疲倦评比分数可能预测透析患者的心脏血管事件


  【24drs.com】March 2, 2010 — 根据一项发表于美国肾脏医学会临床期刊的研究结果显示,一个新的疲倦评比分数可以预测末期肾脏疾病(ESRD)患者心肌梗塞或是其它心脏血管(CV)事件风险增加。
  
  日本大阪市立大学医学院的Hidenori Koyama博士写到,尽管疲倦与相关问题在心血管疾病发生潜在的显著性,流行病学数据显示这之间的连结是非常有限的。这项研究是设计来检验疲倦症状或疲倦的相关部份是否为ESRD高风险对象心血管疾病的一个预测因子。
  
  在2005年10月到11月之间,总共有788位透析病患(506位男性,282位女性)完成一项共有64个问题的问卷。8个与疲倦有关的因子涵盖在这项问卷调查中,包括疲倦本身、焦虑与忧郁、缺乏注意力与记忆、疼痛、过劳、自主神经失衡、睡眠问题与感染。在后续达26个月的追踪期间,观察这些病患是否发生致命或非致命CV事件。
  
  15.7%病患的疲倦分数平均值比健康自愿者高了2倍标准差。在这些病患中,CV事件发生显著增加(危险比值为2.17;P<0.01)。这样的关系独立于年龄、糖尿病、CV疾病病史、发炎指标与营养不良,还有其它广为人知的危险因子。
  
  次组分析结果显示,CV事件风险与较高疲倦分数的关系在年纪较轻、过去没有CV疾病、血清白蛋白浓度较高与非高密度脂蛋白(HDL)胆固醇浓度较高、以及营养状态较好的病患身上,CV事件风险与较高疲倦指数之间的关系更加显著。
  
  Koyama博士在一项新闻稿中表示,我们的数据第一次突显了疲倦作为一个心血管疾病重要生物警讯的病理生理显著性。
  
  然而,研究者们表示,仍然有许多问题尚未得到解答。
  
  他们写到,我们这个全新的疲倦分数是否可以预测一般大众、或是其它疾病患者的心血管疾病?疲倦的一个定量指标是否为预测心血管疾病的良好生物标记?改善疲倦是否可以降低发病率?这些步骤在突显疲倦作为ESRD病患CVD风险预测因子重要部分的显著性是很关键的。
  
  来自日本教育、文化、运动与科学署21世纪COE计画「战胜疲倦总部」赞助这项研究。这项研究部份由日本厚生劳动省赞助。研究作者们表示没有相关资金上的往来。

Fatigue Rating Scale May Predict Cardiovascular Events in Dialysis Patients

By Laurie Barclay, MD
Medscape Medical News

March 2, 2010 — High scores on a new fatigue rating scale predict an increased risk for myocardial infarction or other cardiovascular (CV) events in patients with end-stage renal disease (ESRD), according to the results of a study reported online in the February 25 issue of the Clinical Journal of the American Society of Nephrology.

"Despite potential significance of fatigue and its underlying components in the occurrence of cardiovascular diseases, epidemiologic data showing the link are virtually limited," write Dr. Hidenori Koyama, from Osaka City University Graduate School of Medicine in Osaka, Japan. "This study was designed to examine whether fatigue symptoms or fatigue's underlying components are a predictor for cardiovascular diseases in high-risk subjects with ESRD."

Between October and November 2005, a total of 788 patients (506 men, 282?women) undergoing hemodialysis completed a survey questionnaire of 64?questions. Eight fatigue-related factors were covered by the survey: fatigue itself, anxiety and depression, loss of attention and memory, pain, overwork, autonomic imbalance, sleep problems, and infection. During follow-up for up to 26 months, patients were monitored for occurrence of fatal or nonfatal CV events.

Fatigue scores were higher than twice the SD of the mean for healthy volunteers in 15.7% of the patients. In these patients, the risk for CV events was significantly increased (hazard ratio, 2.17; P < .01). This association was independent of age, diabetes, CV disease history, markers of inflammation and malnutrition, and other well-known risk factors.

Subgroup analysis showed that the risk for CV events associated with high fatigue score was more pronounced in well-nourished patients of younger age, with absence of past CV diseases, higher serum albumin levels, and high non–high-density lipoprotein (HDL) cholesterol levels.

"Our data highlight for the first time the pathophysiological significance of fatigue as an important bio-alarm for cardiovascular disease," Dr. Koyama said in a news release.

However, the investigators note many unanswered questions.

"Can our novel fatigue score predict cardiovascular events in the general population or other patients with disease?" they write. "Can a quantitative marker for fatigue be a good biomarker to predict cardiovascular events? Can improvement of fatigue lead to decreased morbidity? All of these steps are crucial to highlighting the significance of fatigue as an important piece of risk predictors for CVD in patients with ESRD."

The 21st Century COE Program "Base to Overcome Fatigue" from the Ministry of Education, Culture, Sports, Science and Technology of Japan supported this study. It was also partly supported by grants from the Japanese Ministry of Health, Labor and Welfare. The study authors have disclosed no relevant financial relationships.

Clin J Am Soc Nephrol. Published online February 25, 2010.

    
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