潰瘍性大腸炎患者の精神的ストレスと唾液中クロモグラニンAの検討  [in Japanese] Evaluation Psychological Stress of the Patients with Ulcerative Colitis by Salivary Choromogranin A Concentration  [in Japanese]

潰瘍性大腸炎(以下,UC)では,ストレスとの関連が以前より指摘されている.そこでストレスの指標の1つとされている唾液中クロモグラニンA濃度(以下,CgA)をUC患者と正常対照で計測し,その後各種心理検査(SDS,STAI,POMS)と疾患特異的QOL質問票であるIBDQも行った.UC患者の唾液中CgAは,正常対照と比較して高い傾向があったが有意差はなかった.研究導入時の重症度で分けても,軽症と中等症で唾液中CgAに有意差はなかった.しかしステロイド抵抗性の難治群では正常対照より有意に唾液中CgAが高値であり(p=0.021),非難治群と比べても高値だった(p=O.O13).難治性UC患者でストレスの関与が示唆され,唾液中CgAはその評価方法となることが示唆された.

Background: There is a long history of observations suggesting that psychological stress contributes to exacerbation of ulcerative colitis (UC). However, there have been few reports describing psychosomatic findings. Therefore, we measured salivary chromogranin A concentration (CgA), one of the indices of psychological stress, in patients with UC. Subjects: Sixteen patients with UC (9 males and 7 females, aged 14 to 60 years old), and 14 normal adults were studied. Method: After taking rest for 5 minutes, we sampled the saliva by using a cylindrical piece of cotton which was placed beside the tongue in the oral cavity, so that the secreted saliva was absorbed by the cotton for 3min. Afterward, we measured salivary CgA by the EIA method. We also performed IBDQ which is disorder specific QOL questionnaire and psychological test (SDS, STAI, POMS). Results: We compared the salivary CgA of the UC patients with that of normal controls. The result showed that the CgA level in UC patients tended to be higher than in normal controls, but there was no significant difference. Additionally, there was no significant difference in the salivary CgA levels between the patients with moderate UC and mild UC. However, according to the severity determined before induction point, the salivary CgA of the group of the intractable UC was significantly higher than that of the non-intractable UC group (p=0.013) and that of the normal controls (P=0.021). But the scores of IBDQ ware not significantly different between the groups of intractable UC and non-intractable UC, and there was no significant difference between the two groups in the psychological test. There was no significant correlation between both CgA and the psychological test, and CgA and IBDQ. There was discrepancy between CgA as an objective psychological index and scores by questionnaire as a subjective psychological index. Conclusion: It is suggested that psychological stress contributed to the course of group of intractable UC, and that measurement of salivary CgA levels may be a useful method to evaluate the psychosomatic state of the patients with UC.