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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3mL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。
Background: The exact mechanism of systemic sclerosis is unclear. There are often different forms of psychological stressors before the onset of the disease in clinics. Objective: To investigate in-depth psychosocial factors of patients with systemic sclerosis, compare Chinese norm and control group, and combine with clinical immunology test to analyze the effect of psychological stress factors. Design: Controlled observation. Department of Geriatrics, First Hospital of Zhejiang University, Hangzhou City Hospital and Tongji Hospital, Hangzhou Surgical Object: Selected from December 2002 to September 2005 in the Department of Internal Medicine of the First Hospital of Zhejiang University, Fluid drainage therapy in patients with systemic sclerosis inpatients 26 cases were observed (systemic sclerosis group). Control group from the same period with chronic gastritis inpatients 30 cases. Method: All participants completed a general survey. It includes: age, gender, major symptoms, duration of disease, special examinations, diagnosis and medication. Using psychosocial scale to assess psychosocial factors. The life event scale was used to measure the stress of life events, including common life events such as occupation, study, marriage and love, family and children, economy, judicature and interpersonal relationship. The simple coping style questionnaire was used to assess the coping style and divided into 8 The main components: confrontation, desalination, self-control, help, self-blame, evasion, planning and re-evaluation, the habitual coping style is divided into two types of negative and positive. Eysenck personality questionnaire using personality assessment, composed of four subscales, for the extroverted-introverted, neurotic, mental quality and disguise, false care scale. At the same time take the patient fasting blood 3mL immune turbidimetry serum lgG, lgA, lgM and complement C3. And lgG and other factors related analysis. MAIN OUTCOME MEASURES: Assessment results of psychosocial scale and clinical immunology test results. Results: All 56 patients completed the scale test and immunological test, all of which were involved in the result analysis. In the scoring system of life scandal in patients with systemic sclerosis, the total number of events, the number of negative events and the LEU of negative events were significantly greater than that of the control group. Coping style, the positive response dimension less than the control group, negative coping dimensions more than the control group. Eysenck personality questionnaire assessment, regardless of male and female outgoing - inward factors were less than the control group and normotensive group, neuroticism were greater than the control group and norm group. Humoral immunoassay, lgG, lgA and lgM were greater than the control group, the two groups of C3 levels were no significant difference. IgG negatively correlated with the number of negative events, negative coping dimensions and Eysenck personality questionnaire. Conclusion: There are obvious psychological stress, negative coping style and emotional instability in patients with systemic sclerosis, and there is abnormal humoral immune function. Psychological and social factors have an impact on immunology, suggesting that psychological stress and systemic sclerosis are closely linked.