纤维肌痛综合征肝气郁结证患者躯体症状与心理症状的相关性

Correlation Between Physical Symptoms and Psychological Symptoms in Patients with Fibromyalgia Syndrome with Stagnation of Liver-qi Syndrome

目的观察纤维肌痛综合征(FMS)主要中医证型及其躯体症状和心理症状的相关性。方法采用横断面调查设计,调查2015年5月至2016年3月在中国中医科学院广安门医院风湿科连续就诊的FMS患者。设计调查表,分为两部分,第一部分是患者人口学特征(包括性别、年龄、身高、体重、病程)、压痛点个数(TPC)、中医证候分型,由医生记录;第二部分为FMS病情,由躯体症状和心理症状的评估组成,包括痛觉视觉模拟评分(VAS)、纤维肌痛症影响问卷(FIQ)、多维疲劳量表(MAF)、匹兹堡睡眠质量指数(PSQI)、贝克抑郁量表第2版(BDI-Ⅱ)、压力知觉量表(PSS)、健康状况调查问卷(SF-36)。SF-36可分为SF-36生理部分(PCS)和SF-36心理部分(MCS)2个分量域。躯体症状相关量表总评分=疼痛VAS评分+FIQ总分+MAF总分+PSQI总分+SF-36 PCS评分+TPC;心理症状相关量表总评分=BDI-Ⅱ总分+PSS总分+SF-36 MCS评分。结果共纳入124例FMS患者,主证为肝气郁结证的患者有93例(75%)。Pearson相关性分析表明:FMS肝气郁结证患者的躯体症状和心理症状呈正相关(r=0.470,P<0.001);具体表现在FIQ总分、躯体疼痛程度(疼痛VAS评分)、疲劳程度(MAF总分)、睡眠质量(PSQI总分)和身体健康水平(SF-36 PCS评分)与患者的抑郁程度、心理压力程度、精神健康水平具有相关性(P<0.001)。结论肝气郁结证是FMS常见的中医证型,本证患者躯体症状和心理症状呈正相关关系。

Objective To observe the major traditional Chinese medicine syndrome of fibromyalgia syndrome(FMS)and the correlation between physical symptoms and psychological symptoms.Method A cross-sectional survey design was used to investigate FMS patients who were continuously treated at the Department of Rheumatology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences from May 2015 to March 2016.The questionnaire was designed and divided into 2 parts.The first part was the demographic characteristics of the patient including gender,age,height,weight and course of disease,tender points count(TPC),and the types of TCM syndromes,which were recorded by doctors;the second part was the condition of FMS,which was consisting of the assessment of physical and psychological symptoms,including pain visual analogue scale(VAS),fibromyalgia impact questionnaire(FIQ),multidimensional fatigue scale(MAF),Pittsburgh Sleep Quality Index(PSQI),Baker Depression Scale 2nd Edition(BDI-Ⅱ),Pressure Perception Scale(PSS),Short-Form 36-item Health Survey(SF-36).SF-36 can be divided into 2 component domains,physical component score(PCS)and mental component score(MCS).The total score of the physical symptom-related scale=pain VAS score+FIQ total score+MAF total score+PSQI total score+SF-36 PCS+TPC;total psychological symptom-related scale score=BDI-Ⅱtotal score+PSS total score+SF-36 MCS.Results A total of 124 FMS patients was included,93(75%)among those with the main syndrome of liver stagnation.Pearson correlation analysis showed that in FMS patients with liver-qi stagnation syndrome,the physical symptoms were positively correlated with psychological symptoms(r=0.470,P<0.001).Specifically,it was manifested that the FIQ total score,NAS,MAF,PSQI and SF-36 PCS had a correlation with the degree of depression,psychological pressure,and the level of mental health(r≥0.344,P<0.001).Conclusion Liver-qi stagnation is the common TCM syndrome in FMS patients.The physical symptoms and psychological symptoms of FMS patients with live-qi stagnation syndrome are positively correlated.