炎症性肠病患者合并焦虑和抑郁状态的影响因素

Influencing factors of anxiety and depression in patients with inflammatory bowel diseases

目的:分析炎症性肠病(IBD)患者的焦虑、抑郁状态,并探讨相关影响因素。方法:回顾性收集2015年1月至2019年7月中国医科大学附属盛京医院消化内科收治的IBD患者。通过调查问卷方式收集患者的疾病类型、性别、年龄、确诊年龄、误诊史、病程、复发次数、药物使用情况、疾病活动期、既往心理障碍史、社会支持度、压力等临床资料。应用医院焦虑抑郁量表(HADS)评估IBD患者的焦虑和抑郁状态,采用单因素分析和多因素Logistic回归方法分析IBD患者焦虑和抑郁状态的影响因素。结果:共纳入143例患者,其中克罗恩病(CD)71例(49.7%),溃疡性结肠炎(UC)72例(50.3%);合并焦虑状态50例(35.0%),合并抑郁状态34例(23.8%)。与UC组比较,CD组男性比例较高(P=0.04),年龄和确诊年龄较小,误诊比例明显增高(均P<0.01)。UC患者采用的药物以5-氨基水杨酸(5-ASA)为主,CD患者以英夫利西单克隆抗体(IFX)和(或)硫唑嘌呤为主(均P<0.01);UC组较CD组处于高压力状态的比例更高,获得满意的社会支持的比例更低(均P<0.05)。UC合并抑郁的比例明显高于CD组(P<0.01),而两组间合并焦虑比例差异无统计学意义(P>0.05)。单因素分析显示,疾病活动期(OR=4.90,95%CI:2.33~10.32,P<0.01)、高压力状态(OR=13.37,95%CI:5.84~30.62,P<0.01)、满意的社会支持(OR=0.05,95%CI:0.02~0.20,P<0.01)、心理障碍史(OR=3.47,95%CI:1.57~7.65,P=0.002)、近期使用IFX(OR=2.08,95%CI:1.01~4.32,P=0.045)与IBD患者合并焦虑状态显著相关;IBD类型(OR=4.45,95%CI:1.85~10.72,P<0.01)、疾病活动期(OR=5.83,95%CI:2.41~14.12,P<0.01)、高压力状态(OR=8.87,95%CI:3.68~21.38,P<0.01)、满意的社会支持(OR=0.11,95%CI:0.04~0.31,P<0.01)、复发≥3次(OR=2.92,95%CI:1.32~6.43,P=0.007)、心理障碍史(OR=2.45,95%CI:1.06~5.64,P=0.03)与IBD患者合并抑郁状态显著相关。多因素Logistic回归分析显示,疾病活动期(OR=3.24,95%CI:0.92~6.00,P=0.08)、高压力状态(OR=5.13,95%CI:1.91~13.83,P=0.001)是IBD患者合并焦虑状态的危险因素,满意的社会支持(OR=0.12,95%CI:0.03~0.50,P=0.003)是其保护因素;UC(OR=3.06,95%CI:1.12~8.39,P=0.03)、疾病活动期(OR=2.87,95%CI:1.05~7.89,P=0.04)、高压力状态(OR=3.07,95%CI:1.01~9.31,P=0.048)是IBD患者合并抑郁状态的危险因素。结论:对于IBD患者,UC较CD更易合并抑郁,疾病活动、高压力可增加焦虑、抑郁风险,满意的社会支持可降低焦虑风险。

Objective To analyze the status of anxiety and depression in patients with inflammatory bowel disease(IBD)and explore the associated influencing factors.Methods IBD patients undergoing treatment in Shengjing Hospital of China Medical University from January 2015 to July 2019 were collected retrospectively.The disease types,gender,age,age at diagnosis,misdiagnosis,disease duration,recurrence frequency,medication,disease active stage,mental disorders history,sufficient social support and stress were retrieved from questionnairs.The hospital anxiety and depression scale(HADS)was used to evaluate anxiety and depression status of IBD patients.Univariate and multivariate Logistic regression analyses were performed to identify the influencing factors for anxiety and depression.Results A total of 143 patients were enrolled,including 71(49.7%)cases of Crohn′s disease(CD),72(50.3%)cases of ulcerative colitis(UC),50(35.0%)cases with anxiety,34(23.8%)cases with depression.Compared with UC group,CD group had higher ratio of male(P=0.04),more younger cases and lower age at diagnosis(P<0.01),and higher ratio of misdiagnosis(P<0.01).The main drug used in UC group was 5-aminosalicylic acid(5-ASA),while in CD group was infliximab(IFX)and/or azathioprine(all P<0.01).Compared with CD group,UC group had higher ratio of high stress condition and lower ratio of sufficient social support(all P<0.05).The ratio of depression in UC group was higher than that in CD group(P<0.01),but there was no significant difference in ratio of anxiety between two groups(P>0.05).Univariate analysis showed that the disease active stage(OR=4.90,95%CI:2.33-10.32,P<0.01),high stress condition(OR=13.37,95%CI:5.84-30.62,P<0.01),sufficient social support(OR=0.05,95%CI:0.02-0.20,P<0.01),mental disorders history(OR=3.47,95%CI:1.57-7.65,P=0.002)and using IFX recently(OR=2.08,95%CI:1.01-4.32,P=0.045)were closely associated with anxiety in IBD patients;IBD types(OR=4.45,95%CI:1.85-10.72,P<0.01),disease active stage(OR=5.83,95%CI:2.41-14.12,P<0.01),high stress condition(OR=8.87,95%CI:3.68-21.38,P<0.01),sufficient social support(OR=0.11,95%CI:0.04-0.31,P<0.01),recurrence frequency≥3 times(OR=2.92,95%CI:1.32-6.43,P=0.007)and mental disorders history(OR=2.45,95%CI:1.06-5.64,P=0.03)were closely associated with depression in IBD patients.Multivariate analysis revealed that the disease active stage(OR=3.24,95%CI:0.92-6.00,P=0.08),high stress condition(OR=5.13,95%CI:1.91-13.83,P=0.001)were risk factors of anxiety,and the sufficient social support(OR=0.12,95%CI:0.03-0.50,P=0.003)was the protective factor of anxiety in IBD patients.UC(OR=3.06,95%CI:1.12-8.39,P=0.03),disease active stage(OR=2.87,95%CI:1.05-7.89,P=0.04),high stress condition(OR=3.07,95%CI:1.01-9.31,P=0.048)were the risk factors of depression in IBD patients.Conclusions For IBD patients,UC cases are more prone to have depression than CD cases.Active illness and high stress condition may increase the risk of anxiety and depression,while sufficient social support can decrease the risk of anxiety.