心理干预治疗对慢性乙型病毒性肝炎患者心身症状及T细胞亚群功能的影响

Influence of psychological intervention on the psychosomatic symptoms and peripheral blood T lymphocyte subsets of patients with chronic hepatitis B

目的观察心理干预治疗对慢性乙型病毒性肝炎(CHB)患者心身症状和外周血T细胞亚群的影响。方法选择64例CHB患者,随机分为干预组和对照组,2组患者均给予拉米夫定抗病毒及常规药物保肝治疗,干预组同时进行8周的心理干预治疗。应用症状自评量表(SCL-90)评估2组患者在治疗前、后的心身症状变化,同时观察治疗前、后T细胞亚群比例的变化。结果治疗前,64例患者SCL-90因子中除偏执因子外的8项因子分值与常模组比较差异均有统计学意义(P均<0.05)。与治疗前比较,治疗后干预组该8项因子分值明显下降、CD4+T细胞比例上升、CD8+T细胞比例下降、CD4+/CD8+T细胞比值上升(P均<0.05);对照组9项因子分值均无明显变化(P均>0.05),且T细胞亚群亦无明显变化(P均>0.05)。治疗后,干预组强迫、抑郁、焦虑、敌对、精神病性因子分值均明显低于对照组(P均<0.05);干预组CD4+T细胞比例、CD4+/CD8+T细胞比值高于对照组,CD8+T细胞比例低于对照组(P均<0.01)。结论心理干预治疗可有效改善CHB患者的心身症状,提高外周血T细胞亚群功能。

Objective To investigate the influence of psychological intervention on psychosomatic symptoms and peripheral blood T lymphocyte subsets of patients with chronic hepatitis B （CHB）.Methods Sixty four patients were randomly divided into the intervention and control groups（n =32 for each group）.Pa-tients in both groups received lamivudine and hepatoprotective medicine.Besides,psychological intervention was supplemented for eight weeks in the intervention group.The changes in the psychosomatic symptoms before and after treatment were evaluated by SCL-90 symptom self-evaluation scale.The variations in the percentage of T lymphocyte subsets before and after treatment were observed.Results Prior to treatment,eight factors from the SCL-90 in 64 patients significantly differed from those of the normal group （all P 〈0.05）.In the interven-tion group,the scores of eight factors from the SCL-90 were considerably decreased,the percentage of CD4^＋T was significantly increased,the proportion of CD8^＋T was dramatically reduced and the ratio of CD4^＋/CD8^＋T was significantly elevated after corresponding treatment（all P 〈0.05）.In the control group,the scores of nine factors from the SCL-90 and T lymphocyte subsets did not significantly differ before and after treatment（all P 〉0.05）.Following corresponding treatment,the scores of obsession,depression,anxiety,hostility and psycho-sis in the intervention group were significantly lower compared with those of the control group （all P 〈0.05）. Compared with the control group,the percentage of CD4^＋T and the ratio of CD4^＋/CD8^＋T was significantly higher,whereas the proportion of CD8^＋T was significantly lower （both P 〈0.01）.Conclusion Psychological intervention can effectively improve the psychosomatic symptoms and function of peripheral blood T cell subsets in patients with CHB.