炎症性肠病的疾病严重程度指数与心理症状和生活质量相关，并可预测更复杂的疾病进程。
The disease severity index for inflammatory bowel disease is associated with psychological symptoms and quality of life, and predicts a more complicated disease course.
机构信息
Department of Medicine, University of Otago, Christchurch, New Zealand.
Department of Gastroenterology, Christchurch hospital, Christchurch, New Zealand.
出版信息
Aliment Pharmacol Ther. 2022 Aug;56(4):664-674. doi: 10.1111/apt.17058. Epub 2022 May 27.
BACKGROUND
The Disease Severity Index (DSI) is a novel tool to predict disease severity in inflammatory bowel disease (IBD). However, its ability to predict disease complications and the presence of psychosocial comorbidity is unclear.
AIMS
To assess prospectively associations between the DSI and psychological symptoms, quality-of-life (QoL) and disease outcomes in an IBD cohort.
METHODS
Patients with IBD undergoing ileocolonoscopy were followed prospectively for 12 months. DSI, psychological symptoms (perceived stress (PSS-10), depression (PHQ-9), anxiety (GAD-7)) and QoL (IBDQ-32) scores were assessed at baseline. Logistic regression identified variables predicting a complicated IBD course at 12 months (composite outcome of need for escalation of biological/immunomodulator for disease relapse, recurrent corticosteroid use, IBD-related hospitalisation and surgery). Receiver operating characteristics (ROC) analysis identified optimal DSI thresholds predicting a complicated disease course and multivariable logistic regression assessed the risk of reaching this outcome.
RESULTS
One hundred and seventy-two patients were recruited (100 Crohn's disease, 91 female). Median DSI was 21 (IQR 11-32) and 97 patients had endoscopically active disease at baseline. The DSI was significantly higher in patients with symptoms of moderate-severe stress (PSS-10 > 14, p < 0.01), depression (PHQ-9 ≥ 10, p < 0.01), anxiety (GAD-7 ≥ 10, p < 0.05) and impaired quality-of-life (IBDQ-32 < 168, p < 0.01). Only the baseline DSI (OR 1.05, p < 0.01) and endoscopically active disease (OR 6.12, p < 0.01) were associated with a complicated IBD course. A DSI > 23 was strongly predictive of a complicated IBD course (OR 8.31, p < 0.001).
CONCLUSIONS
The DSI is associated with psychological distress, impaired QoL and predicts a more complicated disease course in patients with IBD.
背景
疾病严重程度指数（DSI）是一种预测炎症性肠病（IBD）疾病严重程度的新工具。然而，其预测疾病并发症和存在心理社会共病的能力尚不清楚。
目的
前瞻性评估 DSI 与 IBD 患者心理症状、生活质量（QoL）和疾病结局之间的关系。
方法
对接受结肠镜检查的 IBD 患者进行前瞻性随访 12 个月。在基线时评估 DSI、心理症状（感知压力（PSS-10）、抑郁（PHQ-9）、焦虑（GAD-7））和 QoL（IBDQ-32）评分。逻辑回归确定了 12 个月时预测复杂 IBD 病程的变量（疾病复发时需要升级生物/免疫调节剂、反复使用皮质类固醇、IBD 相关住院和手术的复合结局）。接收者操作特征（ROC）分析确定了预测复杂疾病病程的最佳 DSI 阈值，并进行多变量逻辑回归评估达到该结局的风险。
结果
共招募了 172 名患者（100 例克罗恩病，91 例女性）。中位数 DSI 为 21（IQR 11-32），97 名患者基线时内镜下存在活动疾病。有中度至重度压力症状（PSS-10＞14，p＜0.01）、抑郁（PHQ-9≥10，p＜0.01）、焦虑（GAD-7≥10，p＜0.05）和生活质量受损（IBDQ-32＜168，p＜0.01）的患者 DSI 显著升高。只有基线 DSI（OR 1.05，p＜0.01）和内镜下活动疾病（OR 6.12，p＜0.01）与复杂的 IBD 病程相关。DSI＞23 强烈预测复杂的 IBD 病程（OR 8.31，p＜0.001）。
结论
DSI 与心理困扰、生活质量受损相关，并可预测 IBD 患者更复杂的疾病病程。
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