肺间质疾病患者疲劳症状的临床特征及影响因素分析

doi:10.11958/20230264

天津医药 ›› 2023, Vol. 51 ›› Issue (11): 1237-1241.doi: 10.11958/20230264

肺间质疾病患者疲劳症状的临床特征及影响因素分析

罗成(), 张宁, 彭艳茹, 李舒, 郭亚丽, 王玉光^△()

首都医科大学附属北京中医医院呼吸科（邮编100010）

收稿日期:2023-02-28 修回日期:2023-03-27 出版日期:2023-11-15 发布日期:2023-11-07
通讯作者: ^△E-mail：wygzhyiaids@126.com
作者简介:罗成（1996），男，硕士研究生在读，主要从事中医药防治呼吸系统疾病方面研究。E-mail：luoyimu@ccmu.edu.cn
基金资助:
首都卫生发展科研专项(首发2020-2-2233);北京市卫生局高层次公共卫生技术人才培养计划(2022-2-016)

Analysis of the clinical characteristics and influencing factors of fatigue symptoms in patients with interstitial lung disease

LUO Cheng(), ZHANG Ning, PENG Yanru, LI Shu, GUO Yali, WANG Yuguang^△()

Department of Respiratory Medicine, Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University, Beijing 100010, China

Received:2023-02-28 Revised:2023-03-27 Published:2023-11-15 Online:2023-11-07
Contact: ^△E-mail：wygzhyiaids@126.com

罗成, 张宁, 彭艳茹, 李舒, 郭亚丽, 王玉光. 肺间质疾病患者疲劳症状的临床特征及影响因素分析[J]. 天津医药, 2023, 51(11): 1237-1241.

LUO Cheng, ZHANG Ning, PENG Yanru, LI Shu, GUO Yali, WANG Yuguang. Analysis of the clinical characteristics and influencing factors of fatigue symptoms in patients with interstitial lung disease[J]. Tianjin Medical Journal, 2023, 51(11): 1237-1241.

摘要/Abstract

摘要：

目的探讨肺间质疾病（ILD）患者疲劳症状的临床特征及影响因素。方法选取ILD患者238例，收集患者的性别、年龄、婚姻状况、体质量指数（BMI）、职业、文化程度，吸烟、饮酒情况；对患者进行肺功能测定，检测用力肺活量占预计值的百分比（FVC%pred）、第1秒用力呼气量占预计值的百分比（FEV1%pred）、第1秒末用力呼气量占用力肺活量的百分比（FEV1/FVCpred）、一氧化碳弥散量占预计值的百分比（DLCO%pred）；采用疲劳评定量表（FAS）评估患者躯体和精神的疲劳情况；采用英国医学研究委员会呼吸问卷改良版（mMRC）评估患者的呼吸困难程度；采用Charlson合并症指数评估合并症的严重程度；采用医院焦虑抑郁量表（HADS）对患者焦虑和抑郁程度进行评分，分别为HADS-A和HADS-D；采用匹兹堡睡眠质量指数（PSQI）评估患者的睡眠质量；分析不同特征人群FAS得分的差异以及FAS得分与临床特征相关性；采用多元线性逐步回归分析ILD患者疲劳的影响因素。结果 238例患者FAS得分为（26.03±9.53）分，其中159例（66.81%）出现疲劳，其中60例（37.74%）为严重疲劳；mMRC 0级和1级ILD患者的FAS得分低于mMRC 2—4级的患者，mMRC 2级ILD患者的FAS得分低于mMRC 4级患者（P<0.01）；不同病程、年龄、性别、婚姻、工作情况、教育程度、吸烟、饮酒情况、ILD类型、Charlson合并症指数患者FAS得分差异均无统计学意义。FAS得分与年龄、病程、HADS-A、HADS-D、PSQI呈正相关，与DLCO% pred呈负相关（P<0.05）；多元线性逐步回归分析显示，HADS-D、mMRC、PSQI和病程是FAS得分的影响因素（P<0.05）。结论 ILD患者中疲劳发生率高，病程长、呼吸困难、抑郁和睡眠障碍是疲劳的重要影响因素。

关键词: 肺疾病, 间质性, 疲劳, 呼吸困难, 抑郁, 睡眠障碍, 疲劳评定量表

Abstract:

Objective To explore the clinical characteristics and influencing factors of fatigue symptoms in patients with interstitial lung disease (ILD). Methods A total of 238 patients with ILD were selected. Gender, age, marital status, body mass index (BMI), occupation, education, smoking and alcohol consumption of patients were collected. The pulmonary function of patients was measured. The percentage of forced vital capacity in the predicted value (FVC%pred), the percentage of forced expiratory volume in the first second in the predicted value (FEV1%pred), the percentage of forced expiratory volume in the end of the first second in the predicted value (FEV1/FVCpred) and the percentage of diffusing capacity of the lungs for carbon monoxide in the predicted value (DLCO%pred) were detected. The fatigue rating scale (FAS) was used to evaluate the physical and mental fatigue of patients. The improved Medical Research Council Respiratory Questionnaire (mMRC) was used to assess the degree of dyspnea. Charlson comorbidity index was used to evaluate the severity of comorbidity. The hospital anxiety and depression scale (HADS) including HADS-A and HADS-D were used to score the anxiety and depression of patients. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality of patients. The differences of FAS scores and the correlation between FAS scores and clinical features were analyzed. Multiple linear stepwise regression analysis was used to explore the influencing factors of fatigue in ILD patients. Results The FAS score of 238 patients was (26.03 ± 9.53), of which 159 (66.81%) experienced fatigue and 60 (37.74%) experienced severe fatigue. The FAS scores of mMRC grade 0 and 1 ILD patients were lower than those of mMRC grade 2, 3 and 4 patients, and the FAS scores of mMRC grade 2 ILD patients were lower than those of mMRC grade 4 patients (P<0.01). There were no significant differences in FAS scores between patients with different course of disease, age, sex, marriage, work, education level, smoking, drinking, ILD type and Charlson complication index. FAS score was positively correlated with age, disease course, HADS-A, HADS-D and PSQI, and negatively correlated with DLCO% pred (P<0.05). Multiple linear stepwise regression analysis showed that HADS-D, mMRC, PSQI and disease course were influencing factors of FAS score (P<0.05). Conclusion The incidence of fatigue is high in ILD patients, and the long course of disease, dyspnea, depression and sleep disorders are important influencing factors of fatigue.

Key words: lung diseases, interstitial, fatigue, dyspnea, depression, sleep disorders, fatigue assessment scale

中图分类号:

R563.9

图/表 2

参考文献 29

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变量		n	FAS得分	t或F
病程	≥60个月	128	27.02±9.60	1.735
病程	<60个月	110	24.88±9.36	1.735
年龄	<60岁	71	24.83±8.33	1.367
	≥60岁	167	26.54±9.98	1.367
性别	男	109	25.38±9.89	0.978
性别	女	129	26.59±9.22	0.978
婚姻情况	已婚	211	25.65±9.58	1.746
婚姻情况	丧偶/离异	27	29.04±8.73	1.746
工作情况	体力劳动	77	26.51±9.73	0.528
工作情况	非体力劳动	161	25.81±9.46	0.528
教育程度	小学及以下	26	29.69±10.15	2.090
	初中	73	25.59±10.13
	高中	77	26.57±9.66
	本科及以上	62	24.35±8.02
吸烟	从不	164	25.98±9.45	0.008
	已戒	60	26.15±9.77
	正在	14	26.14±10.17
饮酒	从不	183	26.23±9.55	0.597
	已戒	47	25.85±9.57
	正在	8	22.50±9.50
ILD类型	IPF	65	25.57±10.43	0.079
	CTD-ILD	76	26.04±8.22
	IIP	46	26.15±9.38
	其他	51	26.51±10.51
Charlson合并症指数	轻度	191	25.54±9.09	0.936
	中度	43	28.19±11.43
	重度	4	26.25±6.34
mMRC分级	0级	51	19.04±6.09	33.890^＊＊
	1级	74	22.43±7.84
	2级	56	28.89±7.83^ab
	3级	32	32.31±8.74^ab
	4级	25	36.52±7.98^abc

变量		n	FAS得分	t或F
病程	≥60个月	128	27.02±9.60	1.735
病程	<60个月	110	24.88±9.36	1.735
年龄	<60岁	71	24.83±8.33	1.367
	≥60岁	167	26.54±9.98	1.367
性别	男	109	25.38±9.89	0.978
性别	女	129	26.59±9.22	0.978
婚姻情况	已婚	211	25.65±9.58	1.746
婚姻情况	丧偶/离异	27	29.04±8.73	1.746
工作情况	体力劳动	77	26.51±9.73	0.528
工作情况	非体力劳动	161	25.81±9.46	0.528
教育程度	小学及以下	26	29.69±10.15	2.090
	初中	73	25.59±10.13
	高中	77	26.57±9.66
	本科及以上	62	24.35±8.02
吸烟	从不	164	25.98±9.45	0.008
	已戒	60	26.15±9.77
	正在	14	26.14±10.17
饮酒	从不	183	26.23±9.55	0.597
	已戒	47	25.85±9.57
	正在	8	22.50±9.50
ILD类型	IPF	65	25.57±10.43	0.079
	CTD-ILD	76	26.04±8.22
	IIP	46	26.15±9.38
	其他	51	26.51±10.51
Charlson合并症指数	轻度	191	25.54±9.09	0.936
	中度	43	28.19±11.43
	重度	4	26.25±6.34
mMRC分级	0级	51	19.04±6.09	33.890^＊＊
	1级	74	22.43±7.84
	2级	56	28.89±7.83^ab
	3级	32	32.31±8.74^ab
	4级	25	36.52±7.98^abc

变量	β	SE	标准化β	t	P
HADS-D	0.730	0.099	0.364	7.359	<0.001
mMRC分级	2.830	0.347	0.372	8.147	<0.001
PSQI	0.495	0.098	0.248	5.054	<0.001
病程	0.139	0.070	0.084	1.993	0.047
常数项	11.797	0.963		12.247	<0.001

变量	β	SE	标准化β	t	P
HADS-D	0.730	0.099	0.364	7.359	<0.001
mMRC分级	2.830	0.347	0.372	8.147	<0.001
PSQI	0.495	0.098	0.248	5.054	<0.001
病程	0.139	0.070	0.084	1.993	0.047
常数项	11.797	0.963		12.247	<0.001

肺间质疾病患者疲劳症状的临床特征及影响因素分析

Analysis of the clinical characteristics and influencing factors of fatigue symptoms in patients with interstitial lung disease

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