轻度创伤性脑损伤后的功能性躯体综合征病史及持续症状
History of Functional Somatic Syndromes and Persistent Symptoms After Mild Traumatic Brain Injury.
作者信息
Green Katherine, Cairncross Molly, Panenka William J, Stubbs Jacob L, Silverberg Noah D
机构信息
Department of Psychiatry (Green, Panenka, Stubbs), and Department of Psychology (Silverberg), University of British Columbia, Vancouver, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, Canada (Panenka, Stubbs); British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, Canada (Panenka); Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada (Cairncross, Silverberg); and Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada (Cairncross, Silverberg).
出版信息
J Neuropsychiatry Clin Neurosci. 2021 Spring;33(2):109-115. doi: 10.1176/appi.neuropsych.20060159. Epub 2020 Nov 18.
OBJECTIVE
Somatization is thought to underlie functional somatic syndromes (FSSs) and may also contribute to prolonged symptoms after mild traumatic brain injury (mTBI). The investigators evaluated the prevalence of FSSs in patients seeking specialty care after mTBI and whether a history of FSSs was associated with symptom persistence.
METHODS
A total of 142 patients with mTBI completed questionnaires regarding demographic information, injury characteristics, and medical history, including history of diagnosed FSSs at clinic intake (mean=41 days postinjury [SD=22.41]). Postconcussion symptoms were assessed at clinic intake and again 1 and 3 months later. A linear mixed-effects model was used to determine whether history of FSSs was related to persistent mTBI symptoms over time.
RESULTS
A history of at least one FSS was reported by 20.4% of patients. In the linear mixed model, postconcussion symptom scores were not significantly different over time among patients with a history of one or more FSSs or two or more FSSs from those with no FSSs. A history of one or more FSSs or two or more FSSs (versus no FSS) was not associated with increased odds of severe postconcussion symptoms at clinic intake (one or more FSSs: odds ratio=0.88, 95% CI=0.38-2.03; two or more FSSs: odds ratio=1.78, 95% CI=0.45-7.03), at the 1-month follow-up visit (one or more FSSs: odds ratio=0.57, 95% CI=0.22-1.45; two or more FSSs: odds ratio=0.57, 95% CI=0.14-2.37), or at the 3-month follow-up visit (one or more FSSs: odds ratio=0.97, 95% CI=0.36-2.63; two or more FSSs: odds ratio=1.27, 95% CI=0.29-5.65).
CONCLUSIONS
In this sample, the prevalence rates of FSSs were higher than rates previously reported for the general population. However, FSS history did not predict higher postconcussion symptom burden at clinic intake or persistence over the following 3 months. Further research is needed to clarify the potential role of somatization in poor mTBI outcome.
目的
躯体化被认为是功能性躯体综合征（FSSs）的潜在原因，也可能导致轻度创伤性脑损伤（mTBI）后症状持续时间延长。研究人员评估了mTBI后寻求专科护理的患者中FSSs的患病率，以及FSSs病史是否与症状持续存在相关。
方法
共有142例mTBI患者完成了关于人口统计学信息、损伤特征和病史的问卷调查，包括在诊所就诊时（受伤后平均41天[标准差=22.41]）诊断为FSSs的病史。在诊所就诊时以及1个月和3个月后再次评估脑震荡后症状。使用线性混合效应模型来确定FSSs病史是否随时间与持续性mTBI症状相关。
结果
20.4%的患者报告有至少一种FSSs病史。在线性混合模型中，有1种或更多FSSs病史或2种或更多FSSs病史的患者与无脑震荡后症状的患者相比，脑震荡后症状评分随时间无显著差异。有1种或更多FSSs病史或2种或更多FSSs病史（与无FSSs相比）与诊所就诊时（1种或更多FSSs：比值比=0.88，95%可信区间=0.38-2.03；2种或更多FSSs：比值比=1.78，95%可信区间=0.45-7.03）、1个月随访时（1种或更多FSSs：比值比=0.57，95%可信区间=0.22-1.45；2种或更多FSSs：比值比=0.57，95%可信区间=0.14-2.37）或3个月随访时（1种或更多FSSs：比值比=0.97，95%可信区间=0.36-2.63；2种或更多FSSs：比值比=1.27，95%可信区间=0.29-5.65）严重脑震荡后症状的几率增加无关。
结论
在本样本中，FSSs的患病率高于先前报道的一般人群患病率。然而，FSSs病史并不能预测诊所就诊时更高的脑震荡后症状负担或接下来3个月内的症状持续情况。需要进一步研究以阐明躯体化在mTBI不良预后中的潜在作用。
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