多发性硬化患者疲劳与抑郁症状的相关性

Fatigue and its association with depressive symptoms in patients with multiple sclerosis

目的探讨多发性硬化患者疲劳与抑郁症状之间的关系。方法选取2018年8月至2021年7月在南京梅山医院神经内科门诊就诊的108例多发性硬化患者为研究对象。采用疲劳影响量表修订版(MFIS)评估疲劳症状,MFIS得分≥38分为疲劳;中文版贝克抑郁量表第2版(BDI-Ⅱ)评估抑郁程度;临床扩展致残量表(EDSS)评估神经系统损伤程度;健康状况调查问卷评估健康状况。采用多因素Logistic回归分析患者疲劳与抑郁程度之间的相关性。采用广义相加混合模型平滑曲线拟合和分段多因素Logistic回归模型分析患者疲劳与抑郁程度之间的分段效应。结果多发性硬化患者疲劳的发生率为50.9%(55/108)。多因素Logistic回归分析显示,疲劳与BDI-Ⅱ得分呈正相关(OR=1.18,95%CI=1.09~1.28,P<0.01)。广义相加模型曲线拟合结果显示,疲劳与BDI-Ⅱ得分之间为非线性关系,存在1个拐点。以拐点进行分段多因素Logistic回归分析,结果显示,当BDI-Ⅱ得分<12.0分,疲劳与BDI-Ⅱ得分呈正相关(OR=1.33,95%CI=1.15~1.54,P<0.01);当BDI-Ⅱ得分≥12.0分时,疲劳与BDI-Ⅱ得分之间的相关性无统计学意义(OR=1.04,95%CI=0.91~1.19,P>0.05)。结论多发性硬化患者疲劳与抑郁症状之间呈非线性相关关系,适当的抑郁管理可能有助于缓解患者的疲劳症状。

Objective To investigate the relationship between fatigue and depressive symptoms in patients with multiple sclerosis.Methods A total of 108 patients with multiple sclerosis who visited the Neurology Clinic of Nanjing Meishan Hospital from August 2018 to July 2021 were selected as the study subjects.Fatigue was assessed using the Modified Fatigue Impact Scale(MFIS),with an MFIS score of 38 or higher defined as fatigue.Depressive symptoms were evaluated using the Chinese version of Beck Depression Inventory-Ⅱ(BDI-Ⅱ).The degree of neurological damage was assessed by the Extended Disability Status Scale(EDSS),and perceived health-related quality of life and health status were measured using the Short-Form-36 Health Survey(SF-36).The correlation segmented effect between patient fatigue and depression level was analyzed by using generalized additive mixed model to smooth curve fitting and segmented multivariate Logistic regression.Results The incidence of fatigue in patients with multiple sclerosis was 50.9%(55/108).The multivariate Logistic regression analysis displayed a significant positive correlation between fatigue and BDI-Ⅱscore(OR=1.18,95%CI=1.09-1.28,P<0.01).The generalized additive mixed model to smooth curve fitting showed the results that there was a non-linear relationship between BDI-Ⅱscore and fatigue,with one inflection point.Using the inflection point for segmented multivariate logistic regression analysis,the results showed that when the BDI-Ⅱscore was less than 12.0,fatigue was positively correlated with the BDI-Ⅱscore(OR=1.33,95%CI=1.15-1.54,P<0.01).When the BDI-Ⅱscore was≥12.0,there was no statistically significant correlation between fatigue and BDI-Ⅱscore(OR=1.04,95%CI=0.91-1.19,P>0.05).Conclusions There was a non-linear correlation between BDI-Ⅱscore and fatigue in patients with multiple sclerosis,and appropriate depression management may help alleviate fatigue symptoms in patients with multiple sclerosis.