原發性乾燥症其疾病活性、精神壓力與人格特質之關聯性

The association of disease activity, personality trait and psychiatric symptoms in patients with primary Sjogren's syndrome

目的：本研究旨在調查原發性乾燥症患者之精神壓力與人格特質，並探討精神壓力、人格特質與疾病活性之關聯性。方法：本研究共招募40名罹患原發性乾燥症之女性患者，並使用簡式症狀表（Brief Symptoms Rating Scale, BSRS）與簡式性格量表（Maudsley Personality Inventory, MPI）來評估其精神壓力與人格特質。精神壓力與人格特質的嚴重性係利用先前建立之醫院參考組資料經性別與年紀校正後取其調整後T分數來計算。所得的心理測量結果與血清學檢驗結果、量化性唾腺閃爍攝影指標之間的關聯性也進一步予以分析。結果：原發性乾燥症患者在簡式症狀表之總嚴重指標（General Severity Index, GSI）與簡式性格量表之神經質指標兩項所得的調整後T分數均顯著高於醫院參考組。神經質指標分數與異常高的類風濕因子顯著相關，且可能與過高的IgG有關。神經質指標分數的高低也與唾腺閃爍攝影評估所得之唾腺功能的破壞程度顯著相關，但精神壓力的嚴重度則與唾腺功能的破壞程度無關。結論：原發性乾燥症患者的精神壓力不容忽視，且其人格之神經質傾向與唾腺功能之破壞程度顯著相關，故全人醫療的觀點對診治原發性乾燥症患者相當重要。本研究發現了原發性乾燥症其疾病活性與人格特質之間的關聯性，而其背後的機轉則有待後續研究。

Objective: This study aims to explore the biological correlates of psychological distress and personality trait in patients with primary Sjögren’s syndrome (pSS). Method: A total of 40 female patients with pSS were recruited for this study. Brief Symptoms Rating Scale (BSRS) and Maudsley Personality Inventory (MPI) were applied to measure psychological distress and personality trait, respectively. Adjusted T scores of these two scales, which were obtained from comparisons with a pre-existing hospital reference group after adjusting for the effects of gender and age, were used to determine severity. We also investigated the association between psychometric variables and biological markers which included serological parameters and quantitative sialoscintigraphy. Results: The adjusted T scores of General Severity Index (GSI) for BSRS and neuroticism for MPI were significantly higher in patients with pSS than in the hospital reference group. The score of neuroticism was significantly associated with an abnormally high rheumatoid factor and marginally correlated with IgG level. The degree of neuroticism in personality trait, rather than the severity of psychological distress, correlates to the extent of salivary gland dysfunction defined by quantitative sialoscintigraphy. Conclusion: Patients with pSS suffered from notable psychological distress. The personality trait of neuroticism significantly associates with the extent of salivary dysfunction. It is important to deliver holistic care to patients with pSS in order to help alleviate their disease burden. Further studies which focus on the relationship between biological markers and personality traits might shed light on the mechanisms connecting body and mind in pSS.