Spiegel Brennan M R, Gralnek Ian M, Bolus Roger, Chang Lin, Dulai Gareth S, Mayer Emeran A, Naliboff Bruce
Division of Gastroenterology, the VA Greater Los Angeles Healthcare System, CA 90073, USA.
Arch Intern Med. 2004 Sep 13;164(16):1773-80. doi: 10.1001/archinte.164.16.1773.
Current guidelines recommend routine assessment of health-related quality of life (HRQOL) in patients with irritable bowel syndrome (IBS). However, physicians rarely have the time to measure HRQOL with the appropriate methodological rigor, and data suggest that HRQOL in patients with IBS is often estimated using inaccurate clinical gestalt. The identification of predictive factors could allow physicians to better assess HRQOL without using misleading clinical clues. We, therefore, sought to identify determinants of HRQOL in patients with IBS.
We examined 770 patients, 18 years or older, with IBS at a university-based referral center. Subjects completed a symptom questionnaire, the Symptoms Checklist-90 items psychometric checklist, and the 36-Item Short-Form Health Survey. The main outcome was HRQOL as measured by the mental and physical component scores of the 36-Item Short-Form Health Survey. We first developed a list of hypothesis-driven HRQOL predictors, and then performed multivariate regression analysis to measure the independent association of each predictor with HRQOL.
Seven factors (r(2) = 0.39) independently predicted physical HRQOL: (1) more than 5 physician visits per year, (2) tiring easily, (3) low in energy, (4) severe symptoms, (5) predominantly painful symptoms, (6) the feeling that there is "something seriously wrong with body," and (7) symptom flares for longer than 24 hours. Eight factors (r(2) = 0.36) independently predicted mental HRQOL: (1) feeling tense, (2) feeling nervous, (3) feeling hopeless, (4) difficulty sleeping, (5) tiring easily, (6) low sexual interest, (7) IBS symptom interference with sexual function, and (8) low energy.
Health-related quality of life in patients with IBS is primarily related to extraintestinal symptoms rather than traditionally elicited gastrointestinal symptoms. These findings suggest that rather than focusing on physiological epiphenomena (stool characteristics and subtype of IBS) and potentially misleading clinical factors (age and disease duration), physicians might be better served to gauge global symptom severity, address anxiety, and eliminate factors contributing to chronic stress in patients with IBS.
当前指南建议对肠易激综合征（IBS）患者进行与健康相关的生活质量（HRQOL）常规评估。然而，医生很少有时间以适当严格的方法来测量HRQOL，并且数据表明IBS患者的HRQOL常通过不准确的临床整体印象来估计。识别预测因素可使医生在不使用误导性临床线索的情况下更好地评估HRQOL。因此，我们试图确定IBS患者HRQOL的决定因素。
我们在一家大学附属医院的转诊中心对770例18岁及以上的IBS患者进行了研究。受试者完成了一份症状问卷、90项症状自评量表心理测评清单以及36项简明健康状况调查。主要结局是通过36项简明健康状况调查的心理和生理成分得分来衡量的HRQOL。我们首先列出了一系列基于假设的HRQOL预测因素，然后进行多因素回归分析以测量每个预测因素与HRQOL的独立关联。
七个因素（r² = 0.39）独立预测生理HRQOL：（1）每年看医生超过5次，（2）容易疲劳，（3）精力不足，（4）症状严重，（5）主要为疼痛症状，（6）感觉“身体有严重问题”，（7）症状发作超过24小时。八个因素（r² = 0.36）独立预测心理HRQOL：（1）感到紧张，（2）感到焦虑，（3）感到绝望，（4）睡眠困难，（5）容易疲劳，（6）性兴趣低下，（7）IBS症状干扰性功能，（8）精力不足。
IBS患者与健康相关的生活质量主要与肠外症状有关，而非传统引发的胃肠道症状。这些发现表明，医生与其关注生理附带现象（粪便特征和IBS亚型）以及可能产生误导的临床因素（年龄和病程），不如更好地评估整体症状严重程度、解决焦虑问题并消除导致IBS患者慢性应激的因素。
