系统性硬化症患者疲劳的社会人口学、疾病及症状相关因素：来自659名加拿大硬皮病研究组登记患者样本的证据

Sociodemographic, disease, and symptom correlates of fatigue in systemic sclerosis: evidence from a sample of 659 Canadian Scleroderma Research Group Registry patients.

作者信息

Thombs Brett D, Hudson Marie, Bassel Marielle, Taillefer Suzanne S, Baron Murray

机构信息

McGill University and Jewish General Hospital, Montreal, Quebec, Canada.

出版信息

Arthritis Rheum. 2009 Jul 15;61(7):966-73. doi: 10.1002/art.24614.

DOI:10.1002/art.24614

PMID:19565539

Abstract

OBJECTIVE

To assess fatigue levels and demographic, socioeconomic, disease, and psychosocial correlates of fatigue in patients with systemic sclerosis (SSc).

METHODS

We conducted a cross-sectional, multicenter study of 659 patients with SSc from the Canadian Scleroderma Research Group Registry. Fatigue was assessed during annual Registry visits with the Short Form 36 (SF-36) health survey vitality subscale. Patients completed measures of depressive symptoms and pain and underwent clinical histories and medical examinations. Kendall's tau was used to assess bivariate association of sociodemographic, medical, and psychosocial variables with fatigue. Multivariable associations of demographic (step 1), socioeconomic (step 2), global disease (step 3), specific disease and lifestyle (step 4), and psychosocial (step 5) factors with fatigue were assessed using hierarchical multiple linear regression.

RESULTS

The mean +/- SD score of the patients on the SF-36 vitality subscale was 45.6 +/- 10.8, substantially lower (indicating more fatigue) than the mean +/- SD score for the Canadian general population (65.8 +/- 18.0). In multivariate analysis, higher fatigue was significantly associated with the number of medical comorbidities (standardized beta = -0.11, P = 0.004), breathing problems (standardized beta = -0.23, P < 0.001), the number of gastrointestinal (GI) symptoms (standardized beta = -0.27, P < 0.001), and current smoking (standardized beta = -0.08, P = 0.018). As a group, specific symptom and lifestyle variables predicted the most incremental variance in fatigue (R(2) = 21.6%, P < 0.001), despite being added to the model after demographic, socioeconomic, and global disease duration/severity indicators. Symptoms of depression (beta = -0.42) and pain (beta = -0.21) were also independently associated with fatigue (P < 0.001).

CONCLUSION

High levels of fatigue are common in patients with SSc and are independently associated with clinical variables, including number of comorbidities, breathing problems, GI symptoms, and smoking.

摘要

目的

评估系统性硬化症（SSc）患者的疲劳水平以及疲劳与人口统计学、社会经济、疾病和心理社会因素之间的相关性。

方法

我们对加拿大硬皮病研究组登记处的659例SSc患者进行了一项横断面多中心研究。在每年登记随访时，使用简短健康调查问卷36项（SF-36）健康调查活力子量表评估疲劳情况。患者完成抑郁症状和疼痛测量，并接受临床病史询问和体格检查。使用肯德尔tau系数评估社会人口统计学、医学和心理社会变量与疲劳的双变量关联。使用分层多元线性回归评估人口统计学（第一步）、社会经济因素（第二步）、整体疾病（第三步）、特定疾病和生活方式（第四步）以及心理社会因素（第五步）与疲劳的多变量关联。

结果

患者在SF-36活力子量表上的平均±标准差得分为45.6±10.8，显著低于加拿大普通人群的平均±标准差得分（65.8±18.0）（表明疲劳程度更高）。在多变量分析中，更高的疲劳程度与合并症数量（标准化β=-0.11，P=0.004）、呼吸问题（标准化β=-0.23，P<0.001）、胃肠道（GI）症状数量（标准化β=-0.27，P<0.001）以及当前吸烟情况（标准化β=-0.08，P=0.018）显著相关。作为一个整体，特定症状和生活方式变量预测了疲劳中最大的增量方差（R²=21.6%，P<0.001），尽管它们是在人口统计学、社会经济和整体疾病持续时间/严重程度指标之后加入模型的。抑郁症状（β=-0.42）和疼痛（β=-0.21）也与疲劳独立相关（P<0.001）。