Analysis Of Depression And Risk Factors Of Crohn's Anal Fistula

Background:Crohn's disease(CD)is a chronic transmural inflammatory disease that can occur in the entire digestive tract associated with the patient a whole life.After crohn's disease was diagnosed,the incidence of anal fistula gradually increased with the cumulative course of the disease.Recently,the incidence rate of crohn's disease in our country has been increased due to its chronic relapse,incurability,disability,etc.The psychological problems of this group of people are easy to breed,especially the depression state of patients of crohn's disease with perianal lesions is most likely to be neglected.At present,there are few studies on depression in crohn's disease patients with perianal disease at domestic area and abroad.The clinicians in our country have a very poor emphasis of depression in patients with crohn's disease,especially in perianal fistulizing crohn's disease.Related content has not yet been reported in the literature.Aim:To understand the depression status of patients with anal fistula in Crohn's disease,and to make clinical comparison studies between perianal fistulizing crohn's disease and Glandular anal fistula.What's more,the differences of depression between the two groups,and the risk factors for depression in patients with crohn's disease and anal fistula were analyzed.Further psychological intervention treatment provides a theoretical basis.Methods:A consecutive series of 140 patients(from January 2017 to February 2018,The Affiliated Hospital of Nanjing University of Chinese Medicine)with confirmed diagnosis of perianal fistulizing crohn's disease and glandular anal fistula(n=70),were included and investigated during ambulatory visits by a standard questionnaire assessing demographic and clinical features of the disease.Current symptoms of depression was assessed by PHQ-9 scale.Risk factors of depression in Perianal fistulizing Crohn's disease were validated with univariate and multivariate analyses.Results:The rate of depression in Crohn's disease patients with anal fistula was significantly higher than that in patients with glandular anal fistula(41.4%&18.6%,P<0.05),and the tendency of self-harm of the former was significantly higher than the latter(17.1%&4.3%,P<0.05).In addition,when PDAI>4(perianal disease is active),patients with crohn's disease have a higher degree of depression.Univariate analysis showed that active perianal disease(OR=3.156,95%CI:1.173-8.49)was a risk factor for depression in crohn's disease patients with anal fistula.The CRP of patients with crohn's disease and anal fistula,within the normal level(OR-0.304,95%CI 0.107-0.864),was a protective factor in the formation of depression.Multivariate analysis suggested that activity perianal disease is an independent risk factor for depression of patients with Crohn's disease.Conclusion:Patients with Crohn's disease and anal fistula are in a state of high depression.Crohn's disease patients with activity perianal diseases show a higher degree of depression and self-harm consciousness.