心理干预对支气管哮喘患者负性情绪的影响

Effects of psychological intervention on negative emotion of patients with bronchial asthma

目的探讨心理干预对支气管哮喘患者负性情绪的影响及可能机制。方法采用随机数字表法,将54例支气管哮喘患者分为观察组和对照组,对照组选择常规治疗,观察组在常规治疗基础上给予心理干预。比较两组临床疗效,检测两组治疗前后的肺功能、负性情绪及细胞免疫指标。结果观察组治疗的显效率为80.77%,显著高于对照组的53.57%(χ2=4.488,P=0.034)。治疗后观察组1秒钟用力呼气容量百分比(FEV1%)和最大呼气流量百分比(PEF%)分别为(79.63±8.73)%和(84.72±9.03)%,显著高于对照组的(74.31±8.02)%和(78.27±9.15)%(P<0.05);观察组汉密尔顿抑郁量表(HRSD)、汉密尔顿焦虑量表(HAMA)、简易应对方式问卷(SCSQ)、焦虑自评量表(SAS)和抑郁自评量表(SDS)评分分别为(7.28±1.27)分、(8.27±1.16)分、(8.24±1.32)分、(42.56±7.26)分和(48.83±5.34)分,显著低于对照组的(14.91±4.34)分、(15.61±4.53)分、(13.58±4.47)分、(54.25±5.42)分和(53.56±6.24)分(均P<0.01)。此外,治疗后观察组血清皮质醇(Cor)水平为(279.25±42.56)ng·m L^(-1),显著低于对照组的(422.31±52.44)ng·m L^(-1)(P<0.01);观察组血清白细胞介素-2(IL-2)水平为(23.05±3.62)ng·m L^(-1),显著高于对照组的(16.34±3.67)ng·m L^(-1)(P<0.01);观察组外周血T淋巴细胞亚群CD3+、CD4+百分比,CD4+/CD8+比值以及自然杀伤细胞(NK)活性分别为(62.51±6.94)%、(39.84±5.02)%、(17.62±2.93)%和(1.24±0.24)%,显著高于对照组的(54.33±7.04)%、(28.42±3.37)%、(0.84±0.18)%和(14.55±2.03)%(均P<0.01)。结论心理干预提高支气管哮喘患者的免疫力,促进病情控制和肺功能的改善,缓解患者的抑郁、焦虑情绪。

Objectives To investigate the effects of psychological intervention on negative emotion of patients with bronchial asthma and explore the possible mechanism. Methods Fifty-four patients with bronchial asthma were randomly divided into control group（ 28 cases） and intervention group（ 26 cases）. The control group received the routine medicine treatment of bronchial asthma,and the intervention group received the psychological intervention based on routine medicine treatment. In two groups,the clinical efficacy was observed,and the lung function,negative emotion indexes and cellular immune indexes before and after treatment were detected. Results The effective rate of treatment in intervention group was 80. 77%,significantly higher than 53. 57% in control group（ χ2= 4. 488,P= 0. 034）. After treatment,the percentage of forced expiratory volume in one second（ FEV1%） and percentage of maximal expiratory flow（ PEF%） in intervention group were（ 79. 63 ± 8. 73） % and（ 84. 72 ± 9. 03） %,significantly higher than（ 74. 31 ± 8. 02） % and（ 78. 27 ± 9. 15） % in control group,respectively（ P〈0. 05）; the scores of Hamilton Depression Scale（ HRSD）,Hamilton Anxiety Scale（ HAMA）,Simplified Coping Style Questionnaire（ SCSQ）,Selfrating Anxiety Scale（ SAS） and Self-rating Anxiety Scale（ SAS）in intervention group were（ 7. 28 ± 1. 27） point,（ 8. 27 ± 1. 16） point,（ 8. 24 ± 1. 32） point,（ 42. 56 ± 7. 26） point and（ 48. 83 ±5. 34） point,significantly lower than（ 14. 91 ± 4. 34） point,（ 15. 61 ± 4. 53） point,（ 13. 58 ± 4. 47） point,（ 54. 25 ± 5. 42） point and（ 53. 56 ± 6. 24） point in control group,respectively（ P〈0. 01）; the serum cortisol（ Cor） level in intervention group was（ 279. 25 ± 42. 56） ng·m L^-1,significantly lower than（ 422. 31 ± 52. 44） ng·m L^-1 in control group（ P〈0. 01）,and the serum Interleukin-2（ IL-2） level in intervention group was（ 23. 05 ± 3. 62） ng·m L^-1,significantly higher than（ 16. 34 ± 3. 67） ng·m L^-1 in control group（ P〈0. 01）; the peripheral blood percentages of T lymphocyte subset CD3＋and CD4＋,CD4＋/CD8＋ratio and natural killer（ NK） cell activity in intervention group were（ 62. 51 ± 6. 94） %,（ 39. 84 ± 5. 02） %,17. 62 ± 2. 93 and（ 1. 24 ± 0. 24） %,significantly higher than（ 54. 33 ± 7. 04） %,（ 28. 42 ± 3. 37） %,0. 84 ± 0. 18 and（ 14. 55 ± 2. 03） % in control group,respectively（ P〈0. 01）. Conclusions In patients with bronchial asthma,the psychological intervention can improve the immunity,promote the disease control and lung function improvement,thus relieving the depression and anxiety.