Häuser Winfried, Dietz Nadine, Steder-Neukamm Ulf, Janke Karl-Heinz, Stallmach Andreas
Department of Internal Medicine I, Klinikum Saarbrücken, D-66119 Saarbrücken, Germany.
Inflamm Bowel Dis. 2004 Jul;10(4):399-407. doi: 10.1097/00054725-200407000-00011.
In patients with ileal pouch anal anastomosis (IPAA) the influences of psychosocial variables and of extraintestinal manifestations of ulcerative colitis (UC) on health-related quality of life (HRQOL) have not been studied so far.
61 patients with UC (age 52.7+/-13.9 years; 47% female) completed the German version of the Inflammatory Bowel Disease Questionnaire (IBDQ-D), the Short Form Health Survey (SF - 36), the German version of the Hospital Anxiety and Depression Scale (HADS-D) and the Giessener Symptom List (GBB 24). Independent of their current clinical activity 37 patients underwent endoscopies. Pouchitis was defined by the Pouch Disease Activity Score (PDAI) > or = 7. Where possible, IPAA-patients were compared with the data for the German general population and with a clinical sample of patients with UC and no IPAA.
Patients with IPAA complained more about fatigue and arthralgia and a reduced physical and mental health (SF-36) than the German general population (P < 0.01). The IBDQ-total score could be predicted (adjusted R2 = 29.1, P < 0.01) by the number of operations due to IPAA-related complications (beta = -18.8) and HADS-D-Anxiety scores > or = 11 (beta = -29.1). The IBDQ-subscale score "Bowel" could be predicted (adjusted R2 = 13.7, P = 0.04) by PDAI > or = 7 (beta = -9.2) and the subscale score "Systemic" (adjusted R2 = 13.3, P = 0.04) by the number of extraintestinal manifestations (beta = -1.9).
HRQOL of patients with UC and IPAA is determined not only by IPAA-related factors but also by anxiety and extraintestinal manifestations with associated musculoskeletal pain.
迄今为止，尚未研究回肠储袋肛管吻合术（IPAA）患者中社会心理变量及溃疡性结肠炎（UC）肠外表现对健康相关生活质量（HRQOL）的影响。
61例UC患者（年龄52.7±13.9岁；47%为女性）完成了德文版炎症性肠病问卷（IBDQ-D）、简短健康调查（SF-36）、德文版医院焦虑抑郁量表（HADS-D）及吉森症状清单（GBB 24）。37例患者不论当前临床活动状态均接受了内镜检查。袋炎由袋病活动评分（PDAI）≥7定义。尽可能将IPAA患者的数据与德国普通人群的数据以及无IPAA的UC患者临床样本的数据进行比较。
与德国普通人群相比，IPAA患者更多地抱怨疲劳、关节痛以及身心健康下降（SF-36）（P<0.01）。IBDQ总分可由因IPAA相关并发症导致的手术次数（β=-18.8）及HADS-D焦虑评分≥11（β=-29.1）预测（调整后R2=29.1，P<0.01）。IBDQ子量表“肠道”得分可由PDAI≥7（β=-9.2）预测（调整后R2=13.7，P=0.04），子量表“全身”得分可由肠外表现的数量（β=-1.9）预测（调整后R2=13.3，P=0.04）。
UC和IPAA患者的HRQOL不仅由IPAA相关因素决定，还由焦虑及伴有肌肉骨骼疼痛的肠外表现决定。
