新诊断溃疡性结肠炎症状轨迹的预测因素:一项为期 3 年的随访队列研究。

Maaike Van Den Houte, Livia Guadagnoli, Lena Öhman, Anders Bergstedt, Berndt Johansson, Magnus Simrén, Hans Strid, Lukas Van Oudenhove, Jan Svedlund
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摘要

背景和目的:心理症状与较差的溃疡性结肠炎(UC)相关结果有关。然而,大多数研究都是横断面的。我们旨在根据消化道症状水平和健康相关生活质量(HRQoL)的纵向演变确定亚组,并厘清消化道症状水平和心理困扰之间的方向性影响:方法:对98名新确诊的UC患者在发病时自我报告的消化道症状严重程度、HRQoL、炎症生物标志物和心理困扰进行评估,并连续3年每年评估一次。采用潜类增长分析法根据症状严重程度和 HRQoL 的纵向轨迹确定亚组,并确定轨迹组成员的基线预测因素。采用交叉滞后结构方程模型来区分心理功能和症状严重程度之间的时间关系:结果:初始心理困扰程度较高的患者腹泻和腹痛程度维持在较高水平的可能性增加。相反,最初腹泻和腹痛程度较低的患者维持较低水平心理困扰的几率较高。基线C反应蛋白水平越高,预示着抗炎治疗后心理健康的改善程度越大。随着时间的推移,腹泻和腹痛的减轻先于心理症状的减轻:结论:基线心理困扰可预测消化道症状严重程度的增加和随着时间推移心理HRQoL的降低,这表明对心理症状的早期评估可识别出疾病轨迹可能恶化的患者。腹痛可预测心理压力的增加,但反之亦然。对腹痛进行干预可能有助于预防或减轻未来的心理困扰。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predictors of Symptoms Trajectories in Newly Diagnosed Ulcerative Colitis: A 3-Year Follow-up Cohort Study.

Background and aims: Psychological symptoms are associated with poorer ulcerative colitis [UC]-related outcomes. However, the majority of research is cross-sectional. We aimed to identify subgroups based on the longitudinal evolution of GI symptom levels and health-related quality of life [HRQoL], and to disentangle the directionality of effects between GI symptom levels and psychological distress.

Methods: Self-reported gastrointestinal [GI] symptom severity, HRQoL, inflammatory biomarkers, and psychological distress were assessed in 98 newly diagnosed UC patients at disease onset and yearly for 3 consecutive years. Latent class growth analysis was used to determine subgroups based on longitudinal trajectories of symptom severity and HRQoL, and baseline predictors of trajectory group membership were determined. Cross-lagged structural equation models were used to disentangle temporal relationships between psychological functioning and symptom severity.

Results: Patients with higher initial psychological distress had increased probability of maintaining higher levels of diarrhoea and abdominal pain. Conversely, patients with lower initial levels of diarrhoea and abdominal pain had higher chances of maintaining lower levels of psychological distress. Higher levels of C-reactive protein at baseline predicted greater improvements in mental health after anti-inflammatory treatment. Reductions in diarrhoea and abdominal pain preceded reductions in psychological symptoms over time.

Conclusions: Baseline psychological distress is predictive of increased GI symptom severity and reduced mental HRQoL over time, suggesting early assessment of psychological symptoms may identify patients who may have worse disease trajectories. Abdominal pain predicted increased psychological distress, but not the other way around. Intervening on abdominal pain may help prevent or reduce future psychological distress.

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