Matsuda Toshiaki, Taniguchi Hiroyuki, Ando Masahiko, Kondoh Yasuhiro, Kimura Tomoki, Kataoka Kensuke, Nishimura Koichi, Nishiyama Osamu, Sakamoto Koji, Hasegawa Yoshinori
Department of Respiratory Medicine and Allergy, Tosei General Hospital, Japan.
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan.
Intern Med. 2017;56(13):1637-1644. doi: 10.2169/internalmedicine.56.7019. Epub 2017 Jul 1.
Objective Depression is reported to be relatively common in idiopathic pulmonary fibrosis (IPF) patients. Thus far, however, whether or not depression independently determines the health-related quality of life (HRQOL) has not been evaluated exclusively in IPF patients. We designed this study to identify independent determinants of the St. George' s Respiratory Questionnaire (SGRQ) score among various factors, including a depression scale, in IPF patients. Methods We retrospectively analyzed consecutive subjects with IPF who completed a systematic evaluation including pulmonary function tests, PaO at rest, 6-minute walk test (6MWT), SGRQ, Baseline Dyspnea Index (BDI), and Hospital Anxiety and Depression Scale (HADS). All eligible patients in the present study had newly diagnosed IPF and had not received any prior treatments, such as antidepressants, pirfenidone, corticosteroids, immunosuppressants, or long-term oxygen therapy. Results The 121 patients with IPF included 99 men. On the SGRQ, mild to moderate disturbance was observed in the total and each component score. According to the HADS, 27 patients (22.3%) had borderline or definite depression. In a univariate regression analysis, the forced vital capacity (FVC), diffusion capacity of carbon monoxide (DLco), PaO at rest, BDI, HADS for Anxiety (HADS-A) and Depression (HADS-D), 6-minute walk distance (6MWD), and lowest SpO during the 6MWT were significantly correlated with the SGRQ total score. In a stepwise multiple regression model, BDI, 6MWD, and HADS-D were selected as independent determinants of the total SGRQ score. The total variance in this model was 59% (p<0.001). Conclusion We concluded that depression was a significant determinant of the HRQOL or health status in patients with IPF.
目的 据报道，抑郁症在特发性肺纤维化（IPF）患者中相对常见。然而，迄今为止，抑郁症是否独立决定健康相关生活质量（HRQOL）尚未在IPF患者中进行专门评估。我们设计本研究以确定IPF患者各种因素（包括抑郁量表）中圣乔治呼吸问卷（SGRQ）评分的独立决定因素。方法 我们回顾性分析了连续的IPF患者，这些患者完成了包括肺功能测试、静息PaO、6分钟步行试验（6MWT）、SGRQ、基线呼吸困难指数（BDI）和医院焦虑抑郁量表（HADS）在内的系统评估。本研究中所有符合条件的患者均为新诊断的IPF患者，且未接受过任何先前治疗，如抗抑郁药、吡非尼酮、皮质类固醇、免疫抑制剂或长期氧疗。结果 121例IPF患者中包括99例男性。在SGRQ上，观察到总分及各分量表得分有轻度至中度紊乱。根据HADS，27例患者（22.3%）有临界或明确的抑郁。在单因素回归分析中，用力肺活量（FVC）、一氧化碳弥散量（DLco）、静息PaO、BDI、焦虑HADS（HADS-A）和抑郁HADS（HADS-D）、6分钟步行距离（6MWD）以及6MWT期间的最低SpO与SGRQ总分显著相关。在逐步多元回归模型中，BDI、6MWD和HADS-D被选为SGRQ总分的独立决定因素。该模型的总方差为59%（p<0.001）。结论 我们得出结论，抑郁症是IPF患者HRQOL或健康状况的重要决定因素。
