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背景:近年来临床和流行病学相关研究都证实部分口腔疾病的发生与心理应激因素相关。目的:分析学生考试前后唾液分泌型IgA及皮质醇的变化与心理应激状况的关系。设计:横断面调查。单位:浙江大学口腔系。对象:调查对象为2003-05/11福州二中高二年级在校学生60人,57人完成调查,均为男性,年龄17～19岁,身体健康,无口腔疾病及免疫系统疾病家庭史,无烟酒嗜好,均参加为期3d的期末考试。方法:考试前应用症状自评量表(共90题,包括躯体化、强迫、人际关系敏感、忧郁、焦虑、敌对、恐惧、偏执、精神病性、其他等10个因素,总均分是将总分除以90),将完成调查的57人分为为低症状组(症状自评量表总分<2.0)和高症状组(症状自评量表总分>2.0)。于考试前5周召集学生填写一般情况调查表;考试前4周和考试当天早晨7:30完成第一、二次唾液标本采集,测定其考试应激前后唾液分泌型IgA、皮质醇值;考试后3d召集学生填写心理健康问卷,评定其心理健康状况。主要观察指标:①症状自评表得分。②应激前后唾液分泌型IgA及皮质醇水平。结果:采用意向处理分析,进入结果分析57人。①学生症状自评表评定结果与中国常模比较:考试后强迫、焦虑、敌对、偏执4个因子分高于中国常模(1.98±0.72,1.69±0.61)分;(1.79±0.31,1.42±0.43)分;(1.77±0.68,1.50±0.57)分;(2.00±0.71,1.52±0.60)分,(P<0.01),其他因子比较未见明显差异(P>0.05)。②应激后的唾液分泌型IgA分泌量比较:考试前低症状组明显高于高症状组(236.6±82.29,194.55±66.29)mg/L,(P<0.05);考试后低症状组学生唾液分泌型IgA分泌量高于高症状组(182.21±55.92,132.89±41.16)mg/L,(P<0.01);③应激后的唾液皮质醇浓度比较:低症状组考试后明显高于考试前(5.96±2.46,3.68±2.26)μg/L,(P<0.01)。④两组分泌型IgA变化率及皮质醇变化率逐步回归分析结果:分泌型IgA下降率(0.012±0.197)、皮质醇上升率(0.199±0.654)和偏执、强迫等心理因素有关。结论:学生考试后症状自评表评定结果中焦虑、强迫、敌对、偏执等因子分高于中国常模,显示考试应激造成学生焦虑水平的上升和心理行为方面变异。高、低症状组学生在考试应激前后唾液分泌型IgA下降率之间存在差异,表明心理症状较多的学生对考试应激耐受力低。
Background: In recent years, clinical and epidemiological studies have confirmed that the occurrence of some oral diseases and psychological stress factors. Objective: To analyze the relationship between changes of salivary secreted IgA and cortisol before and after the students’ psychological stress. Design: Cross-sectional survey. Unit: Department of Oral Department, Zhejiang University. PARTICIPANTS: The surveyed subjects were 2003-05 / 11, Fuzhou No. 2 Middle and High School sophomore year, with 60 students and 57 persons surveyed. All were male, aged 17-19 years. Their family members were healthy and had no family history of oral diseases and immune system diseases. Alcohol and tobacco hobby, are participating in the 3d final exam. Methods: The self-rating Symptom Scale (90 questions, including somatization, compulsion, interpersonal sensitivity, melancholy, anxiety, hostility, fear, paranoid, psychosis and others) Divided by 90), 57 people who completed the survey were divided into low symptom group (symptom self-rating scale total score <2.0) and high symptom group (symptom self-rating scale total score> 2.0). Five weeks prior to the test, the students were asked to fill in the questionnaire for the general situation; the first and second saliva samples were collected at 4 weeks before the test and at 7:30 am on the test day, and the salivary secreted IgA and cortisol values were measured before and after the test; After 3 days, students were asked to fill in the questionnaire on mental health and assess their mental health status. MAIN OUTCOME MEASURES: ① Self-rating symptom score. ② before and after stress salivary secretion of IgA and cortisol levels. Results: Using intention-to-treat analysis, enter the result analysis of 57 people. (1) The result of assessment of self-rating symptom of students was compared with that of norm in China: four factors of forcing, anxiety, hostility and paranoid were higher than those of norm in China (1.98 ± 0.72, 1.69 ± 0.61); (1.79 ± 0.31, 1.42 ± 0.43); (1.77 ± 0.68,1.50 ± 0.57) points; (2.00 ± 0.71,1.52 ± 0.60) points, (P <0.01). There was no significant difference between other factors (P> 0.05). (2) Compared with the secretion of secretory IgA of saliva after stress, the low symptom group before the test was significantly higher than the high symptom group (236.6 ± 82.29, 194.55 ± 66.29) mg / L, (P <0.05) The secretion of secretory IgA was higher than that in the high-symptom group (182.21 ± 55.92, 132.89 ± 41.16) mg / L, (P <0.01); ③The salivary cortisol concentration after stress was significantly higher than that of the low symptom group (5.96 ± 2.46,3.68 ± 2.26) μg / L, respectively (P <0.01). (4) The results of stepwise regression analysis showed that the rate of change of secreted IgA and the rate of change of cortisol were both decreased (0.012 ± 0.197) and 0.199 ± 0.654 (paranoid and forced). Conclusion: The score of anxiety, coercion, hostility and paranoid in symptom self-assessment results after the exam is higher than that of Chinese norm, indicating that the test stress causes the students’ anxiety level to rise and their psychological behavior to vary. There was a difference between the high and low symptom group students in the drop rate of salivary secretion IgA before and after the test stress, indicating that students with more psychological symptoms had lower stress tolerance to the test.