(10):1481-1491.
[9]王庆利,陈金亮,李彦霞.从肝论治溃疡性结肠炎87例.中国中医基础医学杂志,2008,10(10):761-762.
[10] BrownCH. Acute emotional crises and ulcerative colitis. Report of seven cases[J].Am JDigDis,1963,8: 525-536.
[11]郑洪斌.溃疡性结肠炎全球发病情况比较[J].中华消化杂志.2001,4,23,4:242-243.
[12]张成林,储兴,林周,薛飞.溃疡性结肠炎患者的心理健康状况及个性特征[J].中国行为医学科学2001;10: 32-33.
[13]顾华英,温盛霖,梁艳娉.溃疡性结肠炎患者的个性特征及心理状态研究[J].新医学2006;37: 731-732.
[14]程文芳,施瑞华.溃疡性结肠炎患者心理特征的研究[J].胃肠病学和肝病学杂志2007;16: 437-439.
[15]罗秋华,邹天然,陈掌珠,孙学礼.心理社会因素在溃疡性结肠炎中的作用[J].世界华人消化杂志, 2008,(05) .
[16]杨志虎.心里治疗在溃疡性结肠炎治疗中的应用(附70例报告)[J].宁夏医学院学报,2003;25(6): 441-442.
[17]刘爱云.心理干预对溃疡性结肠炎病人治疗依从性的影响分析[J].中国社区医师(医学专业) ,2007,18(11) :129.
[18]靳淑黎,王一平.氟西汀治疗溃疡性结肠炎的疗效观察[J].中国药房,2007,18(11) :854-855.
[19]李旭红.氟哌噻吨美利曲辛治疗伴有焦虑抑郁症状的溃疡性结肠炎患者疗效分析[J].山西中医杂志2006,35(3) :246-247.
[20]崔萌,朱慧卿,孙成刚.百忧解治疗伴有抑郁的溃疡性结肠炎疗效观察[J].山东中医杂志2003,43(34) :33-34
[21]王庆利,陈金亮,李彦霞.从肝论治溃疡性结肠炎87例.中国中医基础医学杂志,2008,10(10):761-762.
[22]谢有权,罗启年,王春丁,陈巧平,何小燕,李华静[J].中医辨证分型治疗与中医结合西酞普兰治疗溃疡性结肠炎的对照研究[J].赣南医学院学报2008,2(28):237-239.
[23]陈英.中药保留灌肠联合针刺抗焦虑治疗溃疡性结肠炎临床观察中国中西医结合消化杂志.2009,17(6):381-382
[2]中华医学会消化病学分会炎症性肠病协作组.对我国炎症性肠病诊断治疗规范的共识意见[J].胃肠病学,2007, 12(8): 488-495.
[3]江学良,崔慧斐.溃疡性结肠炎治疗的新思路[J].世界华人消化杂志2007;15:319-322
[4]中华医学会消化病学分会.对炎症性肠肠病诊断治疗规范的建议[J].中华消化杂志,2001,6:56～59.
[5]郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社:2002.
[6]王春芳.抑郁自评表对1340例正常人评定分[J].中国精神疾病杂志,1996;12(5):267.
[7]吴文源.焦虑自评量表SAS[J].上海精神医学,1990;(2):44.
[8]张声生.溃疡性结肠炎中医诊疗共识意见[J].中华中医药杂志,2010,(06):891-895.
[9]胡兰.论《内经》情志活动与形体物质的辨证关系[J]实用中医杂志,2005,21(2):891-895.
[10] BrownCH. Acute emotional crises and ulcerative colitis. Report of seven cases[J].Am JDigDis,1963,8: 525-536.
[11]郑洪斌.溃疡性结肠炎全球发病情况比较[J].中华消化杂志.2001,4,23,4:242-243.
[12]张成林,储兴,林周,薛飞.溃疡性结肠炎患者的心理健康状况及个性特征[J].中国行为医学科学2001; 10: 32-33.
[13]顾华英,温盛霖,梁艳娉.溃疡性结肠炎患者的个性特征及心理状态研究[J].新医学2006; 37: 731-732.
[14]程文芳,施瑞华.溃疡性结肠炎患者心理特征的研究[J].胃肠病学和肝病学杂志2007; 16: 437-439.
[15]罗秋华,邹天然,陈掌珠,孙学礼.心理社会因素在溃疡性结肠炎中的作用[J].世界华人消化杂志, 2008,(05) .
[16] SewitchMJ,AbrahamowiczM,Bitton A,et al.Psychological distress,social support, and disease activity in patientswith inflammatory bowel disease[J].Am JGastroenterol 2001,96(5):1470-1479.
[17] Levenstein S, PranteraC,VarvoV,et al.Psychological stress and disease activity in ulcerative colitis : a multidimensional cross-sectional-study[J].Am JGastroenterol1994, 89(8): 1219-1225
[18] Mawdsley J E,RamPton D S.psychological stress in IBD:new insights into Pathogenic and therapeutic implications.[J].Gut,2005,54:1481-1491.
[19] MarriSR,Buchman AL.The education and employment status of Patients with inflammatory bowel diseases[J].Inflamm Bowel Dis 2005;11:117-177
[20] Pizzi LT,Weston CM,Goldfarb NI,Moretti D,CobbN,Howell JB,Infantolino A,Dimarino AJ,Cohen S.Impact of chronic conditions on quality of life in Patients with inflammatory bowel disease[J].Inflamm Bowel Dis 2006;12:47-52
[21] Mawdsley J E,Jenkins D G,Macey M G,et al.Nature killer cell numbers are increased by stress and decreased by hypnotherapy in patients with ulcerative colitis[J].Gut,2005,54(SupplⅡ):A23.
[22] Mawdsley J E,Rampton D S.Psychological stress in IBD:new insights into pathogenic and the rapeutic implications[J].Gut,2005,54(10):1481-1491.
[23]江学良,崔慧斐.中国溃疡性结肠炎10218例的特点[J].世界华人消化杂志, 2001,(08) .869-873.
[24]路玉良.中风痰热证病因模型的构建和临床研究[D].山东中医药大学, 2010 .
[25]陈志伟,邵雅斐,李雄.慢性疲劳与心理因素的关系初探[J].江西中医药, 2006,(04) . 17-18
[26]罗兴伟,蔡太生.个体心理模式对慢性疾病预后的探讨[J].医学与哲学(人文社会医学版), 2006,(08) .
[27] Mechanic D. Adolesscent health and illness behaviour: review of the literature and a new hypothesis for study of stress. J Hum stress,1983,94:13.
[28]杨巧芳.《内经》情志致病理论研究[D].北京中医药大学, 2009
[29]张淑芳.心身疾病及心理治疗初探[J].陕西中医学院学报,1992,15(4)8~9
[30]冯丽.血液病患者社会心理特征与中医证候的相关研究[D].广州中医药大学.
[31]蒋清华.四逆散合连理汤加减治疗肝郁脾虚型慢性非特异性溃疡性结肠炎的临床观察[J].湖南中医学院学报, 1999,(02) .
[32]王如茂,胡开生.痛泻要方合四逆散加味治疗肝郁脾虚型溃疡性结肠炎58例[J].中医杂志, 2008,(05) .
[33]卢健,范颖,马骥,王丽娜,林蔗茹,徐丹.四逆散及不同配伍干预溃疡性结肠炎的研究[J].中国实验方剂学杂志, 2010,(16) .
[34]谷松.加味四逆散治疗溃疡性结肠炎肝郁大鼠模型机制的研究[D].北京中医药大学, 2003 .
[35]覃朗.四逆散抗抑郁机制研究[J].当代医学, 2010,(14) .
[1]欧阳钦,Rakesh Tandon, KL Goh,等.亚太地区炎症性肠病处理共识意见(一)[J].胃肠病学,2006,11(4):233-238.
[2]中华医学会消化病学分会炎症性肠病协作组.对我国炎症性肠病诊断治疗规范的共识意见[J].胃肠病学,2007, 12(8): 488-495.
[3]江学良,崔慧斐.溃疡性结肠炎治疗的新思路[J].世界华人消化杂志2007;15:319-322
[4] Mawdsley J E,RamPton D S.psychological stress in IBD:new insights into Pathogenic and therapeutic implications.[J].Gut,2005,54:1481-1491.
[5] MarriSR,Buchman AL.The education and employment status of Patients with inflammatory bowel diseases[J].Inflamm Bowel Dis 2005;11:117-177
[6] Pizzi LT,Weston CM,Goldfarb NI,Moretti D,CobbN,Howell JB,Infantolino A,Dimarino AJ,Cohen S.Impact of chronic conditions on quality of life in Patientswith inflammatory bowel disease[J].Inflamm Bowel Dis 2006;12:47-52
[7] Mawdsley J E,Jenkins D G,Macey M G,et al.Nature killer cell numbers are increased by stress and decreased by hypnotherapy in patients with ulcerative colitis[J].Gut,2005,54(SupplⅡ):A23.
[8] Mawdsley J E,Rampton D S.Psychological stress in IBD:new insights into pathogenic and the rapeutic implications[J].Gut,2005,54(10):1481-1491.
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