疼痛抑郁共病对视神经脊髓炎谱系疾病患者生活质量的影响

目的 了解视神经脊髓炎谱系疾病(NMOSD)患者合并疼痛抑郁共病情况、药物治疗比例、治疗效果及其对患者生活质量的影响。方法 选取北京协和医院神经内科门诊合并疼痛的NMOSD患者,就诊当天由神经内科医师完成对原发病的评估,由麻醉科医师完成对疼痛(简明疼痛评估量表)、抑郁(贝克抑郁量表第2版)及生活质量(健康调查简表-36)的评估。结果 共81例患者参与本研究,其中38例(46.9%)合并抑郁纳入共病组,共病组与非共病组患者评估时疼痛严重程度差异无统计学意义共病组(3.3±3.1)分,非共病组(2.3±2.2)分;P=0.087]。共病组患者简明疼痛评估量表中日常生活、日常工作(P均=0.001)及情绪、与他人关系、生活兴趣(P均<0.001)、行走能力(P=0.004)、睡眠(P=0.016)影响评分均显著高于非共病组,健康调查简表-36中生理功能(P=0.001)及生理职能、身体疼痛、总体健康、活力、社会功能、情感职能、精神健康(P均<0.001)评分均显著低于非共病组。所有患者中仅30.9%接受疼痛治疗药物治疗,疼痛缓解程度(53.6±28.9)%,无患者接受抗抑郁药物治疗。结论 NMOSD合并疼痛抑郁共病发生率较高,严重影响生活质量,然而,接受镇痛或抗抑郁药物治疗比例较低,值得引起重视。

Influence of Pain-depression Comorbidity on Quality of Life in Patients with Neuromyelitis Optica Spectrum Disorder

Objective To investigate the incidence,treatment,therapeutic effect,and impact on quality of life of pain-depression comorbidity in the patients with neuromyelitis optica spectrum disorder(NMOSD). Methods The NMOSD patients comorbid with pain visiting the out-patient clinic of Peking Union Medical College Hospital were interviewed in a face-to-face manner by neurologists for evaluating the neurologic disease.Pain,depression,and quality of life were evaluated by anesthesiologists based on the brief pain inventory,the Beck depression inventory-Ⅱ,and the MOS 36-item short form health survey scales,respectively. Results Totally 81 patients were included in this study,among which 38(46.9%)patients comorbid with depression were enrolled in the comorbidity group.The pain severity showed no significant difference between the two groups(3.3±3.1 vs. 2.3±2.2,P=0.087).The daily life activities and health-related quality of life were more severely influenced in the patients with comorbidity than in the patients without comorbidity as illustrated by the breif pain inventorygeneral activity and normal work(P=0.001);mood,relationship with other people,and enjoyment of life(all P<0.001);walking ability(P=0.004);sleep(P=0.016)]and the MOS 36-item short form health survey scalesphysical functioning(P=0.001);role-physical,bodily pain,general health,vitality,social functioning,role-emotional,mental health(all P<0.001)].Only 30.9% of pain sufferers received analgesic medications,with the mean pain reduction percentage of(53.6±28.9)%.None of the patients in this study took antidepressants. Conclusions Pain-depression comorbidity was common in NMOSD patients and severely influenced the quality of life of the patients.However,only a few patients received analgesic or antidepressant medications.Pain-depression comorbidity in NMOSD patients should be scrutinized.