Smith Wally R, Bauserman Robert L, Ballas Samir K, McCarthy William F, Steinberg Martin H, Swerdlow Paul S, Waclawiw Myron A, Barton Bruce A
Virginia Commonwealth University, Internal Medicine - Division of Quality Health Care, 1200 E. Broad St. Richmond, VA 23298, USA.
Pain. 2009 Nov;146(1-2):91-8. doi: 10.1016/j.pain.2009.07.008. Epub 2009 Aug 14.
No multi-site comparisons have tested whether seasonally cold temperature or climate exacerbate pain intensity in sickle cell disease (SCD). We examined seasonal SCD pain intensity and frequency patterns and compared them with concurrent climate conditions (temperature and barometric pressure) and geography of patient residence in the Multicenter Study of Hydroxyurea (MSH). We conducted a time series analysis of the monthly average daily pain intensity (0-9 scale) and pain frequency of the 299 MSH patients from December 1991 to December 1994. We used both an unobserved component model (UCM) and a nonparametric local regression (LOESS) to probe for a cycle and/or trend associated with the time series. We also examined base mixed regression models of season, monthly average temperature and barometric pressure, and geographic region as stand-alone predictors of pain intensity and frequency. Expanded models included additional predictor variables. UCM and LOESS analyses showed a cyclic pattern of pain intensity and frequency with peaks in late Fall/early Winter and troughs in Spring. Base regression models showed colder seasons were significantly associated with greater pain intensity (p = .0035) but not frequency (p = .07); higher monthly temperatures were significantly associated with both lower pain intensity and pain frequency, but higher monthly barometric pressures were significantly associated with greater pain intensity and frequency (all p's < .0001); and northern sites had nonsignificantly higher pain intensity (p = .40) and frequency (p = .07) than southern sites. This pattern of results did not change in expanded models including other predictors. Our results suggest that seasonably colder temperatures exacerbate sickle cell-related pain, but low barometric pressure does not, and geographic region of residence is not significantly related to pain in this sample.
尚无多中心比较研究检验季节性低温或气候是否会加剧镰状细胞病（SCD）的疼痛强度。在羟基脲多中心研究（MSH）中，我们研究了SCD疼痛强度和频率的季节性模式，并将其与同期气候条件（温度和气压）以及患者居住地理位置进行比较。我们对1991年12月至1994年12月期间299名MSH患者的月平均每日疼痛强度（0 - 9级）和疼痛频率进行了时间序列分析。我们使用未观察成分模型（UCM）和非参数局部回归（LOESS）来探究与时间序列相关的周期和/或趋势。我们还检验了季节、月平均温度和气压以及地理区域作为疼痛强度和频率独立预测因素的基础混合回归模型。扩展模型纳入了其他预测变量。UCM和LOESS分析显示疼痛强度和频率呈周期性模式，在秋末/初冬达到峰值，在春季达到低谷。基础回归模型显示较冷季节与更高的疼痛强度显著相关（p = .0035），但与疼痛频率无关（p = .07）；月温度升高与更低的疼痛强度和疼痛频率均显著相关，但月气压升高与更高的疼痛强度和频率显著相关（所有p值 < .0001）；北部地区的疼痛强度（p = .40）和频率（p = .07）略高于南部地区，但差异不显著。在纳入其他预测因素的扩展模型中，这种结果模式没有改变。我们的结果表明，季节性低温会加剧镰状细胞相关疼痛，但低气压不会，并且在该样本中居住地理位置与疼痛无显著相关性。
