职业倦怠伴发的认知功能损伤及其生物学机制

Occupational Burnout is a psychosomatic syndrome which is closely related to hereditary factor, job environment, and social relationship. So far, it is recognized that occupational burn out is associated with cognitive function impairment but the mechanism is still unclear. Building on our prior work, we seek to increase and extend our understanding of occupational burnout via integrating cognitive psychological and biological approach.There has been a growing body of data on the Brain Derived Neurotrophic Factor(BDNF) and free radical involved in the pathology of occupational burnout as well as cognitive function impairment. So we proposed that BDNF and free radical may involved in the cognitive function impairment caused by occupational burnout. We select doctors and nurses in hospital as subjects. The occupational burnout group and control group were screened by the score of MBI-GS test. Case-control design was used in comparing the difference between two groups of BDNF (serum BDNF level and 12 labeled SNPs) and free radical (antioxidative enzyme SOD, CAT, GSH-Px and lipid peroxidation LPO et al.). Cognitive function was detected via signal stop task, attention net test, working memory test and RBANS test. The overarching goal of this proposal is to examine the cognitive function impairment related to occupational burnout through biological mechanism, psychological mechanism, as well as the interaction of them, and test how they contribute to this syndrom. we seek to establish a base for the clinical intervention, further shift current research approaches.

职业倦怠是一种由个体特定遗传、职业环境以及社会交往诱发的心理障碍。近期的研究发现，职业倦怠能导致认知功能损伤，但是机理不明确。基于我们前期的探索性研究，本研究从职业倦怠认知心理和生物学机制研究职业倦怠。研究发现，脑源性神经营养因子（BDNF）和自由基代谢异常参与了职业倦怠的病理机制，同时它们也参与了认知功能损伤，因此我们假设BDNF和自由基代谢异常与职业倦怠伴发的认知功能损伤有关。选取医护人员作为研究对象，根据职业倦怠症状量表评定筛选出职业倦怠组和正常对照组，采用病例-对照设计，检测BDNF指标（包括BDNF血清水平和12个标签SNP）和自由基代谢指标（包括抗氧化酶SOD、CAT、GSH-Px和脂质过氧化物LPO等），并检测认知功能指标（包括停止信号任务、注意网络实验、工作记忆范式以及RBANS量表）。本研究重点探讨职业倦怠所致认知功能损伤的生物机制，为职业倦怠人群的早期筛查提供理论依据。

职业压力和倦怠引起包括认知功能障碍在内的一系列的心理症状。该研究旨在探讨职业压力引起的认知功能障碍和倦怠及其生物机制。选取北京某三甲医院的医护人员724名，采用自评量表测定其职业压力、倦怠、POMS情感状态，并随机抽取127人进行RBANS认知功能测试及Stroop执行功能测试，采集并测定其血清BDNF浓度、SOD活力、CAT活力、GSH-px活力，最后选取380人测定多个基因的29个位点多态性，检测基因多态性与职业压力的交互作用，筛选抗压力基因。结果：职业压力得分为32.28±11.21，职业倦怠得分为24.26±13.40，职业压力、职业倦怠和情感状态均高度相关（p<0.05）；职业压力与认知总分负相关（r=-0.237，p<0.01），其中主要损伤即刻记忆（r=-0.297，p<0.01）和注意功能（r=-0.275，p<0.01），但对视觉广度、言语功能、延时记忆和执行功能无显著影响；职业压力和倦怠与血清BDNF浓度负相关（r=-0.216，p<0.05；r=-0.245，p<0.01），进一步检验发现BDNF浓度是职业压力与认知功能之间的中介变量；职业倦怠与SOD和GSH-px活力显著正相关（r=0.183，p<0.05；r=0.189，p<0.05）；调节效应检测结果显示，BDNF、5-HTT、CLOCK、CRHR1和NOS1基因多态性与职业压力存在交互作用。结论：职业压力和倦怠会导致认知功能损伤，长期慢性职业压力会引发职业倦怠，而不同个体在相同环境中的应激反应也不相同，BDNF、5-HTT等基因相关位点的多态性与职业压力有交互作用。

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