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研究生:謝珮琦
研究生(外文):HSIEH, PEY-CHI
論文名稱:全身性紅斑性狼瘡病患心理─神經─免疫功能與症狀困擾之相關性探討
論文名稱(外文):The Correlations Among Psycho-Neuro-Immune Functions and Symptom Distress in Patients with Systemic Lupus Erythematosus
指導教授:陳玉如陳玉如引用關係
指導教授(外文):CHEN, YU-JU
口試委員:陳相成李其融陳玉如
口試委員(外文):CHEN, HSIANG-CHENGLI, CHI-RONGCHEN, YU-JU
口試日期:2017-05-10
學位類別:碩士
校院名稱:國防醫學院
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:中文
論文頁數:166
中文關鍵詞:全身性紅斑性狼瘡心理神經免疫學心理困擾自律神經功能發炎前驅因子症狀困擾
外文關鍵詞:Systemic Lupus Erythematosuspsychoneuroimmuneologypsychological distressautonomic nervous system (ANS)immune-mediated inflammatory responsesymptom distress
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背景:導致SLE疾病的發生是多因子的,除了基因遺傳因子外,環境因子中的心理困擾亦被認為與疾病的發生及惡化有關,這樣的概念來自於心理神經免疫理論。以往與該主題相關的文獻多以橫斷性研究方式進行探討,抑或是加入追蹤的概念但未加入常見的心理困擾與症狀困擾因子進行探討,而神經功能的研究大多將焦點放在與健康者、其他自體免疫疾病的比較,缺乏以追蹤型研究方式瞭解整體的心理─神經─免疫功能與症狀困擾之相關性。
目的:探討SLE病患心理困擾、神經功能、免疫發炎反應與症狀困擾間的相關性。
方法:本研究為前瞻性研究設計,以方便取樣方式進行收案,共分兩個時間點進行資料收集:收案第一天及間隔兩個月後,以北部某醫學中心風濕過敏關節炎科門診進行收案,以結構式問卷、心律變異監測以及血液檢體進行資料收集,探討收案對象的特質、兩個月後的追蹤是否有差異(前測與後測的差異)、第一次資料變項間之相關性,以及兩次追蹤變相改變量(後測-前測)之相關性,應用統計軟體SPSS 22.0進行分析,分別以描述性統計、配對T檢定、成對樣本中位數差異檢定、以及皮爾森積差相關等方式進行資料分析。
研究結果:本研究預計招收60位個案,50位接受完整測試並納入資料分析,分析第一次收案資料,壓力、焦慮與憂鬱彼此呈高度相關(r=.484—.690, p<.001),然而與自律神經功能、免疫發炎指標無相關性(p>.05)。心理困擾各分量與疲勞(r=.484—.638, p<.001)、疼痛有相關(r=.293—.432, p<.05),與疾病活動度無顯著相關(p>.05);自律神經功能、免疫發炎反應與症狀困擾無顯著相關(p>.05)。分析兩次追蹤資料,焦慮程度、憂鬱程度、心率變異相關參數以及疲勞嚴重程度、疼痛感受程度並無顯著的前測、後測差異,分析改變量的相關性,心理困擾的改變量、神經功能的改變量、免疫發炎反應的改變量與症狀困擾的改變量尚未見顯著相關性(p>.05)。
結論:基於上述結果得知,SLE病患相較於文獻指出的健康者有較差自律神經調節功能。且當SLE病患心理困擾得分越高,疲勞嚴重程度及疼痛感受程度亦越高。兩個月觀察中因追蹤時間較為短暫,尚無法看到SLE病患顯著的心理神經免疫變化,及其與症狀困擾變化間的相關性。建議未來增加追蹤時間及次數以觀察SLE病患心理、神經、免疫之變化及其對於症狀困擾的影響。
Background:The flare of Systemic Lupus Erythematosus (SLE) was contributed by multiple factors. Beside the genetic factor, psychological distress from the environment was accused for triggering and deteriorating the disease progression in SLE. This phenomenon can be explained by the theory of psychoneuroimmunology. Due to the nature of cross-sectional exploration in previous SLE studies, psychological distress and symptom distress did not be concurrently studied. In addition, studies related to neurologic function in SLE were mostly focused on its cross-sectional comparison with healthy or other auto-immune diseases subjects. The panel studies were lack of longitudinal follow-up to test associations among psychological,neurological, and immunological function, and symptom severity.
Purpuse:To investigate the correlations among psychological distress, autonomic nervous system (ANS) function, immune-mediated inflammatory response and symptom distress in two month .
Methods:This is a prospctive study, convenience sampling is applied. Patients with SLE were recruited from the outpatient clinic of the Allergy, Immunology and Rheumatology in a medical center of northern Taiwan. Data were repeatly collected by structured questionnaire delivering, heart-rate variability (HRV) monitoring and blood sample collecting at the day patients consent for participation and 2-month follow-up. The characteristics of participants and two times measures were listed and discussed at first. Then, the correlations among psycho-neuro-immune functions and symptom distress at baseline measures were tested. At last, the associations among changes in psycho-neuro-immune functions and symptom distress between two measures were discussed. All results were analyzed by descriptive statistics, paired-t test, Wilcoxon Rank Signed test, and Pearson’s correlation with the statistical software SPSS 22.0.
Results:Sixty patients with SLE were initially enrolled, and 83% of participants (50 out of 60) completed all measures and contributed to final analyses. Results from baseline measures revealed that subjects’perceived stress, anxiety and depression were significantly mutual correlated (r=.484-.690, p<.001), but psychological factors were nonsignificantly correlated with ANS function represented by HRV and immuno-inflammatory indicator (p>.05). Psychological factors were associated with fatigue (r=.484-.638, p<.001) and pain (r=.293-.432, p<.05). Compared two times measures, there were no significant difference of neither indicator between them. The changes of psychological stress, neurologic function, and immune-mediated inflammatory response were not significantly correlated with symptom distress (p>.05).
Conclusions:Our results indicated that the higher psychological distress in SLE patient is, the higher symptom distress (e.g., fatigue and pain) will be. Insufficient length of follow-up period in this study limitedthe detection of the changes and correlationsamong psycho-neuro-immunological factors and symptom distress. Suggestions for future study are to extend follow-up period and frequency of measures for detecting the changes of psychoneuroimmunological factors and their effects on symptom distress.
正文目錄

第一章 緒論.............................1
第一節 研究背景、動機與重要性.............1
第二節 研究目的..........................5
第三節 研究假設..........................6
第二章 文獻查證..........................7
第一節 全身性紅斑性狼瘡之相關概念..........7
一、全身性紅斑性狼瘡之緣由與流行病學........7
二、全身性紅斑性狼瘡之病因與病生理機轉......9
三、全身性紅斑性狼瘡之診斷標準與治療........13
第二節 心理神經免疫學....................17
一、心理神經免疫學之緣由...................17
二、心理─神經─免疫系統之機轉...............19
第三節 全身性紅斑性狼瘡病患之心理困擾、自律神經功能、免疫系統、生理症狀的相關研究 .........................................24
一、壓力..................................25
二、憂鬱與焦慮.............................28
三、自律神經功能...........................32
四、疲勞..................................33
五、疼痛..................................34
第三章 概念架構...........................60
第一節 研究架構...........................60
第二節 名詞解釋與操作型定義................61
第四章 研究方法與過程......................66
第一節 研究設計...........................66
第二節 研究對象及研究場所..................67
第三節 研究工具...........................68
第四節 研究倫理考量........................80
第五節 資料收集過程........................81
第六節 資料處理及分析......................84
第五章 研究結果...........................87
第一節 SLE病患人口學特性、疾病及治療特性之分佈狀態.................87
第二節 SLE病患心理困擾、神經功能、免疫功能與症狀困擾之分佈情形......91
第三節 SLE病患心理困擾、神經功能、免疫功能參數間之相關性............98
第四節 SLE病患心理-神經-免疫功能表現與症狀困擾程度之相關性..........99
第五節 SLE病患於兩個月追蹤期間,心理困擾、神經功能、免疫功能與症狀困擾改變之關係 ................................................................101
第六章 討論.....................................................104
第一節 SLE病患人口學特性、疾病及治療特性之分佈狀態..................104
第二節 SLE病患心理困擾、神經功能、免疫功能與症狀困擾之分佈情形...... 106
第三節 SLE病患心理困擾、神經功能、免疫功能參數間之相關性............110
第四節 SLE病患心理-神經-免疫功能表現與症狀困擾程度之相關性..........113
第五節 SLE病患於兩個月追蹤期間,心理困擾、神經功能、免疫功能與症狀困擾改變之關係 .................................................................116
第七章 結論與建議.................................................117
第一節 結論.......................................................117
第二節 建議與限制.................................................118
英文參考資料.......................................................120
中文參考資料.......................................................159

表 目錄

表2-1壓力與神經內分泌、發炎反應及症狀困擾之相關文獻....................36
表2-2焦慮、憂鬱與神經內分泌、發炎反應及症狀困擾之相關文獻..............41
表2-3自律神經相關檢測之方法與結果....................................48
表4-1心率變異度時域分析法...........................................78
表4-2心率變異度頻域分析法...........................................79
表4-3描述性統計....................................................85
表4-4推論性統計....................................................86
表5-1研究個案基本人口學之描述性分析..................................89
表5-2研究個案疾病特性之描述性分析....................................90
表5-3研究個案第一次與兩個月後追蹤之心理、神經、免疫與症狀困擾測量之分佈..97
表5-4研究個案的心理困擾、自律神經功能、免疫發炎反應及症狀困擾之相關.... 102
表5-5研究個案心理困擾的變化、自律神經功能改變量、免疫發炎反應改變量及症狀困擾程度改變量之相關.........................................................107 

圖 目錄

圖3-1 研究架構....................................................60
圖4-1 收案流程圖..................................................83

附錄 目錄

附錄一 人體實驗同意函
附錄二 10題中文版壓力知覺量表授權同意書
附錄三 英文版醫院焦慮憂鬱量表授權同意書
附錄四 中文版醫院焦慮憂鬱量表授權同意書
附錄五 中文版疲勞嚴重程度量表授權同意書
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