克罗恩病患者精神心理及迷走神经功能改变与临床特征的相关性分析
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The correlation between the changes of psychophysiology and vagus nerve function and clinical characteristics in patients with Crohn’s disease
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    摘要:

    目的:探讨克罗恩病(Crohn’s disease,CD)患者精神心理及迷走神经功能改变,并分析其与临床特征的关系,为CD 的综合治疗提供依据。方法:纳入2014年1月—2018年12月在南京医科大学第一附属医院确诊为CD的患者共124例,并纳入年龄及性别匹配的104例健康对照。收集CD患者的临床资料,采用CD疾病活动指数评估CD患者疾病活动情况,采用广泛性焦虑障碍量表、抑郁症筛查量表评估精神心理状况,并对48例CD患者和17例健康对照进行心率变异性分析评估迷走神经功能,分析高频(high frequency,HF)、低频(low frequency,LF)、LF/HF及HF/(HF+LF)数据。通过皮尔森相关分析及斯皮尔曼相关分析、有序Logistic回归分析患者焦虑抑郁及迷走神经功能与临床特征间的关系。结果:124例CD患者中,焦虑发生比例为 42.7%(53/124),抑郁发生比例为 27.4%(34/124);而对照组焦虑发生比例 8.7%(9/104),抑郁发生比例为 16.3%(17/104)。 CD患者焦虑、抑郁发生比例均显著高于对照组(P 焦虑<0.001,P 抑郁=0.046)。肛周手术史与CD患者焦虑评分呈正相关(OR= 5.405,95%CI:1.213~24.085,P=0.027),疾病复发≥2 次也与 CD 患者焦虑评分呈正相关(OR=3.887,95%CI:1.242~12.166,P= 0.020)。肠道手术史(OR=5.491,95%CI:1.356~22.243,P=0.017)和上消化道病变(OR=4.774,95%CI:1.529~14.910,P=0.007)与 CD患者抑郁评分呈正相关。CD患者HF/(HF+LF)为0.490±0.151,显著低于对照组(0.661±0.092,P<0.001),提示迷走功能减弱,迷走神经功能与焦虑(r=-0.377,P=0.008)、抑郁(r=-0.350,P=0.015)呈负相关。结论:CD患者焦虑、抑郁发生率升高,迷走神经功能下降。CD患者迷走神经功能水平可能与焦虑、抑郁严重程度呈负相关。

    Abstract:

    Objective:The aim of this study was to assess the disorder of psychopsychological and vagus nerve function in patients with Crohn’s disease(CD)and analyze the relationship with clinical characteristics of CD patients so as to provide evidence for the comprehensive treatment of CD. Methods:A total of 124 CD patients were enrolled in the First Affiliated Hospital of Nanjing Medical University between January 2014 and December 2018. A total of 104 healthy controls matched by age and sex were also included. Disease activities were evaluated by the Crohn’s disease activity index(CDAI). Anxiety and depression were assessed by Generalized Anxiety Disorder(GAD -7)and Patient Health Questionnaire(PHQ -9). Vagal nerve function was evaluated by heart rate variability (HRV)in 48 CD patients and 17 healthy controls. High frequency(HF),low frequency(LF),LF/HF and HF/(HF+LF)were analyzed. Pearson correlation analysis,Spearman correlation analysis and ordinal logistic regression analysis were used to analyze the possible link among the incidence of anxiety and depression,vagus nerve function and clinical features of CD patients. Results:Among the 124 CD patients,the incidence of anxiety and depression was 42.7%(53/124)and 27.4%(34/124),which was significantly higher than that in the control group[8.7%(9/104)and 16.3%(17/104)],P value were<0.001 and 0.046 respectively. Perianal surgery history(OR= 5.405,95%CI:1.213~24.085,P=0.027)and frequency of recurrence≥2(OR=3.887,95%CI:1.242~12.166,P=0.020)were positive factors for the escalation of anxiety grades. Enterectomy surgery history(OR=5.491,95%CI:1.356~22.243,P=0.017)and upper GI tract involvement(OR=4.774,95% CI:1.529~14.910,P=0.007)were positive factors for the escalation of depression grades. The average value of HF/(LF+HF)of CD patients was 0.490±0.151,which was significantly lower than that of control group(0.661±0.092, P<0.001). Vagal activity had negative correlation with symptom of anxiety(r=-0.377,P=0.008)and depression(r=-0.350,P=0.015). Conclusion:CD patients had increased incidence of anxiety and depression and showed vagus nerve dysfunction. The function of vagus nerve had negative correlation with severity of anxiety and depression in CD patients.

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叶子萍,赵小静,焦春花,唐娜娜,张红杰,马晶晶.克罗恩病患者精神心理及迷走神经功能改变与临床特征的相关性分析[J].南京医科大学学报(自然科学版),2022,42(11):1553-1559

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  • 在线发布日期: 2022-11-24
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