中国临床康复
中國臨床康複
중국림상강복
CHINESE JOURNAL OF CLINICAL REHABILITATION
2006年
6期
162-164
,共3页
陈跃%黄继宗%章巧云%周飞雪%乔晓芝%强裕%郭国侠
陳躍%黃繼宗%章巧雲%週飛雪%喬曉芝%彊裕%郭國俠
진약%황계종%장교운%주비설%교효지%강유%곽국협
应激,心理学%监测,免疫学%硬化病,成人
應激,心理學%鑑測,免疫學%硬化病,成人
응격,심이학%감측,면역학%경화병,성인
背景:系统性硬化病的确切机制尚不清楚,临床发现该病发病前往往有形式不同的心理应激因素存在.目的:对系统性硬化病患者进行深入的心理社会因素调查,对比中国常.模和对照组,结合临床免疫学检测,初步分析心理应激因素所起的作用.设计:对照观察.单位:浙江大学医学院第一医院城站院区老年病科和杭州同济医院外科对象:选择2002-12/2005-09在浙江大学医学院第一医院城站院区内科病区接受胸导管淋巴液引流疗法治疗的系统性硬化病住院患者26例为观察对象(系统性硬化病组).对照组来自同病区同时期的慢性胃炎住院患者30例.方法:所有参加者均填写一般情况调查表.内容包括:年龄、性别、主要症状、病程、特殊检查、诊断和药物治疗.采用心理社会量表评定心理社会因素.采用生活事件量表测评生活事件应激,包括职业、学习、婚姻和恋爱、家庭和子女、经济、司法、人际关系等方面常见的生活事件;采用简易应对方式问卷评定应对方式,分为8个主成分:对抗、淡化、自控、求助、自责、逃避、计划和再评,将习惯性应对方式分为消极和积极两类.采用艾森克个性问卷评定人格特征,4个分量表组成,为外向-内向量表、神经质量表、精神质量表和掩饰、假托量表.同时取患者空腹血3 mL采用免疫比浊法测定血清lgG、lgA、lgM和补体C3.并对lgG与其他因素进行相关分析.主要观察指标:心理社会量表评定结果及临床免疫学检测结果.结果:56例患者均完成量表测评和免疫学检测,全部进入结果分析.系统性硬化病组患者生活事件量表评定中,生活事件发生的总件数、负性事件数和负性事件LEU值均显著大于对照组.应对方式中,积极应对维度少于对照组,消极应对维度多于对照组.艾森克个性问卷评定中,无论男女外向-内向因子分均小于对照组及常模组,神经质分均大于对照组及常模组.体液免疫测定,lgG、lgA和lgM均大于对照组,两组C3水平比较差异无显著性.IgG与负性事件数、消极应对维度、艾森克个性问卷中外向-内向因子分呈负相关.结论:系统性硬化病患者存在明显的心理应激、消极的应对方式和情绪不稳定,存在着体液免疫功能异常.心理社会因素对免疫学有影响,提示心理应激与系统性硬化病发病有密切联系.
揹景:繫統性硬化病的確切機製尚不清楚,臨床髮現該病髮病前往往有形式不同的心理應激因素存在.目的:對繫統性硬化病患者進行深入的心理社會因素調查,對比中國常.模和對照組,結閤臨床免疫學檢測,初步分析心理應激因素所起的作用.設計:對照觀察.單位:浙江大學醫學院第一醫院城站院區老年病科和杭州同濟醫院外科對象:選擇2002-12/2005-09在浙江大學醫學院第一醫院城站院區內科病區接受胸導管淋巴液引流療法治療的繫統性硬化病住院患者26例為觀察對象(繫統性硬化病組).對照組來自同病區同時期的慢性胃炎住院患者30例.方法:所有參加者均填寫一般情況調查錶.內容包括:年齡、性彆、主要癥狀、病程、特殊檢查、診斷和藥物治療.採用心理社會量錶評定心理社會因素.採用生活事件量錶測評生活事件應激,包括職業、學習、婚姻和戀愛、傢庭和子女、經濟、司法、人際關繫等方麵常見的生活事件;採用簡易應對方式問捲評定應對方式,分為8箇主成分:對抗、淡化、自控、求助、自責、逃避、計劃和再評,將習慣性應對方式分為消極和積極兩類.採用艾森剋箇性問捲評定人格特徵,4箇分量錶組成,為外嚮-內嚮量錶、神經質量錶、精神質量錶和掩飾、假託量錶.同時取患者空腹血3 mL採用免疫比濁法測定血清lgG、lgA、lgM和補體C3.併對lgG與其他因素進行相關分析.主要觀察指標:心理社會量錶評定結果及臨床免疫學檢測結果.結果:56例患者均完成量錶測評和免疫學檢測,全部進入結果分析.繫統性硬化病組患者生活事件量錶評定中,生活事件髮生的總件數、負性事件數和負性事件LEU值均顯著大于對照組.應對方式中,積極應對維度少于對照組,消極應對維度多于對照組.艾森剋箇性問捲評定中,無論男女外嚮-內嚮因子分均小于對照組及常模組,神經質分均大于對照組及常模組.體液免疫測定,lgG、lgA和lgM均大于對照組,兩組C3水平比較差異無顯著性.IgG與負性事件數、消極應對維度、艾森剋箇性問捲中外嚮-內嚮因子分呈負相關.結論:繫統性硬化病患者存在明顯的心理應激、消極的應對方式和情緒不穩定,存在著體液免疫功能異常.心理社會因素對免疫學有影響,提示心理應激與繫統性硬化病髮病有密切聯繫.
배경:계통성경화병적학절궤제상불청초,림상발현해병발병전왕왕유형식불동적심리응격인소존재.목적:대계통성경화병환자진행심입적심리사회인소조사,대비중국상.모화대조조,결합림상면역학검측,초보분석심리응격인소소기적작용.설계:대조관찰.단위:절강대학의학원제일의원성참원구노년병과화항주동제의원외과대상:선택2002-12/2005-09재절강대학의학원제일의원성참원구내과병구접수흉도관림파액인류요법치료적계통성경화병주원환자26례위관찰대상(계통성경화병조).대조조래자동병구동시기적만성위염주원환자30례.방법:소유삼가자균전사일반정황조사표.내용포괄:년령、성별、주요증상、병정、특수검사、진단화약물치료.채용심리사회량표평정심리사회인소.채용생활사건량표측평생활사건응격,포괄직업、학습、혼인화연애、가정화자녀、경제、사법、인제관계등방면상견적생활사건;채용간역응대방식문권평정응대방식,분위8개주성분:대항、담화、자공、구조、자책、도피、계화화재평,장습관성응대방식분위소겁화적겁량류.채용애삼극개성문권평정인격특정,4개분량표조성,위외향-내향량표、신경질량표、정신질량표화엄식、가탁량표.동시취환자공복혈3 mL채용면역비탁법측정혈청lgG、lgA、lgM화보체C3.병대lgG여기타인소진행상관분석.주요관찰지표:심리사회량표평정결과급림상면역학검측결과.결과:56례환자균완성량표측평화면역학검측,전부진입결과분석.계통성경화병조환자생활사건량표평정중,생활사건발생적총건수、부성사건수화부성사건LEU치균현저대우대조조.응대방식중,적겁응대유도소우대조조,소겁응대유도다우대조조.애삼극개성문권평정중,무론남녀외향-내향인자분균소우대조조급상모조,신경질분균대우대조조급상모조.체액면역측정,lgG、lgA화lgM균대우대조조,량조C3수평비교차이무현저성.IgG여부성사건수、소겁응대유도、애삼극개성문권중외향-내향인자분정부상관.결론:계통성경화병환자존재명현적심리응격、소겁적응대방식화정서불은정,존재착체액면역공능이상.심리사회인소대면역학유영향,제시심리응격여계통성경화병발병유밀절련계.
BACKGROUND: The real mechanism of systemic sclerosis is still not clear, it is found clinically that there are psychological stress factors of different forms before the attack.OBJECTIVE: To deeply investigate the psychosocial factors in patients with systemic sclerosis, and primarily analyze the role of psychological stress factors by comparing with national norms and controls as well as combining with clinical immunological test.DESIGN: A controlled observation.SETTING: The experiments were carried out in the Department of Geriatrics, the First Hospital Affiliated to Medical College, Zhejiang University and the Department of Surgery, Hangzhou Tongji Hospital.PARTICIPANTS: Between December 2002 and September 2005. 26 patients with systemic sclerosis (systemic sclerosis group), who received thoracic duct lymph drainage therapy, and 30 inpatients with chronic gastritis(control group) were selected from the same disease area of the Department of Internal Medicine, the First Hospital of Medical College, Zhejiang University.METHODS: All the patients filled the general information inventory, the contents included were age, gender, main symptoms, disease course, special examination, diagnosis and drug therapy. The psychosocial scale was used to evaluate the psychosocial factors. Life event scale (LES) was used to assess the life events stress, including profession, learning, marriage and love, family and child, economics, justice, interpersonal relationship and other common life events. The simplified coping style questionnaire (SCSQ)was applied to assess the coping styles, including 8 main components: confrontation, indifference, self-control, seeking help, self-blame, escape, planning and reassessment, and then the habitual coping styles were divided into negative ones and positive ones. The Eysenck personality questionnaire (EPQ) was used to evaluate the personality characters, it consisted of4 subscales: extraversion-introversion scale, neuroticism scale, psychoticism scale, lie and cover up scale. The fasting blood samples (3 mL) were drawn from the patients to detect serum levels of immunoglobulin G (IgG), immunoglobulin A (IgA) immunoglobulin M (IgM) and complement C3 with immunoturbidimetry, and the correlations between IgG and other factors were analyzed.MAIN OUTCOME MEASURES: The evaluative results of psychosocial scale and results of clinical immunological detection were mainly observed.RESULTS: All the 56 patients finished the scale survey and immunological detection, and all were involved in the analysis of results. The total number of life events, number of negative events and LEU value of negative events in LES were all significantly greater in the systemic sclerosis group than in the control group. For the coping style, the dimension of positive coping was less but that of negative coping was more in the systemic sclerosis group than in the control group. For EPQ, the scores of extraversion-introversion were lower but the scores of neuroticism in both males and females in the systemic sclerosis group were higher than in the control group and norms. For the immunological detection, the levels of lgG, lgA and lgM were all higher in the systemic sclerosis group than in the control group, but C3 level had insignificant difference between the two groups.IgG had negative correlations with the number of negative events, dimension of negative coping and the score of extraversion-introversion in EPQ.CONCLUSION: Patients with systemic sclerosis have obvious psychological stress, negative coping style, unstable mood and abnormal humoral immune function. Psychosocial stress has influence on immunology, it is indicated that psychological stress is closely correlated with the attack of systemic sclerosis.
