精神心理因素與IBD的相關(guān)研究國內(nèi)外文獻(xiàn)綜述目前相關(guān)研究認(rèn)為，精神心理因素與IBD的發(fā)病之間存在密切關(guān)系，并且IBD患者在病程中除了存在消化道癥狀，通常也會伴隨情緒異常，如焦慮、抑郁等，這些精神癥狀不僅對患者的病情與病程產(chǎn)生負(fù)面影響，也會影響患者的社會生活以及尋求醫(yī)療支持等社會屬性，腹痛、腹瀉以及各種全身性癥狀不僅僅代表IBD處于活動期，在IBD的緩解期，即使疾病已經(jīng)得到控制，在那些具有精神心理問題的患者身上，上述癥狀可能會作為與情感相關(guān)的軀體癥狀再次出現(xiàn)。同時，焦慮、抑郁也會加重腸道炎癥反應(yīng)，從而使患者的生活質(zhì)量不能得到保障，生活負(fù)擔(dān)也隨之增加，這些負(fù)面因素又反過來加重了焦慮與抑郁狀態(tài)，從而使IBD患者陷入負(fù)面循環(huán)中。IBD患者的焦慮與抑郁與消化系統(tǒng)相關(guān)的疾病，大多數(shù)與精神心理因素存在千絲萬縷的聯(lián)系，IBD與功能性胃腸疾病等心身疾病類似，也容易合并精神心理障礙，因此，與IBD相關(guān)的心理問題越來越得到人們的重視。IBD患者大多在消化道癥狀的基礎(chǔ)上伴隨有焦慮、抑郁等精神心理問題，與健康人群相比，IBD患者焦慮與抑郁的發(fā)病風(fēng)險明顯增加ADDINEN.CITE<EndNote><Cite><Author>Bernstein</Author><Year>2019</Year><RecNum>110</RecNum><DisplayText><styleface="superscript">[34]</style></DisplayText><record><rec-number>110</rec-number><foreign-keys><keyapp="EN"db-id="texz0f50svs2rkedstoxwtzjtzrp5rd9edsx"timestamp="1616334749">110</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Bernstein,CharlesN.</author><author>Hitchon,CarolA.</author><author>Walld,Randy</author><author>Bolton,JamesM.</author><author>Sareen,Jitender</author><author>Walker,JohnR.</author><author>Graff,LesleyA.</author><author>Patten,ScottB.</author><author>Singer,Alexander</author><author>Lix,LisaM.</author><author>El-Gabalawy,Renee</author><author>Katz,Alan</author><author>Fisk,JohnD.</author><author>Marrie,RuthAnn</author><author>CihrTeamDefiningBurdenManagi</author></authors></contributors><titles><title>IncreasedBurdenofPsychiatricDisordersinInflammatoryBowelDisease</title><secondary-title>InflammatoryBowelDiseases</secondary-title></titles><periodical><full-title>InflammatoryBowelDiseases</full-title></periodical><pages>360-368</pages><volume>25</volume><number>2</number><dates><year>2019</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1078-0998</isbn><accession-num>WOS:000462580900026</accession-num><urls><related-urls><url><GotoISI>://WOS:000462580900026</url></related-urls></urls><electronic-resource-num>10.1093/ibd/izy235</electronic-resource-num></record></Cite></EndNote>[34]，發(fā)表于2016年的一項系統(tǒng)綜述統(tǒng)計了IBD患者焦慮的患病率約為20%，抑郁的患病率約為15%ADDINEN.CITE<EndNote><Cite><Author>Neuendorf</Author><Year>2016</Year><RecNum>111</RecNum><DisplayText><styleface="superscript">[35]</style></DisplayText><record><rec-number>111</rec-number><foreign-keys><keyapp="EN"db-id="texz0f50svs2rkedstoxwtzjtzrp5rd9edsx"timestamp="1616334912">111</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Neuendorf,Rachel</author><author>Harding,Aubrey</author><author>Stello,Noelle</author><author>Hanes,Douglas</author><author>Wahbeh,Helane</author></authors></contributors><titles><title>DepressionandanxietyinpatientswithInflammatoryBowelDisease:Asystematicreview</title><secondary-title>JournalofPsychosomaticResearch</secondary-title></titles><periodical><full-title>JournalofPsychosomaticResearch</full-title></periodical><pages>70-80</pages><volume>87</volume><dates><year>2016</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0022-3999</isbn><accession-num>WOS:000380297300010</accession-num><urls><related-urls><url><GotoISI>://WOS:000380297300010</url></related-urls></urls><electronic-resource-num>10.1016/j.jpsychores.2016.06.001</electronic-resource-num></record></Cite></EndNote>[35]。IBD屬于慢性疾病，疾病持續(xù)時間一般較長，并且表現(xiàn)為發(fā)作與緩解相互交替出現(xiàn)的特點，頻繁出現(xiàn)腹瀉以及黏液膿血便等癥狀，病情嚴(yán)重者甚至?xí)霈F(xiàn)全身癥狀或者腸道外表現(xiàn)，IBD患者常常需要多次前往醫(yī)院就診，而且目前仍然無法治愈，需要長期的維持治療，花費巨大。上述情況使得IBD患者容易出現(xiàn)輕重不一的精神心理問題。Nahon等人通過研究發(fā)現(xiàn)，焦慮與抑郁在IBD活動期和病情嚴(yán)重時表現(xiàn)更為明顯ADDINEN.CITE<EndNote><Cite><Author>Nahon</Author><Year>2012</Year><RecNum>112</RecNum><DisplayText><styleface="superscript">[36]</style></DisplayText><record><rec-number>112</rec-number><foreign-keys><keyapp="EN"db-id="texz0f50svs2rkedstoxwtzjtzrp5rd9edsx"timestamp="1616334987">112</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Nahon,Stephane</author><author>Lahmek,Pierre</author><author>Durance,Christelle</author><author>Olympie,Alain</author><author>Lesgourgues,Bruno</author><author>Colombel,Jean-Frederic</author><author>Gendre,Jean-Pierre</author></authors></contributors><titles><title>Riskfactorsofanxietyanddepressionininflammatoryboweldisease</title><secondary-title>InflammatoryBowelDiseases</secondary-title></titles><periodical><full-title>InflammatoryBowelDiseases</full-title></periodical><pages>2086-2091</pages><volume>18</volume><number>11</number><dates><year>2012</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1078-0998</isbn><accession-num>WOS:000310252500012</accession-num><urls><related-urls><url><GotoISI>://WOS:000310252500012</url></related-urls></urls><electronic-resource-num>10.1002/ibd.22888</electronic-resource-num></record></Cite></EndNote>[36]，在UC患者的相關(guān)研究中也發(fā)現(xiàn)了類似的趨勢，UC患者的Mayo評分，即疾病活動程度越高，焦慮、抑郁的評分也隨之升高ADDINEN.CITEADDINEN.CITE.DATA[37]。此外，Neuendorf等人的研究結(jié)果也提醒我們應(yīng)當(dāng)注意，即使疾病處于緩解期，IBD患者抑郁的患病率也高于一般人群ADDINEN.CITE<EndNote><Cite><Author>Neuendorf</Author><Year>2016</Year><RecNum>111</RecNum><DisplayText><styleface="superscript">[35]</style></DisplayText><record><rec-number>111</rec-number><foreign-keys><keyapp="EN"db-id="texz0f50svs2rkedstoxwtzjtzrp5rd9edsx"timestamp="1616334912">111</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Neuendorf,Rachel</author><author>Harding,Aubrey</author><author>Stello,Noelle</author><author>Hanes,Douglas</author><author>Wahbeh,Helane</author></authors></contributors><titles><title>DepressionandanxietyinpatientswithInflammatoryBowelDisease:Asystematicreview</title><secondary-title>JournalofPsychosomaticResearch</secondary-title></titles><periodical><full-title>JournalofPsychosomaticResearch</full-title></periodical><pages>70-80</pages><volume>87</volume><dates><year>2016</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0022-3999</isbn><accession-num>WOS:000380297300010</accession-num><urls><related-urls><url><GotoISI>://WOS:000380297300010</url></related-urls></urls><electronic-resource-num>10.1016/j.jpsychores.2016.06.001</electronic-resource-num></record></Cite></EndNote>[35]，因為即使疾病處于緩解期，患者仍然會對未來疾病是否會復(fù)發(fā)而產(chǎn)生擔(dān)憂。Geiss等人又比較了CD與UC兩組疾病之間的抑郁風(fēng)險水平，研究發(fā)現(xiàn)CD患者重度抑郁的患病率明顯高于UC患者，然而輕度抑郁則在UC患者群體中更為常見ADDINEN.CITE<EndNote><Cite><Author>Geiss</Author><Year>2018</Year><RecNum>114</RecNum><DisplayText><styleface="superscript">[38]</style></DisplayText><record><rec-number>114</rec-number><foreign-keys><keyapp="EN"db-id="texz0f50svs2rkedstoxwtzjtzrp5rd9edsx"timestamp="1616335158">114</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Geiss,Thomas</author><author>Schaefert,RainerM.</author><author>Berens,Sabrina</author><author>Hoffmann,Peter</author><author>Gauss,Annika</author></authors></contributors><titles><title>Riskofdepressioninpatientswithinflammatoryboweldisease</title><secondary-title>JournalofDigestiveDiseases</secondary-title></titles><periodical><full-title>JournalofDigestiveDiseases</full-title></periodical><pages>456-467</pages><volume>19</volume><number>8</number><dates><year>2018</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1751-2972</isbn><accession-num>WOS:000445188000002</accession-num><urls><related-urls><url><GotoISI>://WOS:000445188000002</url></related-urls></urls><electronic-resource-num>10.1111/1751-2980.12644</electronic-resource-num></record></Cite></EndNote>[38]，這種區(qū)別可能與CD是較UC更加偏向于系統(tǒng)性疾病，并且腸外表現(xiàn)較UC更為普遍相關(guān)。合并有其他癥狀或并發(fā)癥的患者，更容易出現(xiàn)精神心理問題ADDINEN.CITE<EndNote><Cite><Author>Ng</Author><Year>2018</Year><RecNum>115</RecNum><DisplayText><styleface="superscript">[39]</style></DisplayText><record><rec-number>115</rec-number><foreign-keys><keyapp="EN"db-id="texz0f50svs2rkedstoxwtzjtzrp5rd9edsx"timestamp="1616335217">115</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Ng,JeremyYongwen</author><author>Chauhan,Usha</author><author>Armstrong,David</author><author>Marshall,John</author><author>Tse,Frances</author><author>Moayyedi,Paul</author><author>Reinisch,Walter</author><author>Halder,Smita</author></authors></contributors><titles><title>AComparisonofthePrevalenceofAnxietyandDepressionBetweenUncomplicatedandComplexIBDPatientGroups</title><secondary-title>GastroenterologyNursing</secondary-title></titles><periodical><full-title>GastroenterologyNursing</full-title></periodical><pages>427-435</pages><volume>41</volume><number>5</number><dates><year>2018</year><pub-dates><date>Sep-Oct</date></pub-dates></dates><isbn>1042-895X</isbn><accession-num>WOS:000450882200008</accession-num><urls><related-urls><url><GotoISI>://WOS:000450882200008</url></related-urls></urls><electronic-resource-num>10.1097/sga.0000000000000338</electronic-resource-num></record></Cite></EndNote>[39]。另外，IBD的病程也會對精神心理產(chǎn)生影響，即疾病持續(xù)時間越久，與精神心理健康相關(guān)的量表的評分越高，代表患者出現(xiàn)情緒異常ADDINEN.CITE<EndNote><Cite><Author>許芳</Author><Year>2017</Year><RecNum>117</RecNum><DisplayText><styleface="superscript">[40]</style></DisplayText><record><rec-number>117</rec-number><foreign-keys><keyapp="EN"db-id="texz0f50svs2rkedstoxwtzjtzrp5rd9edsx"timestamp="1616335293">117</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>許芳</author><author>吳海珍</author></authors><translated-authors><author>Xu,Fang</author><author>Wu,Haizhen</author></translated-authors></contributors><auth-address>214002,無錫市第二人民醫(yī)院消化內(nèi)科</auth-address><titles><title>炎癥性腸病患者心理健康狀況及其影響因素分析</title><secondary-title>中華現(xiàn)代護(hù)理雜志</secondary-title></titles><periodical><full-title>中華現(xiàn)代護(hù)理雜志</full-title></periodical><pages>3881-3885</pages><volume>23</volume><number>30</number><keywords><keyword>心理</keyword><keyword>炎癥性腸病</keyword><keyword>影響因素</keyword></keywords><dates><year>2017</year></dates><isbn>1674-2907</isbn><urls><related-urls><url>/details/detail.do?_type=perio&id=xdhl201730016</url></related-urls></urls><electronic-resource-num>10.3760/cma.j.issn.1674-2907.2017.30.015</electronic-resource-num><remote-database-provider>北京萬方數(shù)據(jù)股份有限公司</remote-database-provider><language>chi</language></record></Cite></EndNote>[40]。IBD常用的治療藥物主要包括5-氨基水楊酸制劑、激素以及新型生物制劑等，研究顯示，使用激素治療的患者更容易出現(xiàn)焦慮，但與抑郁沒有明顯的相關(guān)性，此外，相對于激素來說，使用生物制劑則更容易避免焦慮的發(fā)生ADDINEN.CITEADDINEN.CITE.DATA[36,37]。焦慮與抑郁可能是因IBD的治療需要長期應(yīng)用藥物維持而產(chǎn)生的不良反應(yīng)，也可能與患者對藥物本身的不良反應(yīng)所產(chǎn)生的擔(dān)憂以及恐懼有關(guān)。除上述因素外，患者的年齡、受教育水平、經(jīng)濟(jì)能力、社會支持、心理壓力以及對手術(shù)的擔(dān)憂等也會加重焦慮情緒ADDINEN.CITE<EndNote><Cite><Author>Bannaga</Author><Year>2015</Year><RecNum>122</RecNum><DisplayText><styleface="superscript">[41]</style></DisplayText><record><rec-number>122</rec-number><foreign-keys><keyapp="EN"db-id="texz0f50svs2rkedstoxwtzjtzrp5rd9edsx"timestamp="1616335404">122</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Bannaga,AymanS.</author><author>Selinger,ChristianP.</author></authors></contributors><titles><title>Inflammatoryboweldiseaseandanxiety:links,risks,andchallengesfaced</title><secondary-title>ClinicalandExperimentalGastroenterology</secondary-title></titles><periodical><full-title>ClinicalandExperimentalGastroenterology</full-title></periodical><pages>111-117</pages><volume>8</volume><dates><year>2015</year><pub-dates><date>2015</date></pub-dates></dates><isbn>1178-7023</isbn><accession-num>WOS:000214016300011</accession-num><urls><related-urls><url><GotoISI>://WOS:000214016300011</url></related-urls></urls><electronic-resource-num>10.2147/ceg.S57982</electronic-resource-num></record></Cite></EndNote>[41]。綜上所述，分析IBD患者易患焦慮與抑郁的原因主要為以下幾個方面：首先，IBD的病程較長，并且反復(fù)發(fā)作，頻繁的腹瀉會影響患者的正常生活；其次，為了治療和維持疾病的緩解，患者需要多次就醫(yī)，并且需要長期應(yīng)用藥物，頻繁的就診以及因檢查與治療而產(chǎn)生的高額醫(yī)療支出會導(dǎo)致患者的生活壓力上升，心理壓力也隨之增大；另外，患者經(jīng)常會擔(dān)心疾病的復(fù)發(fā)或擔(dān)憂是否需要進(jìn)行手術(shù)，長期的恐懼與壓力也會對情緒調(diào)節(jié)造成負(fù)面影響；最后，疾病的活動會對學(xué)習(xí)、工作甚至家庭以及社會關(guān)系產(chǎn)生影響，經(jīng)濟(jì)來源改變以及社會功能受損都會對患者產(chǎn)生打擊，長此以往，或者容易形成消極的心態(tài)，進(jìn)而加重焦慮與抑郁。焦慮與抑郁對IBD患者的影響焦慮與抑郁情緒會對機(jī)體的免疫調(diào)節(jié)能力帶來不利影響，導(dǎo)致IBD患者的病情加重ADDINEN.CITEADDINEN.CITE.DATA[42,43]，這也可能是應(yīng)用常規(guī)治療藥物并不能達(dá)到滿意治療效果的原因之一。Navabi等人研究發(fā)現(xiàn)，患有焦慮癥與抑郁癥的IBD患者不僅臨床癥狀會更加嚴(yán)重，也傾向于出現(xiàn)更多與疾病相關(guān)的并發(fā)癥，并且更容易出現(xiàn)腸道外表現(xiàn)，也較普通IBD患者增加使用激素以及生物制劑類藥物治療的幾率ADDINEN.CITE<EndNote><Cite><Author>Navabi</Author><Year>2018</Year><RecNum>125</RecNum><DisplayText><styleface="superscript">[44]</style></DisplayText><record><rec-number>125</rec-number><foreign-keys><keyapp="EN"db-id="texz0f50svs2rkedstoxwtzjtzrp5rd9edsx"timestamp="1617818077">125</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Navabi,Seyedehsan</author><author>Gorrepati,VenkataSubhash</author><author>Yadav,Sanjay</author><author>Chintanaboina,Jaykrishna</author><author>Maher,Sarah</author><author>Demuth,Peter</author><author>Stern,Benjamin</author><author>Stuart,August</author><author>Tinsley,Andrew</author><author>Clarke,Kofi</author><author>Williams,EmmanuelleD.</author><author>Coates,MatthewD.</author></authors></contributors><titles><title>InfluencesandImpactofAnxietyandDepressionintheSettingofInflammatoryBowelDisease</title><secondary-title>InflammatoryBowelDiseases</secondary-title></titles><periodical><full-title>InflammatoryBowelDiseases</full-title></periodical><pages>2303-2308</pages><volume>24</volume><number>11</number><dates><year>2018</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1078-0998</isbn><accession-num>WOS:000449192800002</accession-num><urls><related-urls><url><GotoISI>://WOS:000449192800002</url></related-urls></urls><electronic-resource-num>10.1093/ibd/izy143</electronic-resource-num></record></Cite></EndNote>[44]。焦慮、抑郁情緒也與IBD的復(fù)發(fā)存在顯著關(guān)聯(lián)，研究表明，患有抑郁癥的IBD患者處于緩解期的時間縮短，疾病更容易復(fù)發(fā)ADDINEN.CITE<EndNote><Cite><Author>Mikocka-Walus</Author><Year>2016</Year><RecNum>127</RecNum><DisplayText><styleface="superscript">[45]</style></DisplayText><record><rec-number>127</rec-number><foreign-keys><keyapp="EN"db-id="texz0f50svs2rkedstoxwtzjtzrp5rd9edsx"timestamp="1617818096">127</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Mikocka-Walus,Antonina</author><author>Pittet,Valerie</author><author>Rossel,Jean-Benoit</author><author>vonKanel,Roland</author><author>Swiss,I.B.D.CohortStudyGrp</author></authors></contributors><titles><title>SymptomsofDepressionandAnxietyAreIndependentlyAssociatedWithClinicalRecurrenceofInflammatoryBowelDisease</title><secondary-title>ClinicalGastroenterologyandHepatology</secondary-title></titles><periodical><full-title>ClinicalGastroenterologyandHepatology</full-title></periodical><pages>829-+</pages><volume>14</volume><number>6</number><dates><year>2016</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1542-3565</isbn><accession-num>WOS:000376456400015</accession-num><urls><related-urls><url><GotoISI>://WOS:000376456400015</url></related-urls></urls><electronic-resource-num>10.1016/j.cgh.2015.12.045</electronic-resource-num></record></Cite></EndNote>[45]，這可能與患者出現(xiàn)精神心理問題后，對治療的依從性減低有關(guān)ADDINEN.CITE<EndNote><Cite><Author>Nahon</Author><Year>2012</Year><RecNum>112</RecNum><DisplayText><styleface="superscript">[36]</style></DisplayText><record><rec-number>112</rec-number><foreign-keys><keyapp="EN"db-id="texz0f50svs2rkedstoxwtzjtzrp5rd9edsx"timestamp="1616334987">112</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Nahon,Stephane</author><author>Lahmek,Pierre</author><author>Durance,Christelle</author><author>Olympie,Alain</author><author>Lesgourgues,Bruno</author><author>Colombel,Jean-Frederic</author><author>Gendre,Jean-Pierre</author></authors></contributors><titles><title>Riskfactorsofanxietyanddepressionininflammatoryboweldisease</title><secondary-title>InflammatoryBowelDiseases</secondary-title></titles><periodical><full-title>InflammatoryBowelDiseases</full-title></periodical><pages>2086-2091</pages><volume>18</volume><number>11</number><dates><year>2012</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1078-0998</isbn><accession-num>WOS:000310252500012</accession-num><urls><related-urls><url><GotoISI>://WOS:000310252500012</url></related-urls></urls><electronic-resource-num>10.1002/ibd.22888</electronic-resource-num></record></Cite></EndNote>[36]，由于不能按照醫(yī)囑進(jìn)行規(guī)范治療，疾病不能得到有效控制，另外，患者的情緒也會隨著疾病活動而產(chǎn)生波動，導(dǎo)致疾病的進(jìn)一步發(fā)展與加重。不僅如此，有學(xué)者也認(rèn)為精神心理因素可以預(yù)測IBD患者疾病的走勢，正如一項大型前瞻性研究的結(jié)果顯示，目前處于抑郁狀態(tài)的IBD患者，在未來出病情惡化的風(fēng)險顯著增加，并且增加了治療藥物升級以及住院、手術(shù)的概率ADDINEN.CITE<EndNote><Cite><Author>Kochar</Author><Year>2018</Year><RecNum>128</RecNum><DisplayText><styleface="superscript">[46]</style></DisplayText><record><rec-number>128</rec-number><foreign-keys><keyapp="EN"db-id="texz0f50svs2rkedstoxwtzjtzrp5rd9edsx"timestamp="1617818147">128</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Kochar,Bharati</author><author>Barnes,EdwardL.</author><author>Long,MillieD.</author><author>Cushing,KellyC.</author><author>Galanko,Joseph</author><author>Martin,ChristopherF.</author><author>Raffals,LauraE.</author><author>Sandler,RobertS.</author></authors></contributors><titles><title>DepressionIsAssociatedWithMoreAggressiveInflammatoryBowelDisease</title><secondary-title>AmericanJournalofGastroenterology</secondary-title></titles><periodical><full-title>AmericanJournalofGastroenterology</full-title><abbr-1>Am.J.Gastroenterol.</abbr-1></periodical><pages>80-85</pages><volume>113</volume><number>1</number><dates><year>2018</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0002-9270</isbn><accession-num>WOS:000423762500017</accession-num><urls><related-urls><url><GotoISI>://WOS:000423762500017</url></related-urls></urls><electronic-resource-num>10.1038/ajg.2017.423</electronic-resource-num></record></Cite></EndNote>[46]，另外一項前瞻性研究雖然也提示抑郁水平較高的CD患者在一年后出現(xiàn)癥狀加重與住院率提高等情況，但卻沒有發(fā)現(xiàn)治療藥物升階以及手術(shù)的概率與抑郁水平較低的患者之間的差異ADDINEN.CITE<EndNote><Cite><Author>Gaines</Author><Year>2016</Year><RecNum>129</RecNum><DisplayText><styleface="superscript">[47]</style></DisplayText><record><rec-number>129</rec-number><foreign-keys><keyapp="EN"db-id="texz0f50svs2rkedstoxwtzjtzrp5rd9edsx"timestamp="1617818416">129</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Gaines,LawrenceS.</author><author>Slaughter,JamesC.</author><author>Horst,SaraN.</author><author>Schwartz,DavidA.</author><author>Beaulieu,DawnB.</author><author>Haman,KirstenL.</author><author>Wang,Li</author><author>Martin,ChristopherF.</author><author>Long,MillieD.</author><author>Sandler,RobertS.</author><author>Kappelman,MichaelD.</author></authors></contributors><titles><title>AssociationBetweenAffective-CognitiveSymptomsofDepressionandExacerbationofCrohn'sDisease</title><secondary-title>AmericanJournalofGastroenterology</secondary-title></titles><periodical><full-title>AmericanJournalofGastroenterology</full-title><abbr-1>Am.J.Gastroenterol.</abbr-1></periodical><pages>864-870</pages><volume>111</volume><number>6</number><dates><year>2016</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0002-9270</isbn><accession-num>WOS:000382006300025</accession-num><urls><related-urls><url><GotoISI>://WOS:000382006300025</url></related-urls></urls><electronic-resource-num>10.1038/ajg.2016.98</electronic-resource-num></record></Cite></EndNote>[47]。焦慮與抑郁也使IBD患者無法保證自身的生活質(zhì)量。患者的生存質(zhì)量評分在癥狀、情感、社交等各方面均較普通人群顯著下降，生活質(zhì)量也更低ADDINEN.CITEADDINEN.CITE.DATA[48]。陳凌華等人通過調(diào)查還發(fā)現(xiàn)，IBD患者的生存質(zhì)量評分雖然下降，但下降的程度存在差異，該差異表現(xiàn)為與情感以及社會功能相關(guān)的方面，與焦慮、抑郁的聯(lián)系更加明顯ADDINEN.CITEADDINEN.CITE.DATA[43]。情緒的異常會加重病情，增加患者前往醫(yī)院就診或者住院的頻率，導(dǎo)致正常的工作、學(xué)習(xí)以及生活規(guī)律被打亂，并且患者頻繁的腹瀉以及排氣的增加，導(dǎo)致IBD患者不得不避免參加附近沒有衛(wèi)生間或者不方便如廁的社交活動，因此，與家人、朋友間的交流減少，患者也因此缺乏被尊重感，不被理解與支持。上述原因?qū)е翴BD患者不能很好地參與社會活動，進(jìn)行情感交流。另外，伴隨情緒異常的IBD患者更傾向于選擇不良的生活方式，比如吸煙等ADDINEN.CITE<EndNote><Cite><Author>Navabi</Author><Year>2018</Year><RecNum>125</RecNum><DisplayText><styleface="superscript">[44]</style></DisplayText><record><rec-number>125</rec-number><foreign-keys><keyapp="EN"db-id="texz0f50svs2rkedstoxwtzjtzrp5rd9edsx"timestamp="1617818077">125</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Navabi,Seyedehsan</author><author>Gorrepati,VenkataSubhash</author><author>Yadav,Sanjay</author><author>Chintanaboina,Jaykrishna</author><author>Maher,Sarah</author><author>Demuth,Peter</author><author>Stern,Benjamin</author><author>Stuart,August</author><author>Tinsley,Andrew</author><author>Clarke,Kofi</author><author>Williams,EmmanuelleD.</author><author>Coates,MatthewD.</author></authors></contributors><titles><title>InfluencesandImpactofAnxietyandDepressionintheSettingofInflammatoryBowelDisease</title><secondary-title>InflammatoryBowelDiseases</secondary-title></titles><periodical><full-title>InflammatoryBowelDiseases</full-title></periodical><pages>2303-2308</pages><volume>24</volume><number>11</number><dates><year>2018</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1078-0998</isbn><accession-num>WOS:000449192800002</accession-num><urls><related-urls><url><GotoISI>://WOS:000449192800002</url></related-urls></urls><electronic-resource-num>10.1093/ibd/izy143</electronic-resource-num></record></Cite></EndNote>[44]，此種現(xiàn)象不僅促使病情進(jìn)展，也更進(jìn)一步導(dǎo)致生活質(zhì)量的降低。根據(jù)以上研究結(jié)果進(jìn)行綜合分析，焦慮與抑郁之所以會對IBD產(chǎn)生影響，主要與以下原因有關(guān)：首先，不良的情緒會使IBD患者的腸道與全身癥狀被放大，出現(xiàn)并發(fā)癥以及腸外表現(xiàn)的可能性增加，病情穩(wěn)定的維持時間縮短，增加了住院以及手術(shù)的風(fēng)險，治療藥物的升級以及隨之而產(chǎn)生的高額的醫(yī)療費用，增加了患者的經(jīng)濟(jì)壓力；其次，焦慮與抑郁會使情緒調(diào)節(jié)能力進(jìn)一步下降，心理問題長期存在會嚴(yán)重影響到IBD的治療與緩解；最后，因情緒所致的疾病活動，導(dǎo)致患者社會活動以及情感交流明顯減少，社交能力的降低也會使IBD患者的生活質(zhì)量下降?？偨Y(jié)對于精神心理因素與IBD的探索，讓我們更加深刻地認(rèn)識到對IBD的治療不能僅僅只關(guān)注于患者的軀體癥狀，也應(yīng)該同時重視對患者的心理疏導(dǎo)以及幫助患者提高生活質(zhì)量，并且IBD患者的情緒障礙不只存在于疾病的活動期，對于緩解參考文獻(xiàn)：甄建華,黃光瑞.潰瘍性結(jié)腸炎病因和發(fā)病機(jī)制的現(xiàn)代醫(yī)學(xué)研究進(jìn)展[J].世界華人消化雜志,2019,27(04):245-251.[2] 吳開春,梁潔,冉志華,等.炎癥性腸病診斷與治療的共識意見(2018年·北京)[J].中國實用內(nèi)科雜志,2018,38(09):796-813.[3] CarabottiM,SciroccoA,MaselliMA,etal.Thegut-brainaxis:interactionsbetweenentericmicrobiota,centralandentericnervoussystems[J].AnnalsofGastroenterology,2015,28(2):203-209.[4] AlOmranY,AzizQ.TheBrain-GutAxisinHealthandDisease[M]//LYTEM,CRYANJF.MicrobialEndocrinology:TheMicrobiota-Gut-BrainAxisinHealthandDisease.2014:135-153.[5] MenonV,UddinLQ.Saliency,switching,attentionandcontrol:anetworkmodelofinsulafunction[J].BrainStructure&Function,2010,214(5-6):655-667.[6] AmftM,BzdokD,LairdAR,etal.Definitionandcharacterizationofanextendedsocial-affectivedefaultnetwork[J].BrainStructure&Function,2015,220(2):1031-1049.[7] VeinanteP,YalcinI,BarrotM.Theamygdalabetweensensationandaffect:aroleinpain[J].Journalofmolecularpsychiatry,2013,1(1):9-9.[8] BlanksteinU,C