Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Inflamm Bowel Dis. 2021 Oct 20;27(11):1740-1746. doi: 10.1093/ibd/izaa338.
Fatigue is a disabling symptom in patients with inflammatory bowel disease (IBD). Its prevalence, mechanism, and impact remain poorly understood. We determined changes in fatigue status over time and identified predictors of incident or resolving fatigue.
This was a prospective study nested within the IBD Partners cohort. Participants prospectively completed the Multidimensional Fatigue Inventory and the Functional Assessment of Chronic Illness Therapy-Fatigue at baseline, 6 months, and 12 months. A Functional Assessment of Chronic Illness Therapy-Fatigue score ≤43 defined significant fatigue. Multivariable regression models using baseline covariates were used to identify risk factors for incident fatigue at 6 months and to predict the resolution of fatigue.
A total of 2429 patients (1605 with Crohn disease, 824 with ulcerative colitis) completed a baseline assessment, and 1057 completed a second assessment at 6 months. Persistent fatigue (at baseline and at 6 months) was the most common pattern, affecting two-thirds (65.8%) of patients. One-sixth (15.7%) of patients had fatigue at 1 timepoint, whereas fewer than one-fifth (18.5%) of patients never reported fatigue. Among patients not fatigued at baseline, 26% developed fatigue at 6 months. The strongest predictor of incident fatigue was sleep disturbance at baseline (odds ratio, 2.91; 95% confidence interval, 1.48-5.72). In contrast, only 12.3% of those with fatigue at baseline had symptom resolution by month 6. Resolution was more likely in patients with a diagnosis of ulcerative colitis, quiescent disease, and an absence of significant psychological comorbidity.
Fatigue is common in patients with IBD. However, only a few fatigued patients experience symptom resolution at 6 or 12 months, suggesting the need for novel interventions to ameliorate its impact.
疲劳是炎症性肠病（IBD）患者的一种致残症状。其患病率、机制和影响仍知之甚少。我们确定了随时间推移疲劳状况的变化，并确定了发生或缓解疲劳的预测因素。
这是一项嵌套在 IBD 伙伴队列中的前瞻性研究。参与者前瞻性地在基线、6 个月和 12 个月时完成多维疲劳量表和慢性疾病治疗疲劳功能评估。功能评估慢性疾病治疗疲劳评分≤43 定义为显著疲劳。使用基线协变量的多变量回归模型，用于确定 6 个月时发生疲劳的风险因素，并预测疲劳的缓解。
共有 2429 名患者（1605 名克罗恩病患者，824 名溃疡性结肠炎患者）完成了基线评估，1057 名患者在 6 个月时完成了第二次评估。持续性疲劳（在基线和 6 个月时）是最常见的模式，影响了三分之二（65.8%）的患者。六分之一（15.7%）的患者在一个时间点出现疲劳，而不到五分之一（18.5%）的患者从未报告过疲劳。在基线时无疲劳的患者中，26%在 6 个月时出现疲劳。发生疲劳的最强预测因素是基线时的睡眠障碍（优势比，2.91；95%置信区间，1.48-5.72）。相比之下，只有 12.3%的基线疲劳患者在第 6 个月时症状缓解。在溃疡性结肠炎、疾病静止和无明显心理合并症的患者中，缓解的可能性更大。
疲劳在 IBD 患者中很常见。然而，只有少数疲劳患者在 6 或 12 个月时出现症状缓解，这表明需要新的干预措施来减轻其影响。
