目的:探讨环境应激诱发慢性瘙痒性皮肤病患者与焦虑、抑郁共病的神经内分泌激素改变情况。方法:选取2023年5月至2023年8月在某基层医院诊断为神经性皮炎的长期野外环境驻训患者15名为病例组,取同期共同生活的15名健康人员为对照组;检测相关激素水平,并进行抑郁自评评分(SDS)和焦虑自评评分(SAS),同时着重分析抑郁自评评分(SDS)第4项和焦虑自评评分(SAS)第19项关于睡眠质量的赋分数值,用于睡眠问题分析;重点分析神经性皮炎患者的激素水平是否出现异常,以及是否伴发抑郁、焦虑、睡眠障碍。结果:病例组较对照组明显增高的激素分别是促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)、皮质酮(CORT)、皮质醇(COR)、促甲状腺激素(TSH)(P＜0.05);病例组孕酮(PGN)较对照组明显降低(P＜0.05);病例组睾酮(TT)、雌激素(E2)与对照组比较差异无统计学意义(P＞0.05);病例组14例去甲肾上腺素(NE)含量低于90 pg/mL,只有1例高于90 pg/mL(113.5 pg/mL),而对照组仅3例低于90 pg/mL,12例高于90 pg/mL。另外,病例组SDS和SAS均明显高于对照组(P＜0.01);病例组SDS相关睡眠障碍(第4项)评分和SAS相关睡眠障碍(第19项)评分均明显高于对照组(P＜0.000 1)。提示病例组的CRH、ACTH、CORT、COR、TSH、PGN、NE等激素出现明显的异常;并且,在罹患慢性瘙痒性皮肤病的同时也伴随明显的焦虑、抑郁情绪及睡眠障碍。结论:与同环境下健康人员相比,环境应激相关神经性皮炎患者血液中的部分激素,尤其是与应激相关的下丘脑-垂体-肾上腺轴(HPA轴)相关激素发生明显变化,且伴随明显的焦虑、抑郁及睡眠障碍。
Objective: To investigate the changes of neuroendocrine hormones in patients with chronic pruritus dermatosis, anxiety and depression induced by environmental stress. Methods: Selected 15 patients who were diagnosed with neurodermatitis in a primary hospital from May 2023 to August 2023 were selected as the case group, and 15 healthy people who lived together during the same period were selected as the control group. The levels of related hormones were detected, and the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were tested. At the same time, the scores of Self-Rating Depression Scale (SDS) item 4 and Self-Rating Anxiety Scale (SAS) item 19 on sleep quality were analyzed for sleep problem analysis. In addition, it focuses on whether the hormone levels of patients with neurodermatitis were abnormal, and whether they were accompanied by depression, anxiety and sleep disorders. Results: The levels of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), corticosterone (CORT), cortisol (COR) and thyroid stimulating hormone (TSH) in the case group were significantly higher than those in the control group (P＜0.05). Progesterone (PGN) in the case group was significantly lower than that in the control group (P＜0.05). There was no significant difference in testosterone (TT) and estrogen (E2) between the case group and the control group (P＞0.05). Norepinephrine (NE) level was lower than 90 pg/mL in 14 cases and higher than 90 pg/mL in 1 case (113.5 pg / mL ) in the case group, while it was lower than 90 pg/mL in 3 cases and higher than 90 pg/mL in 12 cases in the control group. In addition, SDS and SAS in the case group were significantly higher than those in the control group (P＜0.01). The scores of SDS-related sleep disorder (item 4) and SAS-related sleep disorder (item 19) in the case group were significantly higher than those in the control group (P＜0.000 1), indicating that CRH, ACTH, CORT, COR, TSH, PGN, NE and other hormones in the case group showed obvious abnormalities, and patients with chronic itchy skin disease were also accompanied by obvious anxiety, depression and sleep disorders. Conclusion: Compared with those of healthy people under the same environment, patients with environmental stress-related neurodermatitis show significant changes in certain blood hormones, especially those related to the stress-related hypothalamic-pituitary-adrenal axis (HPA axis), and the patients are accompanied by obvious anxiety, depression and sleep disorders.
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