狼疮患者发生抑郁的风险升高且与用激素无关

作者: Nishimura K, et al. 翻译:张警丰

摘要：目的：对于系统性红斑狼疮（SLE）患者的心理问题，如抑郁与焦虑，已经有较多的研究关注。然而，这些研究绝大多数纳入的患者为接受糖皮质激素治疗的患者，而糖皮质激素本身即有可能导致情感问题。本研究纳入人群为未应用糖皮质激素的系统性红斑狼疮患者，且无神经精神症状，研究内容为上述患者的心理问题。

方法：本研究纳入43例系统性红斑狼疮患者，现在或既往无神经精神异常病史。另纳入30例人口统计学与人格特点均与患者组匹配的健康对照。对上述两组进行全面系统的心理/神经精神测评。应用情绪状态评估表（POMS）对抑郁和焦虑进行评估。对临床特点、实验室检查及神经检查进行比较分析。

结果：患者组 (n?=?11, 25.6%)抑郁的发生率高于对照组(n?=?2, 6.7%; p?=?0.035)，而焦虑的发生率两组间无差别（患者34.9%, n?=?15，对照controls: 16.7%, n?=?5; p?=?0.147）。应用多元logistic回归分析发现回避的处理方式(OR, 1.3; 95% CI 1.030-1.644; p?=?0.027)是抑郁的独立危险因素。

结论：本研究发现与健康对照相比，早期活动性未应用糖皮质激素的SLE患者发生抑郁的风险更高，但焦虑的风险并未升高。抑郁的发生可能与罹患疾病后的心理反应相关。

附原文：Abstract：OBJECTIVE:Psychological distress, such as depression and anxiety, has been intensively studied in patients with systemic lupus erythematosus(SLE). However, those studies have mostly included patients who were treated with corticosteroids, which might themselves induce mood disturbances. We investigated psychological distress in corticosteroid-naive patients with SLE who did not exhibit any overt neuropsychiatric manifestations.METHODS:Forty-three SLE in-patients with no current or past abnormal neuropsychiatric history participated in the study. Patients and 30 healthy control subjects with similar demographic and personality characteristics were administered a comprehensive battery of psychological/neuropsychological tests. The Profile of Mood States (POMS) was used to assess depression and anxiety. Results of clinical, laboratory, and neurological tests were compared with regard to their presence.RESULTS:Prevalence of depression was higher in patients (n?=?11, 25.6%) than in controls (n?=?2, 6.7%; p?=?0.035), although prevalence of anxiety did not differ across groups (patients: 34.9%, n?=?15; controls: 16.7%, n?=?5; p?=?0.147). Using multiple logistic regression analysis, we identified avoidance coping methods (OR, 1.3; 95% CI 1.030-1.644; p?=?0.027) as an independent risk factor for depression.CONCLUSION:Our results indicate that depression presents more frequently in corticosteroid-naive patients with early-stage, active SLE than in the normal population, but anxiety does not. Depression may be related to psychological reactions to suffering from the disease.

引自：Nishimura K, Omori M, Katsumata Y, et al. Psychological distress in corticosteroid-naive patients with systemic lupus erythematosus: A prospective cross-sectional study. Lupus. 2016 Apr;25(5):463-71.