系统性硬化症患者焦虑和抑郁的临床显著症状的临床、功能及健康相关生活质量相关性：一项横断面调查
Clinical, functional and health-related quality of life correlates of clinically significant symptoms of anxiety and depression in patients with systemic sclerosis: a cross-sectional survey.
作者信息
Nguyen Christelle, Ranque Brigitte, Baubet Thierry, Bérezné Alice, Mestre-Stanislas Caroline, Rannou François, Papelard Agathe, Morell-Dubois Sandrine, Revel Michel, Moro Marie-Rose, Guillevin Loïc, Poiraudeau Serge, Mouthon Luc
机构信息
Pôle de Médecine Interne, Centre de Référence pour les Vascularites Nécrosantes et la Sclérodermie Systémique, Hôpital Cochin, Faculté de Médecine Paris Descartes, Université Paris Descartes & Assistance Publique-Hôpitaux de Paris, Paris, France ; Service de Médecine Physique et Réadaptation, Hôpital Cochin, Faculté de Médecine Paris Descartes, Université Paris Descartes & Assistance Publique-Hôpitaux de Paris, INSERM, Institut Fédératif de Recherche sur le Handicap, Paris, France.
Service de Médecine Interne, Hôpital Européen Georges Pompidou, Faculté de Médecine Paris Descartes, Université Paris Descartes & Assistance Publique-Hôpitaux de Paris, Paris, France.
出版信息
PLoS One. 2014 Feb 28;9(2):e90484. doi: 10.1371/journal.pone.0090484. eCollection 2014.
OBJECTIVES
To identify clinical, functional and health-related quality of life (HRQoL) correlates of clinically significant symptoms of anxiety and depression in patients with systemic sclerosis (SSc).
METHODS
Three-hundred-and-eighty-one patients fulfilling the American College of Rheumatology and/or the Leroy and Medsger criteria for SSc were assessed for visceral involvement, disability and HRQoL (assessed by SF-36). Clinically significant symptoms of anxiety and depression were evaluated with the Hospital Anxiety Depression Scale (HAD) (defined cut-off≥8).
RESULTS
9.2% the patients had limited SSc, 50.5% limited cutaneous SSc (lcSSc), and 40.3% diffuse cutaneous SSc (dcSSc). Overall, 40.4% and 58.8% of the patients had clinically significant symptoms of depression and anxiety, respectively. Compared to patients without clinically significant symptoms of depression, patients with clinically significant symptoms of depression had poorer health status, HRQoL mental and physical component, and greater global disability, hand disability and aesthetic impairment. Compared to patients without clinically significant symptoms of anxiety, patients with clinically significant symptoms of anxiety had poorer SF-36 mental and physical component scores. On multivariable analysis, excluding mental component score of SF-36, variables independently associated with clinically significant symptoms of depression and anxiety were global disability and physical component of SF-36, plus female gender for clinically significant symptoms of anxiety only. Remarkably, patients with and without clinically significant psychiatric symptoms were comparable for all disease-related clinical features assessed.
CONCLUSION
High levels of clinically significant symptoms of anxiety and depression are observed among SSc patients. Clinically significant psychiatric symptoms are rather associated with increased disability and altered HRQoL, than with disease-specific organ manifestations.
目的
确定系统性硬化症（SSc）患者中焦虑和抑郁的临床显著症状与临床、功能及健康相关生活质量（HRQoL）之间的相关性。
方法
对381例符合美国风湿病学会和/或勒鲁瓦及梅兹格SSc标准的患者进行内脏受累情况、残疾程度及HRQoL（采用SF-36评估）评估。使用医院焦虑抑郁量表（HAD）（定义临界值≥8）评估焦虑和抑郁的临床显著症状。
结果
9.2%的患者为局限性SSc，50.5%为局限性皮肤型SSc（lcSSc），40.3%为弥漫性皮肤型SSc（dcSSc）。总体而言，分别有40.4%和58.8%的患者有抑郁和焦虑的临床显著症状。与无抑郁临床显著症状的患者相比，有抑郁临床显著症状的患者健康状况、HRQoL心理和生理成分较差，且整体残疾、手部残疾和美观受损程度更高。与无焦虑临床显著症状的患者相比，有焦虑临床显著症状患者的SF-36心理和生理成分得分较低。多变量分析显示，排除SF-36心理成分得分后，与抑郁和焦虑临床显著症状独立相关的变量为整体残疾和SF-36生理成分，仅焦虑临床显著症状还与女性性别相关。值得注意的是，有和无临床显著精神症状的患者在所有评估的疾病相关临床特征方面具有可比性
结论
SSc患者中观察到高水平的焦虑和抑郁临床显著症状。临床显著精神症状与残疾增加和HRQoL改变相关，而非与疾病特异性器官表现相关。
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