应重视干燥综合征患者的疲劳抑郁症状
发表者：李常虹
日期：2015-03-05
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摘要（德国）：目的：原发性干燥综合症（pSS）患者经常遭受多重可导致丧失工作能力疾病的困扰，因此他们需要接受多方面的专科医生的治疗。我们旨在找到导致pSS患者门诊就医和劳动能力丧失的预测因素。
方法：176例女性pSS患者及115例年龄匹配的人群作为研究对象，比较了他们在过去6个月中的门诊就医、就业状况及请病假情况。应用欧洲抗风湿联盟干燥综合征患者报告指数评定量表(ESSPRI)、疲劳不适量表(PROFAD)及患者健康问卷抑郁量表(PHQ-9)对他们的干燥，疼痛，疲劳和抑郁状况进行评价。应用多元逻辑回归分析的方法确定与就医次数和劳动能力丧失人数增加的相关因素。
结果：pSS患者与正常人群在年龄及受教育程度上均相当，但是在抑郁发生率(38.1 vs 7.9%, P<0.001)，就医次数[17.0 (10.0) vs 6.5 (4.5); P<0.001] 和 正式工作年限(464年: 52.8 vs 77.1% P<0.001)上存在明显的差异。多元逻辑回归分析显示抑郁(PHQ-9) 和/或疲劳，尤其是缺乏活力与pSS患者就医次数和工作状况明显相关，而与干燥的状况无关。那些经常陈述“我有困难继续前进，我容易疲劳或者缺乏精力”的pSS患者通常更不容易能获得一份有报酬的工作。
结论：在pSS患者中，缺乏精力和/或抑郁比眼干口干的症状更能够带来社会和家庭负担。因此，疲劳和抑郁作为pSS治疗的靶标应受到更多的重视。
附原文：Abstract Objectives. Patients with primary SS (pSS) are frequently suffering from multiple enduring disorders that raise the risk of work disability and require treatment by various health-care specialists. We aimed at determining predictors of physician visits and work disability in pSS patients.Methods. Physician visits within the past 6 months, employment status and sick leave were compared among 176 female pSS patients and 115 age-matched controls. Dryness, pain, fatigue and depression were assessed by rating scales of the EULAR Sjo¨ gren’s Syndrome Patient Reported Index (ESSPRI), the Profile of Fatigue and Discomfort (PROFAD) and Patient Health Questionnaire depression measurements (PHQ-9). Factors associated with an increased number of physician visits and inability to work were determined by multivariate logistic regression analysis.Results. Patients and controls were comparable in age and education, but differed significantly in the prevalence of depression (38.1 vs 7.9%, P<0.001), the number of physician visits [17.0 (10.0) vs 6.5 (4.5); P<0.001] and gainful employment (464 years: 52.8 vs 77.1% P<0.001). Multivariate regression analyses revealed that depression (PHQ-9) and/or fatigue, particularly lack of stamina, but not dryness, were significantly associated with physician visits and working status in pSS patients. Patients with high ratings for the statement ‘I have had difficulties to keep going, was easily worn out or lacking in energy’ had a highly increased risk of not being gainfully employed (adjusted OR 4.1; 95% CI 1.5, 11.2; P<0.001).(OR 4.1; 95% CI 1.5, 11.2; P<0.001)。Conclusion. In pSS, lack of stamina and/or depression cause a higher level of individual and societal burden than dry eyes and mouth. Fatigue and depression deserve more recognition as treatment targets in pSS.
引自：Gisela Westhoff, Thomas Dorner, Angela Zink. Fatigue and depression predict physician visits and work disability in women with primary Sjogren’s syndrome: results from a cohort study. Rheumatology. 2012;51:262[1]269. （注：干燥综合症病人或亲属可加QQ群交流，群号： 118194945 ，本网站站长私人微信号： ssgzz88 ）
方法：176例女性pSS患者及115例年龄匹配的人群作为研究对象，比较了他们在过去6个月中的门诊就医、就业状况及请病假情况。应用欧洲抗风湿联盟干燥综合征患者报告指数评定量表(ESSPRI)、疲劳不适量表(PROFAD)及患者健康问卷抑郁量表(PHQ-9)对他们的干燥，疼痛，疲劳和抑郁状况进行评价。应用多元逻辑回归分析的方法确定与就医次数和劳动能力丧失人数增加的相关因素。
结果：pSS患者与正常人群在年龄及受教育程度上均相当，但是在抑郁发生率(38.1 vs 7.9%, P<0.001)，就医次数[17.0 (10.0) vs 6.5 (4.5); P<0.001] 和 正式工作年限(464年: 52.8 vs 77.1% P<0.001)上存在明显的差异。多元逻辑回归分析显示抑郁(PHQ-9) 和/或疲劳，尤其是缺乏活力与pSS患者就医次数和工作状况明显相关，而与干燥的状况无关。那些经常陈述“我有困难继续前进，我容易疲劳或者缺乏精力”的pSS患者通常更不容易能获得一份有报酬的工作。
结论：在pSS患者中，缺乏精力和/或抑郁比眼干口干的症状更能够带来社会和家庭负担。因此，疲劳和抑郁作为pSS治疗的靶标应受到更多的重视。
附原文：Abstract Objectives. Patients with primary SS (pSS) are frequently suffering from multiple enduring disorders that raise the risk of work disability and require treatment by various health-care specialists. We aimed at determining predictors of physician visits and work disability in pSS patients.Methods. Physician visits within the past 6 months, employment status and sick leave were compared among 176 female pSS patients and 115 age-matched controls. Dryness, pain, fatigue and depression were assessed by rating scales of the EULAR Sjo¨ gren’s Syndrome Patient Reported Index (ESSPRI), the Profile of Fatigue and Discomfort (PROFAD) and Patient Health Questionnaire depression measurements (PHQ-9). Factors associated with an increased number of physician visits and inability to work were determined by multivariate logistic regression analysis.Results. Patients and controls were comparable in age and education, but differed significantly in the prevalence of depression (38.1 vs 7.9%, P<0.001), the number of physician visits [17.0 (10.0) vs 6.5 (4.5); P<0.001] and gainful employment (464 years: 52.8 vs 77.1% P<0.001). Multivariate regression analyses revealed that depression (PHQ-9) and/or fatigue, particularly lack of stamina, but not dryness, were significantly associated with physician visits and working status in pSS patients. Patients with high ratings for the statement ‘I have had difficulties to keep going, was easily worn out or lacking in energy’ had a highly increased risk of not being gainfully employed (adjusted OR 4.1; 95% CI 1.5, 11.2; P<0.001).(OR 4.1; 95% CI 1.5, 11.2; P<0.001)。Conclusion. In pSS, lack of stamina and/or depression cause a higher level of individual and societal burden than dry eyes and mouth. Fatigue and depression deserve more recognition as treatment targets in pSS.
引自：Gisela Westhoff, Thomas Dorner, Angela Zink. Fatigue and depression predict physician visits and work disability in women with primary Sjogren’s syndrome: results from a cohort study. Rheumatology. 2012;51:262[1]269. （注：干燥综合症病人或亲属可加QQ群交流，群号： 118194945 ，本网站站长私人微信号： ssgzz88 ）