Gong Shan-Shan, Fan Yi-Hong, Lv Bin, Zhang Mie-Qing, Xu Yi, Zhao Jing
Department of Gastroenterology, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China.
Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China.
World J Gastroenterol. 2021 Mar 21;27(11):1076-1089. doi: 10.3748/wjg.v27.i11.1076.
Fatigue is a very common but relatively neglected problem in patients with inflammatory bowel disease (IBD). The prevalence rate of IBD in China is the highest in Asia, but there is little research on fatigue in patients with IBD. Neither the relationship between fatigue and quality of life (QoL) nor the relationship between fatigue and work productivity (WP) in Chinese IBD patients has been reported.
To investigate the prevalence of fatigue related to IBD in Eastern China, to identify the risk factors associated with fatigue, to assess the impact of fatigue on QoL, and to evaluate the relationship between fatigue and WP.
A cross-sectional study was conducted in a Regional Tertiary IBD Diagnostic and Treatment Center in Eastern China. Clinical data of patients were collected, and disease activity was evaluated. Blood samples were analyzed to assess anemia, albumin, and inflammation. Fatigue was assessed using the multidimensional fatigue inventory. QoL and WP were measured using the short inflammatory bowel disease questionnaire and the work productivity and activity impairment general health questionnaire, respectively. The patients also completed assessments of depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder 7-item Scale).
A total of 311 IBD patients, comprising 168 Crohn's disease patients and 143 ulcerative colitis patients, were enrolled. The prevalence of fatigue in patients with IBD was 60.77%. In a univariate logistic regression analysis, factors such as disease activity, depression, anxiety, anemia, and IBD-related surgery were individually related to a significantly increased risk of fatigue in IBD patients. Multivariate logistic regression analysis indicated that depression [odds ratio (OR) = 8.078, 95% confidence interval (CI): 4.113-15.865], anxiety (OR = 2.373, 95%CI: 1.100-5.119), anemia (OR = 2.498, 95%CI: 1.290-4.834), and IBD-related surgery (OR = 2.035, 95%CI: 1.084-3.819) were related to fatigue in IBD patients. There was a negative correlation between fatigue and QoL ( = -0.831; < 0.0001) but a positive correlation between fatigue and WP loss.
The prevalence of fatigue in IBD patients in Eastern China is remarkably high even in clinical remission. Factors such as depression, anxiety, anemia, and IBD-related surgery are major risk factors for fatigue in IBD patients. In addition, fatigue has a negative impact on QoL and is positively correlated with WP loss.
疲劳是炎症性肠病（IBD）患者中非常常见但相对被忽视的问题。中国IBD的患病率在亚洲最高，但对IBD患者疲劳的研究较少。中国IBD患者中疲劳与生活质量（QoL）之间的关系以及疲劳与工作效率（WP）之间的关系均未见报道。
调查中国东部地区IBD相关疲劳的患病率，确定与疲劳相关的危险因素，评估疲劳对QoL的影响，并评估疲劳与WP之间的关系。
在华东地区一家区域性三级IBD诊断和治疗中心进行了一项横断面研究。收集患者的临床资料，并评估疾病活动度。分析血样以评估贫血、白蛋白和炎症情况。使用多维疲劳量表评估疲劳程度。分别使用简短炎症性肠病问卷和工作效率与活动障碍综合健康问卷测量QoL和WP。患者还完成了抑郁（患者健康问卷-9）和焦虑（广泛性焦虑障碍7项量表）评估。
共纳入311例IBD患者，其中克罗恩病患者168例，溃疡性结肠炎患者143例。IBD患者中疲劳的患病率为60.77%。单因素逻辑回归分析显示，疾病活动度、抑郁、焦虑、贫血和IBD相关手术等因素分别与IBD患者疲劳风险显著增加相关。多因素逻辑回归分析表明，抑郁[比值比（OR）=8.078，95%置信区间（CI）：4.113 - 15.865]、焦虑（OR = 2.373，95%CI：1.100 - 5.119）、贫血（OR = 2.498，95%CI：1.290 - 4.834）和IBD相关手术（OR = 2.035，95%CI：1.084 - 3.819）与IBD患者的疲劳相关。疲劳与QoL呈负相关（ = -0.831； < 0.0001），但与WP损失呈正相关。
中国东部地区IBD患者即使在临床缓解期疲劳患病率也非常高。抑郁、焦虑、贫血和IBD相关手术等因素是IBD患者疲劳的主要危险因素。此外，疲劳对QoL有负面影响，且与WP损失呈正相关。
