Fatigue in patients with myasthenia gravis
Fatigue in patients with myasthenia gravis
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DOI：
10.1007/s00415-018-8995-4
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发表时间：
2018-10-01
影响因子：
6
通讯作者：
Valko, Y.
中科院分区：
文献类型：
--
作者：
Alekseeva, T. M.;Gavrilov, Y. V.;Valko, Y.
重症肌无力（MG）患者的主观疲劳感尚不清楚，部分原因是它经常与肌肉疲劳的客观体征混淆。另一个原因是缺乏有效的疲劳问卷调查MG。我们采用9项疲劳严重程度量表（FSS）和40项疲劳影响量表（FIS）73 MG患者和230名年龄和性别匹配的对照组。我们确定了受教育程度、婚姻状况和合并症，如抑郁、嗜睡、睡眠时间和睡眠债务。根据美国重症肌无力基金会（MGFA）的分类对疾病的严重程度进行分级。除认知FIS子量表外，MG患者的所有疲劳评分均高于对照组。在MG中，疲劳（由FSS评分4.0定义）的患病率为70%。多元回归分析揭示了疲劳的几个独立关联，包括抑郁症（所有疲劳量表），MGFA阶段（FSS，物理FIS），女性性别（认知和心理社会FIS），和睡眠债务（物理FIS）JG中的疲劳是非常普遍的，主要是身体，并受抑郁症状，疾病严重程度，女性性别和睡眠债务的影响。MG患者的认知疲劳可能不是直接的疾病表现，而是继发于抑郁。FSS和FIS代表了可靠和经验证的工具，适用于识别MG疲劳的有意义的临床方面。临床认识疲劳的复杂性，可能会促进受影响的MG患者的个性化治疗方法。
The subjective feeling of fatigue in myasthenia gravis (MG) is poorly elucidated, in part because it is often confounded with the objective sign of muscle fatigability. Another reason is the paucity of validated fatigue questionnaires in MG.We applied the 9-item Fatigue Severity Scale (FSS) and the 40-item Fatigue Impact Scale (FIS) to 73 MG patients and 230 age- and sex-matched control subjects. We ascertained levels of education, marital status, and comorbidities such as depression, sleepiness, sleep times and sleep debt. Disease severity was graded according to the Myasthenia Gravis Foundation of America (MGFA) classification.All fatigue scores, with the exception of the cognitive FIS subscale, were higher in MG patients than controls. In MG, the prevalence of fatigue (defined by FSS scores 4.0) was 70%. Multiple regression analyses revealed several independent associates of fatigue, including depression (all fatigue scales), MGFA stage (FSS, physical FIS), female sex (cognitive and psychosocial FIS), and sleep debt (physical FIS).Fatigue in MG is highly prevalent, mainly physical, and influenced by depressive symptoms, disease severity, female sex and sleep debt. Cognitive fatigue in MG may not be a direct disease manifestation, but secondary to depression. The FSS and FIS represent reliable and validated tools, appropriate to discern meaningful clinical aspects of fatigue in MG. Clinical recognition of the complexity of fatigue may foster individualized treatment approaches for affected MG patients.