Stebbings Simon M, Treharne Gareth J, Jenks Katey, Highton John
Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, 9054, New Zealand,
Clin Rheumatol. 2014;33(10):1467-74. doi: 10.1007/s10067-013-2445-6. Epub 2013 Dec 10.
The study aimed to assess the severity of fatigue in patients with axial spondyloarthritis (AxSpA), to assess the performance of two different fatigue measures in AxSpA, and to examine disease variables which may influence the severity of fatigue. Fatigue was examined among 67 patients with AxSpA using two measures: the fatigue Visual Analogue Scale (VAS) from the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Multidimensional Assessment of Fatigue (MAF) score. These measures were tested for convergent validity using linear regression analysis. Correlations between fatigue measured using both questionnaires, and key disease variables was examined using the following assessments: BASDAI, Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, spondyloarthritis modification of the Dudley Inflammatory Bowel Symptom Questionnaire (DISQ) and pain VAS. Human leucocyte antigen (HLA) B27 and CRP were performed and followed by physical examination, Bath AS Metrology Index (BASMI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). Correlations were assessed using multivariate regression analysis. Mean (±SD) fatigue measured by MAF (range 0-50) was 24.7 (±11.5) and 5.14 (±2.47) on the BASDAI VAS fatigue item (range 0-10). The MAF scores and BASDAI VAS fatigue were strongly correlated (r = 0.71, P < 0.001), but 50 % of variance remained unexplained, so both were retained as separate variables in bivariate and multivariate analyses. In multivariate regression models, a significant relationship for both fatigue measures was consistently noted with DISQ bowel symptom scores. MAF fatigue scores were most strongly associated with poorer ASQoL in multivariate models and mediated the effects of BASFI functioning, ASDAS disease activity and HLA-B27 status that were apparent in multivariate models. Patients with AxSpA experience substantial fatigue, which is associated with poorer quality of life. Fatigue VAS and MAF scores were strongly correlated. Factors most strongly associated with fatigue were disease activity and inflammatory bowel symptoms.
该研究旨在评估中轴型脊柱关节炎（AxSpA）患者疲劳的严重程度，评估两种不同疲劳测量方法在AxSpA中的表现，并检查可能影响疲劳严重程度的疾病变量。使用两种测量方法对67例AxSpA患者的疲劳情况进行了检查：来自巴斯强直性脊柱炎疾病活动指数（BASDAI）的疲劳视觉模拟量表（VAS）和疲劳多维评估（MAF）评分。使用线性回归分析对这些测量方法的收敛效度进行了测试。使用以下评估方法检查了两种问卷测量的疲劳与关键疾病变量之间的相关性：BASDAI、巴斯强直性脊柱炎功能指数（BASFI）、强直性脊柱炎生活质量（ASQoL）问卷、达德利炎症性肠病症状问卷（DISQ）的脊柱关节炎修正版和疼痛VAS。检测了人类白细胞抗原（HLA）B27和CRP，并进行了体格检查、巴斯AS计量指数（BASMI）和强直性脊柱炎疾病活动评分（ASDAS）。使用多元回归分析评估相关性。MAF测量的平均（±标准差）疲劳（范围0 - 50）为24.7（± 11.5），在BASDAI VAS疲劳项目上为5.14（± 2.47）（范围0 - 10）。MAF评分与BASDAI VAS疲劳密切相关（r = 0.71，P < 0.001），但仍有50%的方差无法解释，因此在双变量和多变量分析中两者均作为独立变量保留。在多变量回归模型中，两种疲劳测量方法均与DISQ肠道症状评分存在显著关系。在多变量模型中，MAF疲劳评分与较差的ASQoL关联最为强烈，并介导了多变量模型中明显的BASFI功能、ASDAS疾病活动和HLA - B27状态的影响。AxSpA患者经历严重疲劳，这与较差的生活质量相关。疲劳VAS和MAF评分密切相关。与疲劳关联最强烈的因素是疾病活动和炎症性肠症状。
