考试应激与唾液免疫功能的变化(英文)

Exam stress and salivary immunological function

背景:近年来临床和流行病学相关研究都证实部分口腔疾病的发生与心理应激因素相关。目的:分析学生考试前后唾液分泌型IgA及皮质醇的变化与心理应激状况的关系。设计:横断面调查。单位:浙江大学口腔系。对象:调查对象为2003-05/11福州二中高二年级在校学生60人,57人完成调查,均为男性,年龄17～19岁,身体健康,无口腔疾病及免疫系统疾病家庭史,无烟酒嗜好,均参加为期3d的期末考试。方法:考试前应用症状自评量表(共90题,包括躯体化、强迫、人际关系敏感、忧郁、焦虑、敌对、恐惧、偏执、精神病性、其他等10个因素,总均分是将总分除以90),将完成调查的57人分为为低症状组(症状自评量表总分<2.0)和高症状组(症状自评量表总分>2.0)。于考试前5周召集学生填写一般情况调查表;考试前4周和考试当天早晨7:30完成第一、二次唾液标本采集,测定其考试应激前后唾液分泌型IgA、皮质醇值;考试后3d召集学生填写心理健康问卷,评定其心理健康状况。主要观察指标:①症状自评表得分。②应激前后唾液分泌型IgA及皮质醇水平。结果:采用意向处理分析,进入结果分析57人。①学生症状自评表评定结果与中国常模比较:考试后强迫、焦虑、敌对、偏执4个因子分高于中国常模(1.98±0.72,1.69±0.61)分;(1.79±0.31,1.42±0.43)分;(1.77±0.68,1.50±0.57)分;(2.00±0.71,1.52±0.60)分,(P<0.01),其他因子比较未见明显差异(P>0.05)。②应激后的唾液分泌型IgA分泌量比较:考试前低症状组明显高于高症状组(236.6±82.29,194.55±66.29)mg/L,(P<0.05);考试后低症状组学生唾液分泌型IgA分泌量高于高症状组(182.21±55.92,132.89±41.16)mg/L,(P<0.01);③应激后的唾液皮质醇浓度比较:低症状组考试后明显高于考试前(5.96±2.46,3.68±2.26)μg/L,(P<0.01)。④两组分泌型IgA变化率及皮质醇变化率逐步回归分析结果:分泌型IgA下降率(0.012±0.197)、皮质醇上升率(0.199±0.654)和偏执、强迫等心理因素有关。结论:学生考试后症状自评表评定结果中焦虑、强迫、敌对、偏执等因子分高于中国常模,显示考试应激造成学生焦虑水平的上升和心理行为方面变异。高、低症状组学生在考试应激前后唾液分泌型IgA下降率之间存在差异,表明心理症状较多的学生对考试应激耐受力低。

BACKGROUND： It has been verified in relevant clinical and epidemiclogical researches in recent years that a part of stomatopathy, is associated to psychological stress factors. OBJECTIVE： To analyze the relationship between the changes in salivary secretory IgA and cortisol and psychological stress states. DESIGN： cross-sectional investigation was designed. SETTING： Department of Stomatology, Zhejiang University. PARTICIPANTS： The investigated participants were 60 students in the 24 grade of Fuzhou No.2 Senior School selected from May to November 2003, Fifty-seven of them accomplished the investigation, of male; aged varied from 17 to 19 years, of healthy, no stomatopathy and family history of disorders in immune system and without indulgence in smoke and alcohol. All of them had participated in the 3-day terminal exam. METHODS： Before the exam, evaluation with symptom checklist （there are 90 questions, including about 10 factors, such as somatization, compulsive state, sensitive interpersonal relationships, melancholy, anxiety, hostility, fear, paranoid state, psychotic state and others. The total average score results by divided total score with 90. ） was applied. Fifty-seven students that had accomplished the investigation were divided in low-symptom group （the total score of symptom checklist 〈 2.0） and high-symptom group （the total score ≥ 2.0）, 5 weeks before the exam, the students were called together to fill up investigation form of general situation. Four weeks before the exam and at 7： 30 am on the day of exam, the first and second saliva specimens were collected respectively to determine salivary secretory IgA and cortisol before and after exam stress. The students were called together again 3 days after exam to fill up questionnaire on psychological health to evaluate their psychological health state. MAIN OUTCOME MEASURES： ① Score in evaluation with symptom checklist. ② levels of salivary secretory IgA and cortisol before and after stress. RESULTS： Intention management analysis was adopted, in which 57 students entered result analysis. ① Comparison of results in symptom cheeklist with Chinese norm： after exam, the scores of 4 factors, named compulsive state, anxiety, hostility and paranoid state, were higher than Chinese norm 1（1.98±0.72, 1.69±0.61） scores; （1.79±0.31, 1.42±0.43） scores; （1.77±0.68, 1.50±0.57）scores; （2.00±0.71, 1.52±0.60）scores, P 〈 0.01] and there was no remarkable difference in comparison of rest factors （P 〉 0.05）. ②Comparison of salivary secretory IgA content after stress： that before exam in low symptom group was remarkably higher than that in high symptom group [（236.6±82.29）,（194.55±66.29） mg/L, P 〈 0.05], that after exam in low symptom group was higher than that in high symptom group [（182.21 ±55.92, 132.89±41.16）mg/L, P 〈 0.01 ]. ③ Comparison of salivary cortisoI concentration after stress： that after exam in low symptom group was remarkably higher than that in high symptom group [（5.96±2.46, 3.68±2.26） μg/L, P 〈 0.01].④ Results of stepwise regression analysis on alternative rates of secretory IgA and cortisol in two groups： the decrease rate of secretory IgA （0.012±0.197） and increase rate of cortisol （0.199±0.654） were relevant to compulsive state and paranoid state. CONCLUSION： In evaluation with symptom checklist after exam, the scores of anxiety, compulsive state, hostility and paranoid state were higher than Chinese norm, indicating that exam stress induces increased anxietylevel and variation of psychological behavior of students. The difference presented in decrease rate of salivary secretory IgA before and after exam stress between high and low symptom groups, explaining that the students with more psychological symptoms are weak to endure exam stress.