纤维肌痛综合征发病诱因与加重诱因调查研究

Precipitating and aggravating factors in patients with fibromyalgia syndrome:a cross-sectional study

目的以类风湿关节炎(RA)为参照,探讨纤维肌痛综合征(FMS)发病与加重诱因的情况与特点。方法本研究调查时间为2015年1月至2021年11月,采用横断面调查研究方法,基于参考文献制定患者报告的"发病诱因与加重诱因调查表",同时调查FMS和RA患者,统计2组患者发病诱因和加重诱因的种类和所占比例,并采用χ^(2)检验进行组间比较。结果共415例FMS患者和200例RA患者参与调查。146例FMS患者(35.2%)报告了发病诱因,身体伤害(71例,17.1%)、感受风寒/寒湿(30例,7.2%)、精神压力(26例,6.2%)、运动性疲劳(10例,2.4%)是FMS的常见发病诱因;38例RA(19.0%)患者报告了发病诱因。相较于RA患者,更多的FMS患者报告了发病前经历身体伤害和精神压力[6.2%(26/415)和1.5%(3/200),χ^(2)=6.82,P=0.009]。319例FMS患者(76.9%)报告了病情加重诱因,依次为天气变化(219例,52.7%)、体力劳动(192例,46.2%)、情绪波动(147例,35.4%)、睡眠不足(145例,34.9%)、精神压力(130例,31.3%)等;137例RA患者(68.5%)报告了病情加重诱因。FMS患者因体力劳动[46.2%(192/415)]、情绪波动[35.4%(147/415)]、睡眠不足[34.9%(145/415)]、精神压力[31.3%(130/415)]、感染[9.3%(39/415)]因素导致病情加重者明显高于RA患者[35.0%(70/200),χ^(2)=7.00,P=0.008;19.5%(39/200),χ^(2)=16.22,P<0.001;13.5%(27/200),χ^(2)=30.79,P<0.001;17.5%(35/200),χ^(2)=13.14,P<0.001;3.0%(6/200),χ^(2)=8.15,P=0.004]。结论超过1/3的FMS患者报告了发病诱因,近4/5的FMS患者报告了病情加重诱因。相较于RA患者,FMS患者对环境的变化,以及压力的感知更为敏感。这一现象值得深入研究,或可为本病的发生、发展、治疗和预防提供帮助。

Objective To investigate the precipitating and aggravating factors in patients with fibromyalgia(FMS)compared to patients with rheumatoid arthritis(RA).Methods This study was conducted from January 2015 to November 2021,using a cross-sectional survey research method,based on references to develop a patient-reported"onset and exacerbation triggers questionnaire",and surveyed patients with FMS and RA at the same time,and counted the types and proportions of onset and exacerbation triggers in the two groups of patients and used the chi-square test to make comparisons between the groups.Results A total of 415 patients with FMS and 200 patients with RA participated the survey.146 patients with FMS(35.2%)and 38 patients with RA(19.0%)reported morbidity triggers.Experiencing physical injury(71,17.1%),wind-cold/cold-dampness(30 patients,7.2%),mental stress(26,6.2%),and exercise fatigue(10 patients,2.4%)were the common morbidity triggers for FMS.More FMS patients reported to have experienced physical injuries and mental stress before the onset of the disease compared to RA patients[8.2%(17/200),χ^(2)=5.41,P=0.020;1.5%(3/200),χ^(2)=6.82,P=0.009].Exacerbation triggers were reported by 319 patients with FMS(76.9%)and 137 patients with RA(68.5%),in the order of weather changes(219 patients,52.7%),physical labor(192 patients,46.2%),mood swings(147 patients,35.4%),sleep deprivation(145 patients,34.9%),and mental stress(130 patients,31.3%).The proportion of FMS patients with symptom exacerbation due to physical labor[46.2%(192/415)],mood swings[35.4%(147/415)],sleep deprivation[34.9%(145/415)],mental stress[31.3%(130/415)],and infection[9.3%(39/415)]was significantly higher than that of RA patients[35.0%(70/200),χ^(2)=7.00,P=0.008;19.5%(39/200),χ^(2)=16.22,P<0.001;13.5%(27/200),χ^(2)=30.79,P<0.001;17.5%(35/200),χ^(2)=13.14,P<0.001;3.0%(6/200),χ^(2)=8.15,P=0.004].Conclusion More than a third of FMS patients reported precipitating factors,and nearly four fifths FMS patients reported at least one aggravating trigger.FMS patients are likely to be more sensitive to environmental changes and perceived stress than RA patients.