【《精神心理因素与IBD的相关分析国内外文献综述》3300字】

精神心理因素与IBD的相关研究国内外文献综述目前相关研究认为，精神心理因素与IBD的发病之间存在密切关系，并且IBD患者在病程中除了存在消化道症状，通常也会伴随情绪异常，如焦虑、抑郁等，这些精神症状不仅对患者的病情与病程产生负面影响，也会影响患者的社会生活以及寻求医疗支持等社会属性，腹痛、腹泻以及各种全身性症状不仅仅代表IBD处于活动期，在IBD的缓解期，即使疾病已经得到控制，在那些具有精神心理问题的患者身上，上述症状可能会作为与情感相关的躯体症状再次出现。同时，焦虑、抑郁也会加重肠道炎症反应，从而使患者的生活质量不能得到保障，生活负担也随之增加，这些负面因素又反过来加重了焦虑与抑郁状态，从而使IBD患者陷入负面循环中。IBD患者的焦虑与抑郁与消化系统相关的疾病，大多数与精神心理因素存在千丝万缕的联系，IBD与功能性胃肠疾病等心身疾病类似，也容易合并精神心理障碍，因此，与IBD相关的心理问题越来越得到人们的重视。IBD患者大多在消化道症状的基础上伴随有焦虑、抑郁等精神心理问题，与健康人群相比，IBD患者焦虑与抑郁的发病风险明显增加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]，发表于2016年的一项系统综述统计了IBD患者焦虑的患病率约为20%，抑郁的患病率约为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属于慢性疾病，疾病持续时间一般较长，并且表现为发作与缓解相互交替出现的特点，频繁出现腹泻以及黏液脓血便等症状，病情严重者甚至会出现全身症状或者肠道外表现，IBD患者常常需要多次前往医院就诊，而且目前仍然无法治愈，需要长期的维持治疗，花费巨大。上述情况使得IBD患者容易出现轻重不一的精神心理问题。Nahon等人通过研究发现，焦虑与抑郁在IBD活动期和病情严重时表现更为明显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患者的相关研究中也发现了类似的趋势，UC患者的Mayo评分，即疾病活动程度越高，焦虑、抑郁的评分也随之升高ADDINEN.CITEADDINEN.CITE.DATA[37]。此外，Neuendorf等人的研究结果也提醒我们应当注意，即使疾病处于缓解期，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]，因为即使疾病处于缓解期，患者仍然会对未来疾病是否会复发而产生担忧。Geiss等人又比较了CD与UC两组疾病之间的抑郁风险水平，研究发现CD患者重度抑郁的患病率明显高于UC患者，然而轻度抑郁则在UC患者群体中更为常见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]，这种区别可能与CD是较UC更加偏向于系统性疾病，并且肠外表现较UC更为普遍相关。合并有其他症状或并发症的患者，更容易出现精神心理问题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的病程也会对精神心理产生影响，即疾病持续时间越久，与精神心理健康相关的量表的评分越高，代表患者出现情绪异常ADDINEN.CITE<EndNote><Cite><Author>许芳</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>许芳</author><author>吴海珍</author></authors><translated-authors><author>Xu,Fang</author><author>Wu,Haizhen</author></translated-authors></contributors><auth-address>214002,无锡市第二人民医院消化内科</auth-address><titles><title>炎症性肠病患者心理健康状况及其影响因素分析</title><secondary-title>中华现代护理杂志</secondary-title></titles><periodical><full-title>中华现代护理杂志</full-title></periodical><pages>3881-3885</pages><volume>23</volume><number>30</number><keywords><keyword>心理</keyword><keyword>炎症性肠病</keyword><keyword>影响因素</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>北京万方数据股份有限公司</remote-database-provider><language>chi</language></record></Cite></EndNote>[40]。IBD常用的治疗药物主要包括5-氨基水杨酸制剂、激素以及新型生物制剂等，研究显示，使用激素治疗的患者更容易出现焦虑，但与抑郁没有明显的相关性，此外，相对于激素来说，使用生物制剂则更容易避免焦虑的发生ADDINEN.CITEADDINEN.CITE.DATA[36,37]。焦虑与抑郁可能是因IBD的治疗需要长期应用药物维持而产生的不良反应，也可能与患者对药物本身的不良反应所产生的担忧以及恐惧有关。除上述因素外，患者的年龄、受教育水平、经济能力、社会支持、心理压力以及对手术的担忧等也会加重焦虑情绪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]。综上所述，分析IBD患者易患焦虑与抑郁的原因主要为以下几个方面：首先，IBD的病程较长，并且反复发作，频繁的腹泻会影响患者的正常生活；其次，为了治疗和维持疾病的缓解，患者需要多次就医，并且需要长期应用药物，频繁的就诊以及因检查与治疗而产生的高额医疗支出会导致患者的生活压力上升，心理压力也随之增大；另外，患者经常会担心疾病的复发或担忧是否需要进行手术，长期的恐惧与压力也会对情绪调节造成负面影响；最后，疾病的活动会对学习、工作甚至家庭以及社会关系产生影响，经济来源改变以及社会功能受损都会对患者产生打击，长此以往，或者容易形成消极的心态，进而加重焦虑与抑郁。焦虑与抑郁对IBD患者的影响焦虑与抑郁情绪会对机体的免疫调节能力带来不利影响，导致IBD患者的病情加重ADDINEN.CITEADDINEN.CITE.DATA[42,43]，这也可能是应用常规治疗药物并不能达到满意治疗效果的原因之一。Navabi等人研究发现，患有焦虑症与抑郁症的IBD患者不仅临床症状会更加严重，也倾向于出现更多与疾病相关的并发症，并且更容易出现肠道外表现，也较普通IBD患者增加使用激素以及生物制剂类药物治疗的几率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]。焦虑、抑郁情绪也与IBD的复发存在显著关联，研究表明，患有抑郁症的IBD患者处于缓解期的时间缩短，疾病更容易复发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]，这可能与患者出现精神心理问题后，对治疗的依从性减低有关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]，由于不能按照医嘱进行规范治疗，疾病不能得到有效控制，另外，患者的情绪也会随着疾病活动而产生波动，导致疾病的进一步发展与加重。不仅如此，有学者也认为精神心理因素可以预测IBD患者疾病的走势，正如一项大型前瞻性研究的结果显示，目前处于抑郁状态的IBD患者，在未来出病情恶化的风险显著增加，并且增加了治疗药物升级以及住院、手术的概率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]，另外一项前瞻性研究虽然也提示抑郁水平较高的CD患者在一年后出现症状加重与住院率提高等情况，但却没有发现治疗药物升阶以及手术的概率与抑郁水平较低的患者之间的差异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]。焦虑与抑郁也使IBD患者无法保证自身的生活质量。患者的生存质量评分在症状、情感、社交等各方面均较普通人群显著下降，生活质量也更低ADDINEN.CITEADDINEN.CITE.DATA[48]。陈凌华等人通过调查还发现，IBD患者的生存质量评分虽然下降，但下降的程度存在差异，该差异表现为与情感以及社会功能相关的方面，与焦虑、抑郁的联系更加明显ADDINEN.CITEADDINEN.CITE.DATA[43]。情绪的异常会加重病情，增加患者前往医院就诊或者住院的频率，导致正常的工作、学习以及生活规律被打乱，并且患者频繁的腹泻以及排气的增加，导致IBD患者不得不避免参加附近没有卫生间或者不方便如厕的社交活动，因此，与家人、朋友间的交流减少，患者也因此缺乏被尊重感，不被理解与支持。上述原因导致IBD患者不能很好地参与社会活动，进行情感交流。另外，伴随情绪异常的IBD患者更倾向于选择不良的生活方式，比如吸烟等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]，此种现象不仅促使病情进展，也更进一步导致生活质量的降低。根据以上研究结果进行综合分析，焦虑与抑郁之所以会对IBD产生影响，主要与以下原因有关：首先，不良的情绪会使IBD患者的肠道与全身症状被放大，出现并发症以及肠外表现的可能性增加，病情稳定的维持时间缩短，增加了住院以及手术的风险，治疗药物的升级以及随之而产生的高额的医疗费用，增加了患者的经济压力；其次，焦虑与抑郁会使情绪调节能力进一步下降，心理问题长期存在会严重影响到IBD的治疗与缓解；最后，因情绪所致的疾病活动，导致患者社会活动以及情感交流明显减少，社交能力的降低也会使IBD患者的生活质量下降。总结对于精神心理因素与IBD的探索，让我们更加深刻地认识到对IBD的治疗不能仅仅只关注于患者的躯体症状，也应该同时重视对患者的心理疏导以及帮助患者提高生活质量，并且IBD患者的情绪障碍不只存在于疾病的活动期，对于缓解参考文献：甄建华,黄光瑞.溃疡性结肠炎病因和发病机制的现代医学研究进展[J].世界华人消化杂志,2019,27(04):245-251.[2] 吴开春,梁洁,冉志华,等.炎症性肠病诊断与治疗的共识意见(2018年·北京)[J].中国实用内科杂志,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