Mindfulness-based stress reduction may decrease stress, disease activity, and inflammatory cytokine levels in patients with autoimmune hepatitis

JHEP Reports

James L. Boyer¹  Anne Dutton²  Marina G. Silveira³  Scott J. Roberts³  Maria Ciarleglio³  Yanhong Deng³  Rajita Sinha⁴  Leina S. Alrabadi⁵  Anahita Rabiee⁶  David N. Assis⁶  Richard Bucala⁷  Laura Cusack⁷ 

[1] Immunology, Yale School of Medicine, New Haven, CT, USA;Nutrition, Stanford University School of Medicine, Palo Alto, CA, USA;Department of Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA;;Department of Medicine, Section of Rheumatology, Allergy &;Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology &Department of Psychiatry and Yale Stress Center, Yale School of Medicine, New Haven, CT, USA;Yale Center for Analytical Sciences, Yale University School of Public Health Department of Biostatistics, New Haven, CT, USA;

关键词: Autoimmune hepatitis;    Psychological stress;    Stress reduction;    MBSR;    Cytokines;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background & Aims: Psychological and life stressors may impact autoimmune hepatitis (AIH) disease activity and increase relapse risk. Mindfulness-based stress reduction (MBSR) is a validated course that reduces stress reactivity, and improves stress and emotion regulation. This single-arm exploratory pilot study of adult patients with AIH aimed to define the impact of an 8-week MBSR program on quality of life, disease activity, and cytokine mediators. Methods: The perceived stress survey-10 (PSS) and the brief self-control scale (BSCS) measured subjective distress and self-control. Serum alanine aminotransferase (ALT) and cytokine levels were measured, and immunosuppressant doses recorded. Results: Seventeen patients completed the MBSR program. Post-MBSR, 71% (n = 12) showed PSS score improvement at 8 weeks vs. baseline (median 15 vs. 21, p = 0.02). At 12 months, PSS improvement persisted vs. baseline (median 15 vs. 21, p = 0.02). Post-MBSR, 71% (n = 12) showed BSCS score improvement at 8 weeks vs. baseline (median 4.1 vs. 3.8, p = 0.03). At 12 months, the median BSCS score remained significant (3.9 vs. 3.8, p = 0.03). After the 8-week MBSR, the 35% of patients with ALT >34 U/L had a median ALT reduction (44.5 vs. 71.5 U/L, p = 0.06), whereas the 71% of patients on prednisone had significant dose reductions (5.75 vs. 10 mg, p = 0.02) which persisted at 12 months vs. baseline (3.75 vs. 10 mg, p = 0.02) without a compensatory increase in steroid-sparing dosing. Significant improvement was noted in peripheral blood cytokine levels (IL-6, IL-8, IL-10, IL-17, IL-23, and sCD74/MIF ratio) from baseline to 8 weeks. Conclusions: MBSR significantly improved perceived stress and self-control scores while decreasing ALT levels, steroid requirements, and inflammatory cytokine levels in this pilot study in adult AIH. Stress modification may impact quality of life and disease activity, and should be further evaluated as an intervention in AIH. Clinical Trials registration: This study is registered at ClinicalTrials.gov (NCT02950077). Lay summary: Autoimmune hepatitis can reduce quality of life and mental health, while stress may impact autoimmune hepatitis itself. We piloted mindfulness-based stress reduction as a strategy to reduce stress in adult patients with autoimmune hepatitis and found that the intervention reduced perceived stress and may have also impacted the disease by improving inflammation and medication needs. Stress reduction should be further studied to improve quality of life and possibly to impact disease activity in autoimmune hepatitis.

【 授权许可】

Unknown