焦虑和抑郁相关的躯体症状与寰枢椎疾病：潜在机制联系及临床意义。

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中文摘要

背景： 焦虑和抑郁障碍常包括疼痛、头晕、头痛、疲劳、恶心和睡眠障碍。这些症状也可能出现在寰枢椎疾病中，但重叠并不能确立共同病因。
目的： 探讨临床或机制证据是否支持客观定义的寰枢椎疾病与焦虑或抑郁患者躯体症状负担之间的关联，同时区分直接证据与基于一般颈痛研究的推断。
方法： 检索PubMed/MEDLINE、Embase、Scopus、Web of Science核心合集和APA PsycInfo，检索时间自建库至2026年7月29日。进行了两项互补检索：第一项将寰枢椎/C1-C2疾病与焦虑、抑郁或躯体症状概念相结合，第二项将邻近颈椎疾病与相同的精神科和躯体症状概念相结合。证据被分类为直接或部分直接、邻近、机制推断或假设生成。由于人群、诊断和结局异质性较大，研究结果以叙述性方式综合，而非合并。
结果： 检索共获得8,882条记录，去重后剩余5,225条。仅有三项研究提供了部分直接证据，因为它们在同一个人群中同时纳入了上颈椎变量和精神科变量；两项使用基于影像的脊柱评估，而一项依赖行政诊断和操作代码。没有一项研究旨在调查躯体症状障碍，没有一项研究确立焦虑或抑郁导致结构性C1-C2疾病，也没有一项研究证明双向因果关系。一般颈痛研究支持心理困扰与疼痛相关结局之间的关联，而颈椎性头晕和本体感觉研究提供了可能的邻近机制。自主神经、中枢疼痛处理、炎症、睡眠相关和生物力学通路在寰枢椎疾病方面仍主要为间接或假设性。
结论： 寰枢椎疾病与焦虑或抑郁相关的躯体症状可能共存，并可能有重叠的临床表现。当前证据不足以量化特定关联或推断因果关系。临床评估应优先考虑神经和血管危险信号、C1-C2病理的客观定义、临床-影像学一致性、排除头晕的常见前庭和神经原因，并平行评估焦虑、抑郁、睡眠障碍、恐惧回避和躯体症状负担。需要使用标准化影像标准和经过验证的精神科测量工具的前瞻性研究。

英文摘要

BACKGROUND: Anxiety and depressive disorders often include pain, dizziness, headache, fatigue, nausea, and sleep disturbance. These symptoms may also occur in atlantoaxial disorders, but overlap does not establish a shared cause.
OBJECTIVE: To examine whether clinical or mechanistic evidence supports an association between objectively defined atlantoaxial disorders and somatic symptom burden in people with anxiety or depression, while distinguishing direct evidence from inferences based on general neck-pain research.
METHODS: PubMed/MEDLINE, Embase, Scopus, Web of Science Core Collection, and APA PsycInfo were searched from inception to 29 July 2026. Two complementary searches were conducted: the first combined atlantoaxial/C1-C2 conditions with anxiety, depression, or somatic-symptom concepts, and the second combined adjacent cervical conditions with the same psychiatric and somatic-symptom concepts. Evidence was classified as direct or partial-direct, adjacent, mechanistic inference, or hypothesis-generating. Because populations, diagnoses, and outcomes were heterogeneous, findings were synthesized narratively rather than pooled.
RESULTS: The searches retrieved 8,882 records, of which 5,225 remained after deduplication. Only three studies provided partial-direct evidence by including both an upper-cervical variable and a psychiatric variable in the same population; two used imaging-based spinal assessments, whereas one relied on administrative diagnosis and procedure codes. None was designed to investigate somatic symptom disorder, none established that anxiety or depression caused structural C1-C2 disease, and none demonstrated a bidirectional causal relationship. General neck-pain studies support associations between psychological distress and pain-related outcomes, while studies of cervical dizziness and proprioception provide possible adjacent mechanisms. Autonomic, central pain-processing, inflammatory, sleep-related, and biomechanical pathways remain predominantly indirect or hypothetical in relation to atlantoaxial disease.
CONCLUSIONS: Atlantoaxial disorders and anxiety- or depression-related somatic symptoms may coexist and may have overlapping clinical presentations. Current evidence is insufficient to quantify a specific association or infer causality. Clinical assessment should prioritize neurological and vascular red flags, objective definition of C1-C2 pathology, clinicoradiological concordance, exclusion of common vestibular and neurological causes of dizziness, and parallel assessment of anxiety, depression, sleep disturbance, fear avoidance, and somatic symptom burden. Prospective studies using standardized imaging criteria and validated psychiatric measures are needed.