疲倦評比分數可能預測透析患者的心臟血管事件


  【24drs.com】March 2, 2010 — 根據一項發表於美國腎臟醫學會臨床期刊的研究結果顯示,一個新的疲倦評比分數可以預測末期腎臟疾病(ESRD)患者心肌梗塞或是其他心臟血管(CV)事件風險增加。
  
  日本大阪市立大學醫學院的Hidenori Koyama博士寫到,儘管疲倦與相關問題在心血管疾病發生潛在的顯著性,流行病學數據顯示這之間的連結是非常有限的。這項研究是設計來檢驗疲倦症狀或疲倦的相關部份是否為ESRD高風險對象心血管疾病的一個預測因子。
  
  在2005年10月到11月之間,總共有788位透析病患(506位男性,282位女性)完成一項共有64個問題的問卷。8個與疲倦有關的因子涵蓋在這項問卷調查中,包括疲倦本身、焦慮與憂鬱、缺乏注意力與記憶、疼痛、過勞、自主神經失衡、睡眠問題與感染。在後續達26個月的追蹤期間,觀察這些病患是否發生致命或非致命CV事件。
  
  15.7%病患的疲倦分數平均值比健康自願者高了2倍標準差。在這些病患中,CV事件發生顯著增加(危險比值為2.17;P<0.01)。這樣的關係獨立於年齡、糖尿病、CV疾病病史、發炎指標與營養不良,還有其他廣為人知的危險因子。
  
  次組分析結果顯示,CV事件風險與較高疲倦分數的關係在年紀較輕、過去沒有CV疾病、血清白蛋白濃度較高與非高密度脂蛋白(HDL)膽固醇濃度較高、以及營養狀態較好的病患身上,CV事件風險與較高疲倦指數之間的關係更加顯著。
  
  Koyama博士在一項新聞稿中表示,我們的數據第一次突顯了疲倦作為一個心血管疾病重要生物警訊的病理生理顯著性。
  
  然而,研究者們表示,仍然有許多問題尚未得到解答。
  
  他們寫到,我們這個全新的疲倦分數是否可以預測一般大眾、或是其他疾病患者的心血管疾病?疲倦的一個定量指標是否為預測心血管疾病的良好生物標記?改善疲倦是否可以降低發病率?這些步驟在突顯疲倦作為ESRD病患CVD風險預測因子重要部分的顯著性是很關鍵的。
  
  來自日本教育、文化、運動與科學署21世紀COE計畫「戰勝疲倦總部」贊助這項研究。這項研究部份由日本厚生勞動省贊助。研究作者們表示沒有相關資金上的往來。

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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