系统性硬化症中临床相关疲劳具有独特的胃肠道症状特征。
A distinct gastrointestinal symptom profile characterizes clinically relevant fatigue in systemic sclerosis.
文献信息
| PMID | 42706477 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Francesco Bonomi |
| 作者单位 | Department of Internal Medicine, University Hospital Careggi, Florence, Italy. |
| 期刊 | Clinical rheumatology |
| SCI 分区 | Q3 |
| IF | 2.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
目的： 识别与系统性硬化症（SSc）中临床相关疲劳相关的特定胃肠道（GI）症状，超越总体GI受累与疲劳之间已确立的关联。
方法： 我们开展了一项横断面研究，纳入连续符合2013年ACR/EULAR分类标准的SSc患者。使用慢性病治疗功能评估-疲劳（FACIT-疲劳）量表评估疲劳，临床相关疲劳定义为评分≤30。收集人口学、临床、实验室和器官受累数据。分析个体GI症状域（GERD、吞咽困难、腹胀、腹泻和便秘）以及Medsger GI严重程度评分。进行双变量分析和多变量logistic回归分析，以评估症状特异性与临床相关疲劳的关联。
结果： 在115例患者中，42例（36.5%）观察到临床相关疲劳。FACIT-疲劳≤30的患者更常报告GERD（90.5% vs 60.3%）、吞咽困难（40.5% vs 16.4%）、腹胀（66.7% vs 15.1%）和腹泻（28.6% vs 11.0%）（均p<0.05）。在可用的客观疾病指标中未检测到组间统计学显著差异。在主要Firth惩罚logistic回归模型中，腹胀（OR 9.11，95% CI 3.53-25.71）和GERD（OR 4.08，95% CI 1.29-15.44）与临床相关疲劳相关。吞咽困难显示出方向一致但不太精确的关联。在连续结局敏感性分析中，GERD、吞咽困难和腹胀与较低的FACIT-疲劳评分相关。
结论： SSc中的临床相关疲劳与患者报告的独特GI症状特征相关，尤其是腹胀和GERD。这些发现为SSc中疲劳相关的GI负担提供了更细致的特征描述。要点• 本研究超越总体胃肠道受累，检查系统性硬化症中疲劳的症状特异性相关因素。• 腹胀和GERD与FACIT-疲劳≤30独立相关，而吞咽困难仅在连续结局敏感性分析中与更严重的疲劳相关。• SSc中的临床相关疲劳似乎与患者报告的GI和功能负担比与常规疾病严重程度指标更密切相关。
英文摘要
OBJECTIVE: To identify the specific gastrointestinal (GI) symptoms associated with clinically relevant fatigue in systemic sclerosis (SSc), beyond the established association between overall GI involvement and fatigue.
METHODS: We conducted a cross-sectional study including consecutive patients with SSc fulfilling the 2013 ACR/EULAR classification criteria. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) scale, with clinically relevant fatigue defined as a score ≤ 30. Demographic, clinical, laboratory, and organ involvement data were collected. Individual GI symptom domains (GERD, dysphagia, bloating, diarrhea and constipation), together with the Medsger GI severity score, were analyzed. Bivariate analyses and multivariable logistic regression analyses were performed to evaluate symptom-specific associations with clinically relevant fatigue.
RESULTS: Among 115 patients, clinically relevant fatigue was observed in 42 (36.5%). Patients with FACIT-Fatigue ≤ 30 more frequently reported GERD (90.5% vs 60.3%), dysphagia (40.5% vs 16.4%), bloating (66.7% vs 15.1%), and diarrhea (28.6% vs 11.0%) (all p < 0.05). No statistically significant between-group differences were detected in the available objective disease measures. In the primary Firth penalized logistic regression model, bloating (OR 9.11, 95% CI 3.53-25.71) and GERD (OR 4.08, 95% CI 1.29-15.44) were associated with clinically relevant fatigue. Dysphagia showed a directionally consistent but less precise association. In a continuous-outcome sensitivity analysis, GERD, dysphagia, and bloating were associated with lower FACIT-Fatigue scores.
CONCLUSIONS: Clinically relevant fatigue in SSc was associated with a distinct profile of patient-reported GI symptoms, particularly bloating and GERD. These findings provide a more granular characterization of fatigue-related GI burden in SSc. Key Points • This study moves beyond aggregate gastrointestinal involvement by examining symptom-specific correlates of fatigue in systemic sclerosis. • Bloating and GERD were independently associated with FACIT-Fatigue ≤ 30, whereas dysphagia was associated with greater fatigue severity only in the continuous-outcome sensitivity analysis. • Clinically relevant fatigue in SSc appears to cluster more closely with patient-reported GI and functional burden than with conventional measures of disease severity.