炎症性肠病患者焦虑和抑郁的研究进展
王一波 程 浩 嵇 晴
南京大学医学院附属金陵医院麻醉科,江苏南京 210018
[摘要]炎症性肠病(IBD)包括克罗恩病和溃疡性结肠炎,以慢性复发性肠道炎症为特征。越来越多的证据显示IBD 患者常伴有焦虑抑郁症状,但具体机制仍不清楚。炎症反应、氧化和亚硝酸盐(O&NS)途径、色氨酸分解代谢产物(TRYCAT)途径和肠道菌群机制在IBD 伴发焦虑抑郁的发展中可能起着重要的作用。一些社会经济、环境、生理因素,如教育、饮食、性别和压力也可能影响疾病的发展。目前已经有一些针对IBD 伴发焦虑抑郁治疗的临床试验。本文主要从IBD 合并焦虑抑郁的流行病学特征、发病机制、危险因素和治疗研究进展进行综述。
[关键词]炎症性肠病;焦虑;抑郁;流行病学;发病机制
炎症性肠病 (inflammatory bowel disease,IBD)是一种以胃肠道炎症为特征的慢性疾病,易反复发作。IBD 发病率在全世界范围内不断增加[1]。虽然病因尚未明确,但目前认为遗传、微生物、环境和免疫因素在疾病的发生发展中起着重要作用[2]。IBD 的常见症状包括腹痛、腹泻、便血、直肠出血、疲劳、食欲缺乏等。肠外表现如累及关节、皮肤和眼睛等在IBD 患者也很常见[3]。根据组织学和胃肠道发病的位置不同,IBD 可以分为克罗恩病(Crohn's disease,CD)和溃疡性结肠炎(ulcerative colitis,UC)两个亚型。CD 影响肠壁的全层,其特征为对肠道不连续区域形成透壁肉芽肿性炎症和(或)瘘管,可影响口腔到肛门消化道的任何区域,以回盲部最为多见[4]。而UC 的炎症通常局限于黏膜,持续影响直肠近端的结肠黏膜并经常形成糜烂和(或)溃疡[5]。IBD 主要治疗方案包括药物(氨基水杨酸类药物、糖皮质激素、免疫抑制剂和生物制剂)和手术[6],通常70%~80%的克罗恩病患者和30%的溃疡性结肠炎患者需要手术治疗[7]
目前,IBD 对患者情绪的影响越来越引起人们的关注。IBD 发病高峰岁18~35 岁[8],这意味着IBD 患者最宝贵的岁月都将受疾病困扰,同时IBD 可能会阻碍职业理想,加重经济负担,导致社会歧视并损害患者的生活质量[9]。所以部分IBD 患者产生焦虑抑郁症状。
1 IBD 与焦虑抑郁的关系
1.1 IBD 患者合并焦虑抑郁症状
与普通人相比较,慢性疾病患者的抑郁症和焦虑症患病率更高[10]。许多对成人和儿童的研究得出结论:IBD 患者焦虑症状和抑郁症状的发生率较高[11-12]。Neuendorf 等[11]回顾了171 篇文章,共包括158 371 例IBD 患者,统计发现IBD 患者焦虑症发生率为21%,焦虑症状为35%;抑郁症发生率为15%,抑郁症状为22%。其中CD 患者的抑郁症状发生率较UC 患者高,二者在焦虑症状中无明显差异;活动期焦虑抑郁的发病率明显较缓解期高。青少年患者的焦虑抑郁发生率总体要比成年人低。合并焦虑症状的发生率为16.4%,焦虑症的发生率为4.2%;合并抑郁症状的发生率为15.0%,抑郁症的发生率为3.4%[12]。其原因可能是焦虑抑郁的发生率随年龄的增加而增加[13],IBD的进展会带来越来越严重的不可逆性肠道损伤,加重患者的经济负担,此外IBD 对成人人际关系和工作的影响要大于儿童。
目前主要用于评价焦虑抑郁症状的有效量表包括医院焦虑和抑郁量表、贝克抑郁量表、广义焦虑症7、患者健康问卷9 和汉密尔顿焦虑和抑郁量表[14]
1.2 IBD 活动期和焦虑抑郁的关系
在IBD 活动期的患者焦虑抑郁症状要显著高于缓解 期[11]。Geiss 等[15]收 集了348 例IBD 患 者,用Harvey-Bradshaw 指数或简单临床结肠炎活性指数评分评估IBD 的活动性,用患者健康问卷9 评估患者的抑郁程度,最后得出结论:处于活动期患者健康问卷9 评分显著低于缓解期患者。在一项回顾性研究中,接受免疫抑制剂(英利昔单抗、阿达木单抗或赛妥珠单抗)治疗1~6 个月后,IBD 患者的抑郁评分显著降低,中度至重度抑郁风险的患者人数显著减少[16]。证明IBD 患者活动性降低和与抑郁症状改善有关。综合考虑,活动期IBD 患者焦虑抑郁风险增加,积极治疗活动期患者能改善患者的焦虑抑郁。
1.3 焦虑抑郁症状对IBD 患者病程进展和复发的影响
虽然有很多研究涉及IBD 患者焦虑抑郁的流行,但关于焦虑抑郁对IBD 发展的影响相关研究较少。Alexakis 等[17]回顾了11 项研究,共涉及3194 例IBD患者,发现其中有5 项研究报告了抑郁症状与IBD 病情恶化间存在关联性,研究发现,与UC 患者比较,CD患者的抑郁状态与病情恶化程度更具有相关性。Vidal 等[18]对112 例IBD 患者进行为期6 个月的随访并分析,发现焦虑和抑郁不是IBD 复发的独立预测因子。但是,Mikocka-Walus 等[19]在对IBD 患者分析中发现,抑郁或焦虑症状与临床复发间存在显着相关性,并认为应该对IBD 的患者进行临床相关的抑郁和焦虑水平筛查,并转介给心理学家或精神科医生进一步评估和治疗。这些研究结果差异的原因尚不清楚,还需要进一步研究心理障碍对IBD 发展的潜在影响,但这些结果表明,焦虑抑郁状态可能对IBD 病程进展和复发存在一定的影响。
2 IBD 患者产生情绪障碍的机制
2.1 炎症和IBD 患者的情绪障碍
越来越多的证据表明炎症在情绪障碍病理生理机制中起关键作用。在精神分裂、双相情感障碍和重度抑郁症患者中观察到血液中细胞因子水平升高[20],许多炎症疾病,包括IBD、类风湿关节炎、心血管疾病和糖尿病都与心理障碍的发生有关[21-23]。抑郁症和IBD 患者体内均发生免疫炎症反应,且伴随体内的一些炎症因子升高[24]。Abautret-Daly 等[25]发现焦虑和抑郁评分更高IBD 患者血清炎症因子水平高于焦虑抑郁评分低患者。血清C 反应蛋白(C-reaction protein,CRP)水平已被用来作为在CD 和UC 疾病活动和缓解的标志物[26-27]。CRP 似乎也是抑郁症的危险生物标志物,在抑郁症患者中也发现CRP 的增加。CRP 增加了血脑屏障通透性,提示IBD 患者血清CRP 的增加将导致中枢神经系统损伤[29]。较高的CRP 水平提示发生新型抑郁症的风险可能较高[28]
大量证据表明,慢性肠道炎症与氧化和亚硝化应激(oxidative and nitrosative stress,O&NS)形成密切相关[30]。在IBD 实验模型中发现,炎症细胞如中性粒细胞和巨噬细胞会产生大量的超氧化物和一氧化氮,这两种物质会相互作用形成过氧亚硝酸盐,并引起IBD样炎症和病理变化[31]。同样,在抑郁症的发生中也涉及O&NS 过程[32],两者都伴随着活性氧物质和活性氮物质增加,DNA 和脂质损害,亚硝基化增加和某些抗氧化剂水平降低[24]。全身炎症和细胞内毒素(lipopolysaccharide,LPS)诱导的炎症细胞因子可增强外周和中枢O&NS 过程,并导致中枢神经损害,从而导致抑郁[33]
此外,IBD 和抑郁症都伴随着色氨酸分解代谢产物(tryptophan catabolite,TRYCAT)途径的活化,TPYCAT 包括犬尿氨酸、犬尿酸、喹啉酸和黄嘌呤酸等,具有降压、神经调节和神经毒性作用,并能够推动行为反应变化包括诱发焦虑和抑郁[34-35]。IBD 和抑郁症中促炎细胞因子水平升高可能会诱导TRYCAT 途径激活,从而分解血浆色氨酸并提高TRYCAT 水平[36],并对中枢神经系统产生影响。
2.2 肠道菌群与IBD 情绪障碍
在抑郁症患者尤其是慢性抑郁症的患者中,针对革兰氏阴性肠杆菌中LPS 的免疫球蛋白M 和免疫球蛋白A 抗体的水平升高[37],并且与不同的O&NS 标记显著相关[38],表明LPS 可通过激活的O&NS 途径诱导抑郁和焦虑样行为、疲劳和轻度认知障碍。例如,一些研究表明,使用LPS 可以减少食欲、体重、社交互动和活动,并引起快感缺失[39-40]。同时,越来越多的证据表明,肠道微生物群与黏膜边界的宿主免疫系统之间存在良好的平衡,这是IBD 起始和发病机制的核心[41]。在IBD 患者中,肠活检显示肠道紧密连接复合物下调[42],肠道通透性增加,并伴有肠道菌群多样性降低[43],从而驱动免疫,并最终导致进行性肠道炎症反应。动物实验表明,外周和中枢注射LPS 诱导不同的TRYCAT产生抑郁行为[44]。在正常情况下,肠道屏障阻止LPS进入外周和中枢,但当肠道屏障功能降低的时候,如在IBD 和抑郁症患者中,LPS 移位产生O&NS 途径,改变中枢胶质细胞功能并通过TRYCAT 途径产生抑郁行为[45-46]。这些重叠的过程可能使得抑郁症和IBD相关联。
3 IBD 患者焦虑抑郁的影响因素
一些社会经济、环境、生理因素,例如教育、社会经济状况、性别、饮食、疼痛、感觉到的压力等,可能是IBD 中心理障碍的预测因素或影响因素。
已有研究表明,较低的社会经济情况与IBD 患者的焦虑抑郁相关,Nahon 等[47]通过对IBD 患者问卷调查发现,社会经济水平较低患者,焦虑抑郁所占比例更高。
男女间的IBD 发病率没有差异,但女性患者的焦虑抑郁发病率更高[48],可能和女性IBD 患者更容易疲劳有关,而疲劳与患者焦虑抑郁高度相关[49]
不合理的饮食与UC 和CD 风险增加有关[50],不同的饮食成分影响肠道菌群,并可调节表观遗传机制增加或降低IBD 的风险[51]。服用益生菌似乎能降低健康人群的焦虑抑郁水平[52],但尚未见在IBD 患者的报道。
压力和应激已经证明会使肠壁通透性增加,细菌向肠壁移动,增加促炎细胞因子,中枢疼痛处理不足,最终导致焦虑抑郁[53-54]。在CD 和UC 中,感知到压力和情绪障碍有关[55]
除此之外,家庭情感参与可能在青少年情绪功能中起重要作用,但可能不会减轻疾病严重程度对抑郁症状的影响[56]
4 治疗
4.1 IBD 患者普通治疗
IBD 主要治疗目标是改善患者的生活质量并实现临床缓解,对于临床不能缓解患者,以内镜下缓解和生物标志物缓解为辅助目标,并尽量减少手术治疗[57]。主要治疗药物包括氨基水杨酸酯、抗生素、免疫调节剂和生物制剂,对于药物无法控制的患者采用手术治疗。
4.2 针对IBD 患者焦虑抑郁的治疗
一项对于患有抑郁症患者IBD 风险的系统综述表明,抑郁症增加IBD 的风险,在抑郁症的治疗中使用抗抑郁药对UC 和CD 具有选择性保护作用,主要抗抑郁药包括:非典型抗抑郁剂、米氮平、单胺氧化酶抑制剂、5-羟色胺再摄取抑制剂、5-羟色胺调节剂和三环抗抑郁剂[58]。Goodhand 等[59]通过对IBD 患者的回顾性分析发现,抗抑郁药用于治疗IBD 伴发的情绪障碍时,似乎可以降低复发率,减少类固醇和内镜检查的使用。除抗抑郁药外,认知行为疗法已证明可能对伴有亚临床焦虑抑郁的青少年IBD 患者的肠道炎症产生积极影响[60]。接受和承诺疗法也能够改善IBD 患者的心理压力[61]
5 小结
IBD 患者的情绪障碍越来越引起全世界人们的关注,普遍认为与健康人比较,IBD 与抑郁和焦虑症状的易感性增加有关,特别是在活动性疾病期间。IBD患者发生焦虑抑郁的机制主要和炎症反应、O&NS 途径、TRYCAT 途径和肠道菌群有关,此外还有多种因素影响IBD 患者焦虑抑郁发生,目前针对IBD 患者情绪障碍的治疗意见尚未统一,治疗心理症状可能对IBD患者产生积极影响,但仍需要进一步的临床干预试验来探讨心理治疗是否能对IBD 患者的预后产生影响。
[参考文献]
[1]Sairenji T,Collins KL,Evans DV.An Update on Inflammatory Bowel Disease[J].Prim Care,2017,44(4):673-692.
[2]Zhang YZ,Li YY.Inflammatory bowel disease:pathogenesis[J].World J Gastroenterol,2014,20(1):91-99.
[3]Vavricka SR,Schoepfer A,Scharl M,et al.Extraintestinal Manifestations of Inflammatory Bowel Disease[J].Inflamm Bowel Dis,2015,21(8):1982-1992.
[4]Lichtenstein GR,Hanauer SB,Sandborn WJ,et al.Management of Crohn's disease in adults[J].Am J Gastroenterol,2009,104(2):465-483.
[5]Kornbluth A,Sachar DB,Practice Parameters Committee of the American College of Gastroenterology.Ulcerative colitis practice guidelines in adults:American College Of Gastroenterology,Practice Parameters Committee[J].Am J Gastroenterol,2010,105(3):501-523.
[6]Mowat C,Cole A,Windsor A,et al.Guidelines for the management of inflammatory bowel dis ease in adults[J].Gut,2011,60:571-607.
[7]Hwang JM,Varma MG.Surgery for inflammatory bowel disease[J].World J Gastroenterol,2008,14(17):2678-2690.
[8]Binder V.Epidemiology of IBD during the twentieth century:an integrated view[J].Best Pract Res Clin Gastroenterol,2004,18(3):463-479.
[9]Kaplan GG.The global burden of IBD:from 2015 to 2025[J].Nat Rev Gastroenterol Hepatol,2015,12(12):720-727.
[10]Clarke DM,Currie KC.Depression,anxiety and their relationship with chronic diseases:a review of the epidemiology,risk and treatment evidence[J].Med J Aust,2009,190(7):54-60.
[11]Neuendorf R,Harding A,Stello N,et al.Depression and anxiety in patients with Inflammatory Bowel Disease:A systematic review[J].J Psychosom Res,2016,87:70-80.
[12]Stapersma L,Brink G,Szigethy EM,et al.Systematic review with meta-analysis:anxiety and depression in children and adolescents with inflammatory bowel disease[J].Aliment Pharmacol Ther,2018,48(5):496-506.
[13]Costello EJ,Copeland W,Angold A.Trends in psychopathology across the adolescent years:what changes when children become adolescents,and when adolescents become adults?[J].J Child Psychol Psychiatry,2011,52(10):1015-1025.
[14]Abautret-Daly á,Dempsey E,Parra-Blanco A,et al.Gutbrain actions underlying comorbid anxiety and depression associated with inflammatory bowel disease[J].Acta Neuropsychiatr,2018,30(5):275-296.
[15]Geiss T,Schaefert RM,Berens S,et al.Risk of depression in patients with inflammatory bowel disease[J].J Dig Dis,2018,19(8):456-467.
[16]Horst S,Chao A,Rosen M,et al.Treatment with immunosuppressive therapy may improve depressive symptoms in patients with inflammatory bowel disease[J].Dig Dis Sci,2015,60(2):465-470.
[17]Alexakis C,Kumar S,Saxena S,et al.Systematic review with meta-analysis:the impact of a depressive state on disease course in adult inflammatory bowel disease[J].Aliment Pharmacol Ther,2017,46(3):225-235.
[18]Vidal A,Gómez-Gil E,Sans M,et al.The impact of anxiety and depression on relapse in patients with inflammatory bowel disease[J].Med Clin (Barc),2009,132(8):298-302.
[19]Mikocka-Walus A,Pittet V,Rossel JB,et al.Symptoms of Depression and Anxiety Are Independently Associated With Clinical Recurrence of Inflammatory Bowel Disease[J].Clin Gastroenterol Hepatol,2016,14(6):829-835.
[20]Goldsmith DR,Rapaport MH,Miller BJ.A meta-analysis of blood cytokine network alterations in psychiatric patients:comparisons between schizophrenia,bipolar disorder and depression[J].Mol Psychiatry,2016,21(12):1696-1709.
[21]Margaretten M,Julian L,Katz P,et al.Depression in patients with rheumatoid arthritis:description,causes and mechanisms[J].Int J Clin Rheumatol,2011,6(6):617-623.
[22]Hare DL,Toukhsati SR,Johansson P,et al.Depression and cardiovascular disease:a clinical review[J].Eur Heart J,2014,35(21):1365-1372.
[23]Andreoulakis E,Hyphantis T,Kandylis D,et al.Depression in diabetes mellitus:a comprehensive review[J].Hippokratia,2012,16(3):205-214.
[24]Martin-Subero M,Anderson G,Kanchanatawan B,et al.Comorbidity between depression and inflammatory bowel disease explained by immune-inflammatory,oxidative,and nitrosative stress;tryptophan catabolite;and gut -brain pathways[J].CNS Spectr,2016,21(2):184-198.
[25]Abautret-Daly á,Dempsey E,Riestra S,et al.Association between psychological measures with inflammatory anddisease-related markers of inflammatory bowel disease[J].Int J Psychiatry Clin Pract,2017,21(3):221-230.
[26]Kiss LS,Szamosi T,Molnar T,et al.Early clinical remission and normalisation of CRP are the strongest predictors of efficacy,mucosal healing and dose escalation during the first year of adalimumab therapy in Crohn's disease[J].Aliment Pharmacol Ther,2011,34(8):911-922.
[27]Kiss LS,Papp M,Lovasz BD,et al.High-sensitivity C-reactive protein for identification of disease phenotype,active disease,and clinical relapses in Crohn's disease:a marker for patient classification[J]Inflamm Bowel Dis,2012,18(9):1647-1654.
[28]Pasco JA,Nicholson GC,Williams LJ,et al.Association of high-sensitivity C-reactive protein with de novo major depression[J].Br J Psychiatry,2010,197(5):372-377.
[29]Hsuchou H,Kastin AJ,Mishra PK,et al.C-reactive protein increases BBB permeability:implications for obesity and neuroinflammation[J].Cell Physiol Biochem,2012,30(5):1109-1119.
[30]Zhu H,Li YR.Oxidative stress and redox signaling mechanisms of inflammatory bowel disease:updated experimental and clinical evidence[J].Exp Biol Med (Maywood),2012,237(5):474-480.
[31]Rachmilewitz D,Stamler JS,Karmeli F,et al.Peroxynitriteinduced rat colitis——a new model of colonic inflammation[J].Gastroenterology,1993,105(6):1681-1688.
[32 Leonard B,Maes M.Mechanistic explanations how cell-mediated immune activation,inflammation and oxidative and nitrosative stress pathways and their sequels and concomitants play a role in the pathophysiology of unipolar depression[J] Neurosci Biobehav Rev,2012,36(2):764-785.
[33]Bian Y,Zhao X,Li M,et al.Various roles of astrocytes during recovery from repeated exposure to different doses of lipopolysaccharide[J].Behav Brain Res,2013,253:253-261.
[34]Lapin IP.Neurokynurenines (NEKY) as common neurochemical links of stress and anxiety[J].Adv Exp Med Biol,2003,527:121-125.
[35]O'Connor JC,Lawson MA,André C,et al.Lipopolysaccharide-induced depressive-like behavior is mediated by indoleamine 2,3-dioxygenase activation in mice[J].Mol Psychiatry,2009,14(5):511-522.
[36]Oxenkrug GF.Genetic and hormonal regulation of tryptophan kynurenine metabolism:implications for vascular cognitive impairment,major depressive disorder,and aging[J].Ann N Y Acad Sci,2007,1122:35-49.
[37]Maes M,Kubera M,Leunis,et al.The gut-brain barrier in major depression:intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria(leaky gut)plays a role in the inflammatory pathophysiology of depression[J].Neuro Endocrinol Lett,2008,29(1):117-124.
[38]Maes M,Kubera M,Leunis JC,et al.In depression,bacterial translocation may drive inflammatory responses,oxidative and nitrosative stress (O&NS),and autoimmune responses directed against O&NS-damaged neoepitopes[J].Acta Psychiatr Scand,2013,127(5):344-354.
[39]Yirmiya R.Endotoxin produces a depressive-like episode in rats[J].Brain Res,1996,711(1-2):163-174.
[40]De La Garza R 2nd.Endotoxin-or pro-inflammatory cytokine-induced sickness behavior as an animal model of depression:focus on anhedonia[J].Neurosci Biobehav Rev,2005,29(4-5):761-770.
[41]Zhang YZ,Li YY.Inflammatory bowel disease:pathogenesis[J].World J Gastroenterol,2014,20(1):91-99.
[42]Gassler N,Rohr C,Schneider A,et al.Inflammatory bowel disease is associated with changes of enterocytic junctions[J].Am J Physiol Gastrointest Liver Physiol,2001,281(1):G216-228.
[43]Lepage P,Hasler R,Spehlmann ME,et al.Twin study indicates loss of interaction between microbiota and mucosa of patients with ulcerative colitis[J].Gastroenterology,2011,141(1):227-236.
[44]Lawson MA,Parrott JM,McCusker RH,et al.Intracerebroventricular administration of lipopolysaccharide induces indoleamine-2,3-dioxygenase-dependent depression-like behaviors[J].J Neuroinflammation,2013,10:87.
[45]Doenlen R,Krügel U,Wirth T,et al.Electrical activity in rat cortico-limbic structures after single or repeated administration of lipopolysaccharide or staphylococcal enterotoxin B[J].Proc Biol Sci,2011,278(1713):1864-1872.
[46]Haba R,Shintani N,Onaka Y,et al.Lipopolysaccharide affects exploratory behaviors toward novel objects by impairing cognition and/or motivation in mice:Possible role of activation of the central amygdala[J].Behav Brain Res,2012,228(2):423-431.
[47]Nahon S,Lahmek P,Durance C,et al.Risk factors of anxiety and depression in inflammatory bowel disease[J].Inflamm Bowel Dis,2012,18(11):2086-2091.
[48]Navabi S,Gorrepati VS,Yadav S,et al.Influences and Impact of Anxiety and Depression in the Setting of Inflammatory Bowel Disease[J].Inflamm Bowel Dis,2018,24(11):2303-2308.
[49]Keightley P,Reay RE,Pavli P,et al.Inflammatory bowel disease-related fatigue is correlated with depression and gender[J].Australas Psychiatry,2018,26(5):508-513.
[50]Hou JK,Abraham B,El-Serag H.Dietary intake and risk of developing inflammatory bowel disease:a systematic review of the literature[J].Am J Gastroenterol,2011,106(4):563-573.
[51]Rapozo DC,Bernardazzi C,de Souza HS.Diet and microbiota in inflammatory bowel disease:The gut in disharmony[J].World J Gastroenterol,2017 23(12):2124-2140.
[52]Messaoudi M,Lalonde R,Violle N,et al.Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175)in rats and human subjects[J].Br J Nutr 2011,105(5):755-764.
[53]Konturek PC,Konturek K,Zopf Y.Stress und chronischentzündliche Darmerkrankungen [Stress and inflammatory bowel disease][J].MMW Fortschr Med,2020,162 (Suppl 5):3-6.
[54]Brzozowski B,Mazur-Bialy A,Pajdo R,et al.Brzozowski T.Mechanisms by which Stress Affects the Experimental and Clinical Inflammatory Bowel Disease (IBD):Role of Brain-Gut Axis[J].Curr Neuropharmacol,2016,14(8):892-900.
[55]Goodhand JR,Wahed M,Mawdsley JE,et al.Mood disorders in inflammatory bowel disease:relation to diagnosis,disease activity,perceived stress,and other factors[J].Inflamm Bowel Dis,2012,18(12):2301-2309.
[56]Schuman SL,Graef DM,Janicke DM,et al.An exploration of family problem-solving and affective involvement as moderators between disease severity and depressive symptoms in adolescents with inflammatory bowel disease[J].J Clin Psychol Med Settings,2013,20(4):488-496.
[57]Abraham BP,Ahmed T,Ali T.Inflammatory Bowel Disease:Pathophysiology and Current Therapeutic Approaches[J].Handb Exp Pharmacol,2017,239:115-146.
[58]Frolkis AD,Vallerand IA,Shaheen AA,et al.Depression increases the risk of inflammatory bowel disease,which may be mitigated by the use of antidepressants in the treatment of depression[J].Gut,2019,68(9):1606-1612.
[59]Goodhand JR,Greig FI,Koodun Y,et al.Do antidepressants influence the disease course in inflammatory bowel disease?A retrospective case-matched observational study[J].Inflamm Bowel Dis 2012,18(7):1232-1239.
[60]van den Brink G Stapersma L,Bom AS,et al.Effect of Cognitive Behavioral Therapy on Clinical Disease Course in Adolescents and Young Adults With Inflammatory Bowel Disease and Subclinical Anxiety and/or Depression:Results of a Randomized Trial[J].Inflamm Bowel Dis,2019,25(12):1945-1956.
[61]Wynne B,McHugh L,Gao W,et al.Acceptance and Commitment Therapy Reduces Psychological Stress in Patients With Inflammatory Bowel Diseases[J].Gastroenterology,2019,156(4):935-945.
Research progress of anxiety and depression in patients with inflammatory bowel disease
WANG Yi-bo CHENG Hao JI Qing
Department of Anesthesiology, Jinling Hospital Affiliated to Medical School of Nanjing University, Jiangsu Province,Nanjing 210018, China
[Abstract] Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, was characterized by chronic relapsing intestinal inflammation. Accumulating evidence shows that IBD patients often suffered from anxiety and depression, but the specific mechanism is still unclear. It is thought that inflammatory response, oxidative and nitrosative stress (O&NS) pathways, tryptophan catabolite (TRYCAT) pathways and intestinal flora mechanism may play an important role in the development of anxiety and depression associated with IBD. Some socioeconomic, environment,physiological factors such as education, diet, gender, stress, etc. May have an effect on the development of the disease.Up to now, some clinical trials have been conducted for the treatment of anxiety and depression associated with IBD.The epidemiologic features, pathogenesis, risk factors, and treatment of anxiety and depression associated with IBD will be reviewed in this paper.
[Key words] Inflammatory bowel disease; Anxiety; Depression; Epidemiology; Pathogenesis
[中图分类号] R574.02
[文献标识码] A
[文章编号] 1674-4721(2021)10(c)-0040-05
通讯作者
(收稿日期:2021-05-17)