Claassen-van Dessel Nikki, van der Wouden Johannes C, Dekker Joost, Rosmalen Judith G M, van der Horst Henriëtte E
Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, The Netherlands.
Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, The Netherlands.
J Psychosom Res. 2017 Aug;99:130-136. doi: 10.1016/j.jpsychores.2017.06.010. Epub 2017 Jun 15.
We aimed to assess the cross-sectional relation between levels of cortisol and specific symptom clusters, symptom severity and duration of symptoms in patients with medically unexplained physical symptoms (MUPS).
Baseline data of a cohort of MUPS patients were used. We chose the Cortisol Awakening Response (CAR) as a cortisol parameter, using saliva samples. We used confirmatory factor analysis for the identification of 4 specific symptom clusters: (1) gastro-intestinal symptoms; (2) pain; (3) cardio-pulmonary symptoms; and (4) fatigue. For this factor analysis we used the Physical Symptom Questionnaire (PSQ), which assesses the occurrence and frequency of 51 physical symptoms. Symptom severity was measured with the Patient Health Questionnaire-15 (PHQ-15). Duration of symptoms was based on self-reported duration of top 3 symptoms. We performed multiple linear regression to assess relations between CAR and individual factor scores on symptom clusters, symptom severity and duration of symptoms.
Data from 296 patients (76% female) were included in the analyses. The majority of patients suffered from symptoms in multiple organ systems. Factor analysis confirmed that the model with 4 symptom clusters fitted our data. For the total study population, we found no significant relation between CAR and participants' factor scores on any of the symptom clusters. We also found no significant relations between CAR and severity or duration of symptoms.
Our results suggest that within a heterogeneous MUPS population there is no relation between CAR and symptom severity and duration. However, more studies are needed to confirm our findings.
我们旨在评估医学上无法解释的身体症状（MUPS）患者中皮质醇水平与特定症状群、症状严重程度及症状持续时间之间的横断面关系。
使用了一组MUPS患者的基线数据。我们选择皮质醇觉醒反应（CAR）作为皮质醇参数，采用唾液样本。我们使用验证性因素分析来识别4个特定症状群：（1）胃肠道症状；（2）疼痛；（3）心肺症状；以及（4）疲劳。对于该因素分析，我们使用了身体症状问卷（PSQ），该问卷评估51种身体症状的发生情况和频率。症状严重程度用患者健康问卷-15（PHQ-15）进行测量。症状持续时间基于自我报告的前3种症状的持续时间。我们进行了多元线性回归，以评估CAR与症状群的个体因素得分、症状严重程度及症状持续时间之间的关系。
296名患者（76%为女性）的数据纳入了分析。大多数患者患有多个器官系统的症状。因素分析证实，具有4个症状群的模型符合我们的数据。对于整个研究人群，我们发现CAR与任何症状群的参与者因素得分之间均无显著关系。我们还发现CAR与症状严重程度或持续时间之间也无显著关系。
我们的结果表明，在异质性的MUPS人群中，CAR与症状严重程度及持续时间之间没有关系。然而，需要更多研究来证实我们的发现。
