Fatigue in myasthenia gravis: is it more than muscular weakness?
Fatigue in myasthenia gravis: is it more than muscular weakness?
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DOI：
10.1186/1471-2377-13-132
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发表时间：
2013-10-03
期刊：
影响因子：
2.6
通讯作者：
Kerty E
中科院分区：
文献类型：
--
作者：
Elsais A;Wyller VB;Loge JH;Kerty E
很少有研究关注重症肌无力（MG）的疲劳，并且从未系统地探讨过这些患者的疲劳与自主系统的关系。该研究旨在记录挪威人中与 MG 相关的疲劳的患病率，并检查 MG 严重程度是否与自主神经紊乱症状相关，而自主神经紊乱症状又与疲劳和功能障碍相关。符合研究纳入标准的 97 名参与者中有 82 名参加了该研究。对照组是 410 名年龄和性别匹配的受试者，这些受试者是从代表挪威人口的标准样本 (n=2136) 中抽取的。采用双变量分析和多变量线性回归分析来评估问卷报告的 MG 严重程度、自主神经紊乱症状、疲劳（精神和身体）和功能障碍之间的关联。 44% (36/82) 的患者满足疲劳标准，而对照组为 22% (90/410)（比值比 2.0；p = 0.003）。 21% 的患者 (17/82) 符合慢性疲劳标准，而对照组的这一比例为 12% (48/410)（比值比 1.96；p = 0.03）。 MG 患者的总疲劳评分高于对照组 (p<0.001)，且自主神经症状的发生率较高，尤其是体温调节不良和睡眠障碍。根据控制 MG 评分的多变量分析，自主神经紊乱症状与疲劳独立正相关 (p<0.001)，疲劳与功能水平独立负相关 (p<0.001)。与对照组相比，挪威族 MG 患者的疲劳程度和慢性疲劳患病率更高，即使是完全缓解的患者也是如此。重症肌无力的严重程度高度提示与自主神经紊乱的症状有关，而自主神经紊乱的症状又与疲劳和功能障碍的程度有关。
Few studies have focused on fatigue in myasthenia gravis (MG), and fatigue in relation to the autonomic system has never been systematically explored in these patients. The study aimed to document the prevalence of MG-related fatigue in ethnic Norwegians and to examine whether MG severity is associated with symptoms of autonomic disturbance, which in turn is associated with fatigue and functional disability. Eighty two of the 97 who fulfilled the study inclusion criteria participated in the study. Controls were 410 age- and sex-matched subjects drawn from a normative sample (n = 2136) representative of the Norwegian population. Bivariate analyses and multivariate linear regression analyses were used to assess associations between questionnaire-reported MG severity, symptoms of autonomic disturbance, fatigue (mental and physical) and functional disability. Forty-four per cent (36/82) of patients fulfilled the criteria for fatigue compared with 22% (90/410) of controls (odds ratio 2.0; p = 0.003). Twenty-one per cent of patients (17/82) met the criteria for chronic fatigue versus 12% (48/410) of controls (odds ratio 1.96; p = 0.03). MG patients had higher total fatigue scores than controls (p < 0.001) and a high prevalence of autonomic symptoms, especially poor thermoregulation and sleep disturbance. According to multivariate analyses controlled for MG score, symptoms of autonomic disturbances were independently positively associated with fatigue (p < 0.001), and fatigue was independently negatively associated with functional level (p < 0.001). Norwegian ethnic patients with MG have higher levels of fatigue and a higher prevalence of chronic fatigue than controls, even in patients in full remission. MG severity is highly suggestive to be associated with symptoms of autonomic disturbance, which in turn is associated with fatigue and the level of functional disability.
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