Digestive System Research Unit, Vall d'Hebron University Hospital, Barcelona, Spain
Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain.
BMJ Open. 2024 Nov 27;14(11):e089725. doi: 10.1136/bmjopen-2024-089725.
Systemic sclerosis (SSc) is a chronic autoimmune disease characterised by microvascular damage and fibrosis. Mortality in patients with SSc has significantly decreased. Consequently, patients with SSc have longer life expectancy, and health-related quality of life (HrQoL) has become more relevant in the comprehensive management of the disease.
To evaluate the impact between gastrointestinal (GI) symptom burden and psychological well-being on HrQoL in patients with SSc.
Nested cross-sectional study conducted between January and July 2022.
A single-centre cohort of 166 patients with SSc, including 103 (55%) with limited cutaneous SSc, 43 (24%) with diffuse SSc and 37 (21%) with sine-sclerosis SSc.
GI symptom burden was assessed using the University of California Los Angeles Scleroderma Clinical Trial Consortium gastrointestinal tract 2.0 (UCLA SCTC GIT 2.0) questionnaire, psychological well-being was measured with the Hospital Anxiety and Depression Scale (HADS), and HrQoL was evaluated using the Short Form 36 (SF-36) questionnaire. Demographic, clinical and immunological data were collected from a prospectively maintained database.
Patients with moderate to severe GI symptoms (UCLA SCTC GIT 2.0 score >0.5, n=95, 57%) reported decreased HrQoL in all subdomains except vitality by SF-36, and higher anxiety and depression scores by HADS (all p<0.05). The severity of GI symptom burden and depression were independently associated with a decline in the physical component of QoL (β=-0.273 and β=-0.411, respectively, p<0.01 for both). Only the severity of depression and anxiety (β=-0.482 and β=-0.213, respectively, p<0.05), but not GI symptom burden, were independently associated with a decline in the mental component of QoL.
Our data suggest that in patients with SSc, GI and psychological burden negatively influence quality of life independently, highlighting the need for a holistic approach to patient's care.
系统性硬化症（SSc）是一种慢性自身免疫性疾病，其特征为微血管损伤和纤维化。SSc 患者的死亡率已显著下降。因此，SSc 患者的预期寿命延长，健康相关生活质量（HrQoL）在疾病的综合管理中变得更加重要。
评估胃肠道（GI）症状负担和心理幸福感对 SSc 患者 HrQoL 的影响。
2022 年 1 月至 7 月进行的嵌套横断面研究。
单中心队列包括 166 例 SSc 患者，其中局限性皮肤 SSc 患者 103 例（55%），弥漫性 SSc 患者 43 例（24%），无 sine-硬化 SSc 患者 37 例（21%）。
使用加利福尼亚大学洛杉矶分校硬皮病临床试验联盟胃肠道 2.0（UCLA SCTC GIT 2.0）问卷评估 GI 症状负担，使用医院焦虑和抑郁量表（HADS）评估心理幸福感，使用健康调查简表 36（SF-36）评估 HrQoL。从一个前瞻性维护的数据库中收集人口统计学、临床和免疫学数据。
有中度至重度 GI 症状（UCLA SCTC GIT 2.0 评分>0.5，n=95，57%）的患者在除活力以外的所有 SF-36 亚域中报告 HrQoL 下降，并且 HADS 的焦虑和抑郁评分更高（均 p<0.05）。GI 症状负担的严重程度和抑郁与生活质量的生理成分下降独立相关（β=-0.273 和 β=-0.411，均 p<0.01）。仅抑郁和焦虑的严重程度（β=-0.482 和 β=-0.213，均 p<0.05），而不是 GI 症状负担，与心理成分的生活质量下降独立相关。
我们的数据表明，在 SSc 患者中，胃肠道和心理负担独立地对生活质量产生负面影响，这突出了需要对患者进行整体护理。
