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人们普遍认为，免疫失调在抑郁的发生过程中起着一定作用。大鼠实验也证实了，几种抗抑郁药物能够调节免疫、发挥抗炎作用，改善抑郁和非抑郁大鼠结肠的宏观和病理学组织损伤。 而在抗抑郁药对IBD患者影响的研究中，虽然得到了积极结果，但是大多数文献都更愿意把原因归结为心理共病管理、睡眠质量改善、炎症水平降低等因素。 在一项包含轻微IBD患者和肠易激综合征患者的研究中，59%的IBD患者和46%的肠易激综合征患者都通过抗抑郁药物治疗获得了中度改善[15]；为期2年的纵向研究也显示，服用抗抑郁药物的IBD患者治疗药物升级、住院和肠切除手术的比例低于未服用抗抑郁药物的患者，但是在调整混杂因素之后，两组患者的差异在统计学上不显著[16]。 IBD药物对患者抑郁和焦虑影响的研究较少，而且大部分获益似乎来自于对全身炎症的抑制。 确实有研究发现，活动性IBD患者接受抗肿瘤坏死因子治疗后，抑郁和焦虑症状均有所减轻[17]；但是同时也有研究证明，重度抑郁症患者接受抗肿瘤坏死因子治疗之后，与接受安慰剂治疗的患者抑郁评分没有差异，但是如果按照炎症标志物分层分析，基线C反应蛋白为5mg/L的患者接受抗肿瘤坏死因子治疗可以降低抑郁评分[18]。 总体来说，虽然大家已经认识到抑郁、焦虑是IBD的常见共病，但却一直缺乏大型、高质量、前瞻性、以人群为基础的队列研究来阐明两类疾病之间的实际联系。 以目前来看，在动物模型中诱导结肠炎后出现抑郁表型，以及诱导抑郁后发生结肠炎，这些强调了疾病之间可能存在着双向关联。在未来的研究中，我们要尽可能客观地记录患者的精神变化、精神恢复能力以及IBD的疾病进展，以期为患者提供更有效的治疗方案和干预措施。 参考文献： [1] Bisgaard, T.H., Allin, K.H., Keefer, L. et al. Depression and anxiety in inflammatory bowel disease: epidemiology, mechanisms and treatment. Nat Rev Gastroenterol Hepatol (2022). https:///10.1038/s41575-022-00634-6 [2] Barberio B, Zamani M, Black CJ, Savarino EV, Ford AC. Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(5):359-370. doi:10.1016/S2468-1253(21)00014-5 [3] Ananthakrishnan AN, Khalili H, Pan A, et al. Association between depressive symptoms and incidence of Crohn's disease and ulcerative colitis: results from the Nurses' Health Study. Clin Gastroenterol Hepatol. 2013;11(1):57-62. doi:10.1016/j.cgh.2012.08.032 [4] Blackwell J, Saxena S, Petersen I, et al. Depression in individuals who subsequently develop inflammatory bowel disease: a population-based nested case-control study. Gut. 2021;70(9):1642-1648. doi:10.1136/gutjnl-2020-322308 [5] Bernstein CN, Hitchon CA, Walld R, et al. Increased Burden of Psychiatric Disorders in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2019;25(2):360-368. doi:10.1093/ibd/izy235） [6] Fairbrass KM, Lovatt J, Barberio B, et alBidirectional brain–gut axis effects influence mood and prognosis in IBD: a systematic review and meta-analysisGut Published Online First: 01 November 2021. doi: 10.1136/gutjnl-2021-325985 [7] Levenstein S, Prantera C, Varvo V, et al. Psychological stress and disease activity in ulcerative colitis: a multidimensional cross-sectional study. Am J Gastroenterol. 1994;89(8):1219-1225. [8] Zonis S, Pechnick RN, Ljubimov VA, et al. Chronic intestinal inflammation alters hippocampal neurogenesis. J Neuroinflammation. 2015;12:65. Published 2015 Apr 3. doi:10.1186/s12974-015-0281-0 [9] Bonaz BL, Bernstein CN. Brain-gut interactions in inflammatory bowel disease. Gastroenterology. 2013;144(1):36-49. doi:10.1053/j.gastro.2012.10.003 [10] Emge J R, Huynh K, Miller E N, et al. Modulation of the microbiota-gut-brain axis by probiotics in a murine model of inflammatory bowel disease[J]. American Journal of Physiology-Gastrointestinal and Liver Physiology, 2016, 310(11): G989-G998. [11] Li N, Wang Q, Wang Y, et al. Fecal microbiota transplantation from chronic unpredictable mild stress mice donors affects anxiety-like and depression-like behavior in recipient mice via the gut microbiota-inflammation-brain axis. Stress. 2019;22(5):592-602. doi:10.1080/10253890.2019.1617267 [12] Agostini A, Filippini N, Cevolani D, et al. Brain functional changes in patients with ulcerative colitis: a functional magnetic resonance imaging study on emotional processing. Inflamm Bowel Dis. 2011;17(8):1769-1777. doi:10.1002/ibd.21549 [13] Agostini A, Benuzzi F, Filippini N, et al. New insights into the brain involvement in patients with Crohn's disease: a voxel-based morphometry study. Neurogastroenterol Motil. 2013;25(2):147-e82. doi:10.1111/nmo.12017 [14] Kilinçarslan S, Evrensel A. The effect of fecal microbiota transplantation on psychiatric symptoms among patients with inflammatory bowel disease: an experimental study. Actas Esp Psiquiatr. 2020;48(1):1-7. [15] Iskandar HN, Cassell B, Kanuri N, et al. Tricyclic antidepressants for management of residual symptoms in inflammatory bowel disease. J Clin Gastroenterol. 2014;48(5):423-429. doi:10.1097/MCG.0000000000000049 [16] Hall BJ, Hamlin PJ, Gracie DJ, Ford AC. The Effect of Antidepressants on the Course of Inflammatory Bowel Disease. Can J Gastroenterol Hepatol. 2018;2018:2047242. Published 2018 Sep 9. doi:10.1155/2018/2047242 [17] Zhang M, Zhang T, Hong L, et al. Improvement of psychological status after infliximab treatment in patients with newly diagnosed Crohn's disease. Patient Prefer Adherence. 2018;12:879-885. Published 2018 May 21. doi:10.2147/PPA.S156883 [18] Raison C L, Rutherford R E, Woolwine B J, et al. A randomized controlled trial of the tumor necrosis factor antagonist infliximab for treatment-resistant depression: the role of baseline inflammatory biomarkers[J]. JAMA psychiatry, 2013, 70(1): 31-41. |
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