Barnes Alex, Bryant Robert V, Mukherjee Sutapa, Andrews Jane M, Bampton Peter, Fraser Robert J, Mountifield Réme
Department of Gastroenterology, Flinders Medical Centre, Southern Adelaide Local Health Network, Flinders Drive, Bedford Park, SA 5042, Australia.
College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
Therap Adv Gastroenterol. 2024 Sep 2;17:17562848241271987. doi: 10.1177/17562848241271987. eCollection 2024.
Fatigue is common in people with inflammatory bowel disease (IBD) and is associated with IBD activity, sleep disturbance, anxiety and depression. The relative contribution of these factors to fatigue is unclear. This study aimed to investigate the relationship between fatigue and these factors through a novel approach using structural equation modelling.
Online questionnaire circulated via three tertiary IBD centres and Crohn's Colitis Australia.
Fatigue was assessed using the Functional assessment of chronic illness measurement system fatigue subscale. Validated measures of sleep, anxiety, depression and IBD activity were included. Following correlation analyses, a structural equation model was developed for the outcome of the fatigue score. Direct and indirect effects were calculated.
There were 630 complete responses to the online questionnaire. The median age of respondents was 41 with the majority female and over half (52%) on biologic medication. Structural equation models for Crohn's disease and ulcerative colitis demonstrated a good fit. In Crohn's disease, the relationship between IBD activity and fatigue was mostly mediated indirectly through the influence of IBD activity on sleep, anxiety and primarily depression. Sleep quality mediated the influence of IBD activity and the indirect effects of depression on fatigue, but not anxiety. Unlike in Crohn's disease, the direct influence of IBD activity on fatigue in ulcerative colitis was non-negligible, although remained of lesser magnitude than the indirect effect of IBD activity on fatigue. Depression was the primary indirect mediator of the influence of IBD activity on fatigue in ulcerative colitis.
In Crohn's disease, IBD activity leads to fatigue through its influence on sleep quality and mental health. The data suggest treatment of clinically significant depression, in both ulcerative colitis and Crohn's disease, may result in the largest decline in fatigue score compared to other variables. Treatment algorithms for fatigue should consider depression a priority.
疲劳在炎症性肠病（IBD）患者中很常见，且与IBD活动、睡眠障碍、焦虑和抑郁有关。这些因素对疲劳的相对贡献尚不清楚。本研究旨在通过使用结构方程模型的新方法来研究疲劳与这些因素之间的关系。
通过三个三级IBD中心和澳大利亚克罗恩病与结肠炎协会发放在线问卷。
使用慢性病功能评估测量系统疲劳分量表评估疲劳。纳入了经过验证的睡眠、焦虑、抑郁和IBD活动测量指标。在进行相关性分析后，建立了一个以疲劳评分为结果的结构方程模型。计算直接和间接效应。
在线问卷共收到630份完整回复。受访者的中位年龄为41岁，大多数为女性，超过一半（52%）正在使用生物制剂。克罗恩病和溃疡性结肠炎的结构方程模型显示拟合良好。在克罗恩病中，IBD活动与疲劳之间的关系主要通过IBD活动对睡眠、焦虑以及主要是抑郁的影响间接介导。睡眠质量介导了IBD活动的影响以及抑郁对疲劳的间接影响，但不包括焦虑。与克罗恩病不同，IBD活动对溃疡性结肠炎疲劳的直接影响不可忽略，尽管其程度仍小于IBD活动对疲劳的间接影响。抑郁是IBD活动对溃疡性结肠炎疲劳影响的主要间接介导因素。
在克罗恩病中，IBD活动通过对睡眠质量和心理健康的影响导致疲劳。数据表明，与其他变量相比，治疗溃疡性结肠炎和克罗恩病中具有临床意义的抑郁可能会使疲劳评分下降幅度最大。疲劳的治疗算法应将抑郁作为优先考虑因素。
