Petersen Irene, Noelle Janka, Buchholz Angela, Kroencke Sylvia, Daseking Monika, Grabhorn Enke
Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Pediatr Transplant. 2019 Feb;23(1):e13331. doi: 10.1111/petr.13331. Epub 2018 Dec 26.
The aim of the study was to investigate the occurrence of fatigue in 100 pediatric liver transplant recipients aged 2-18 years and its impact on their health-related quality of life (HRQL). HRQL and fatigue were measured using the PedsQL 4.0 Inventory and the PedsQL Multidimensional Fatigue Scale, which encompasses three subscales: general fatigue, sleep/rest fatigue, and cognitive fatigue. The impact of the different domains of fatigue and of clinical and sociodemographic factors on the HRQL was identified with stepwise multiple regression analyses. Parent proxy-reports were available for all 100 participants (2-18 years), and child self-reports were available for 71 patients (8-18 years). Across all domains, participants and their parents reported significantly more fatigue than healthy peers in a large PedsQL validation study. Thirty-seven percent of patients and 57% of parents scored clinically relevant levels of fatigue. In the multiple regression analyses, none of the clinical and sociodemographic factors contributed to the HRQL for child self-report. Only general and cognitive fatigue were significant predictors of patients' HRQL, explaining 66% of the variance in the PedsQL total score. For parent proxy-report, general and cognitive fatigue also significantly predicted child's HRQL. Further predictors were child's age and family income. The regression model explained 65% of the variance. These findings demonstrate the importance of assessing fatigue during regular follow-up examinations. Further research is urgently needed to better understand the underlying mechanisms of fatigue. Improvement of fatigue symptoms is essential for better HRQL, for cognitive functioning, and for school achievement.
本研究的目的是调查100名2至18岁儿童肝移植受者疲劳的发生情况及其对他们健康相关生活质量（HRQL）的影响。使用儿童生活质量量表4.0（PedsQL 4.0 Inventory）和儿童生活质量多维疲劳量表（PedsQL Multidimensional Fatigue Scale）来测量HRQL和疲劳程度，该多维疲劳量表包含三个子量表：一般疲劳、睡眠/休息疲劳和认知疲劳。通过逐步多元回归分析确定疲劳的不同领域以及临床和社会人口学因素对HRQL的影响。所有100名参与者（2至18岁）均有家长代理报告，71名患者（8至18岁）有儿童自我报告。在一项大型儿童生活质量量表验证研究中，所有领域的参与者及其家长报告的疲劳程度均显著高于健康同龄人。37%的患者和57%的家长疲劳程度达到临床相关水平。在多元回归分析中，对于儿童自我报告，临床和社会人口学因素均未对HRQL产生影响。只有一般疲劳和认知疲劳是患者HRQL的显著预测因素，解释了儿童生活质量量表总分方差的66%。对于家长代理报告，一般疲劳和认知疲劳也显著预测了儿童的HRQL。其他预测因素是儿童年龄和家庭收入。回归模型解释了65%的方差。这些发现表明在定期随访检查中评估疲劳的重要性。迫切需要进一步研究以更好地理解疲劳的潜在机制。改善疲劳症状对于提高HRQL、认知功能和学业成绩至关重要。
