Department of Gastroenterology & Hepatology, Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.
Centre of Physical Activity and Nutrition (C-PAN) Research, School of Exercise and Nutrition Science, Deakin University, Burwood, Victoria, Australia.
J Crohns Colitis. 2014 Feb;8(2):137-46. doi: 10.1016/j.crohns.2013.07.006. Epub 2013 Aug 12.
BACKGROUND & AIMS: The association of fatigue with decreased physical performance and underlying mechanisms are poorly understood in Crohn's disease (CD). We aimed to measure and compare self-reported fatigue with skeletal muscle fatigue in CD subjects and healthy controls, and to identify associated factors that may be amenable to change.
Demographic and clinical data were collected and fatigue assessed using the Fatigue Impact Scale (FIS) in 27 consecutive CD patients and 22 matched healthy controls. Circulating cytokines and growth factors were measured. The rate of quadriceps muscle fatigue was assessed using an isokinetic dynamometer as the decrement of force with 30 contractions performed over a 5-minute period.
Compared with healthy controls, CD patients reported greater levels of fatigue (mean global FIS score 45.3 vs 10.5, physical dimension score 12.3 vs 2.7 respectively; each p<0.01) and muscle fatigue (-5.2 vs -1.3 Nm min(-1); p<0.05). The two indices were correlated (r = -0.52 in CD; p<0.01). Patients with CD had lower mean serum IGF-1 levels (16.1 vs 25.4 pmol/L, p<0.01) and higher oxidative stress (TBARS assay 4.3 vs 3.9 μM, p<0.05). On multivariate analysis, low serum vitamin D, IGF-1 and magnesium, and higher IL-6 levels were associated with increased muscle fatigue (all p ≤ 0.05).
Subjects with CD had more muscle fatigue than matched healthy controls and this correlated well with self-reported fatigue. Of circulating factors that were independently associated with increased muscle fatigue, vitamin D, magnesium and IGF-1 could be targeted in future studies to reduce fatigue and improve physical performance.
在克罗恩病（CD）中，疲劳与身体机能下降之间的关系及其潜在机制尚未明确。本研究旨在测量并比较 CD 患者与健康对照者的自我报告疲劳与骨骼肌疲劳，并确定可能改善的相关因素。
连续纳入 27 例 CD 患者和 22 例匹配的健康对照者，收集其人口统计学和临床数据，并采用疲劳影响量表（FIS）评估疲劳。同时检测循环细胞因子和生长因子。采用等速测力计评估股四头肌疲劳，即连续 30 次收缩 5 分钟后肌力下降的程度。
与健康对照者相比，CD 患者的疲劳程度更高（总体 FIS 评分分别为 45.3 分比 10.5 分，体力维度评分分别为 12.3 分比 2.7 分；p<0.01），且肌肉疲劳更明显（-5.2 分比-1.3 Nm min(-1)；p<0.05）。这两个指标呈正相关（在 CD 患者中 r = -0.52，p<0.01）。CD 患者的血清 IGF-1 水平更低（16.1 分比 25.4 pmol/L，p<0.01），氧化应激更高（TBARS 检测法 4.3 分比 3.9 μM，p<0.05）。多变量分析显示，血清维生素 D、IGF-1 和镁较低，以及 IL-6 水平较高与肌肉疲劳增加相关（p 均≤0.05）。
CD 患者的肌肉疲劳比匹配的健康对照者更明显，且与自我报告的疲劳相关性良好。在与肌肉疲劳独立相关的循环因子中，维生素 D、镁和 IGF-1 可能是未来研究中减轻疲劳和提高身体机能的靶点。
