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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (6): 1001-1008. doi: 10.19723/j.issn.1671-167X.2024.06.009

• 论著 • 上一篇    下一篇

超重和肥胖对纤维肌痛综合征患者症状、整体病情及生活质量的影响

龙梅娟, 王怡丹, 武诗雅, 李梓豪, 李婷延, 李阳, 焦娟*()   

  1. 中国中医科学院广安门医院风湿病科，北京 100053
  • 收稿日期:2024-08-01 出版日期:2024-12-18 发布日期:2024-12-18
  • 通讯作者: 焦娟 E-mail:jiao.juan@hotmail.com
  • 基金资助:
    中国中医科学院创新工程创新团队项目(CI2021B007)

Effects of overweight and obesity on symptoms, overall condition and quality of life in patients with fibromyalgia syndrome

Meijuan LONG, Yidan WANG, Shiya WU, Zihao LI, Yanting LI, Yang LI, Juan JIAO*()   

  1. Department of Rheumatology, Guang' anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
  • Received:2024-08-01 Online:2024-12-18 Published:2024-12-18
  • Contact: Juan JIAO E-mail:jiao.juan@hotmail.com
  • Supported by:
    China Academy of Chinese Medical Sciences Innovation Project Innovation Team Project(CI2021B007)

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摘要：

目的: 探索超重和肥胖对中国纤维肌痛综合征(fibromyalgia syndrome，FMS)患者的症状严重程度和生活质量的影响。方法: 采用横断面调查的研究方法采集2018年10月至2021年12月就诊于广安门医院风湿病科门诊435例FMS患者的身高、体重、性别和年龄等一般资料，压痛点个数、普遍疼痛指数及症状严重性量表数据作为疾病诊断指标，疼痛视觉模拟评分、贝克(Beck)抑郁量表、压力感知量表(perceived stress scale，PSS)、匹兹堡睡眠质量指数(Pittsburg sleep quality index，PSQI)及多维疲劳量表用于评估疾病疼痛、负性情绪、压力感知、睡眠质量，以及疲劳症状的严重程度，采用修订版纤维肌痛影响问卷、纤维肌痛症状量表(fibromyalgia severity，FS)，以及生活质量评价量表(36 item short-form health survey，SF-36)评价FMS患者的整体病情及生活质量。同时招募50例性别和年龄匹配的健康志愿者作为对照组，并采用协方差分析的方法在校正年龄和性别的基础上探索超重和肥胖对FMS患者的影响。结果: 采用中国体重指数(body mass index，BMI)标准，正常体重组与超重和肥胖组FMS患者分别有242例(59%)和170例(41%)，平均BMI分别为(21.66±1.42) kg/m2和(26.25±1.83) kg/m2。与正常体重FMS患者相比，超重和肥胖患者的PSS评分(P=0.010)、PSQI子维度睡眠效率评分(P＜0.001)及FS评分(P=0.025)均更高，SF-36量表子维度的生理机能评分(P=0.041)更低；而健康对照组正常体重者与超重和肥胖者以上指标相比差异均无统计学意义(P＞0.05)。结论: 相较于正常体重FMS患者，超重和肥胖患者压力感知水平更高、睡眠效率更低、纤维肌痛症状严重程度更高，同时表现为以生理机能下降为主的低水平生活质量。由此可见，FMS患者积极控制体重将有助于改善睡眠效率和心理状态，提高生理机能，并减轻整体病情。

关键词: 纤维肌痛综合征, 慢性疼痛, 体重, 减重

Abstract:

Objective: To explore the effects of overweight and obesity (overweight/obesity) on symptom severity and quality of life in Chinese patients with fibromyalgia syndrome (FMS). Methods: A cross-sectional survey was used to collect general data on height, weight, gender and age of 435 FMS patients who visited the rheumatology clinic of Guang 'anmen Hospital from October 2018 to December 2021. The numbers of tender points, widespread pain index and symptom severity scale were used as diagnostic indicators of the disease. The pain visual analogue scale, Beck depression inventory, perceived stress scale (PSS), Pittsburgh sleep quality index (PSQI) and multidimensional fatigue scale were used to assess the severity of pain and negative emotions, stress perception, sleep quality, and fatigue symptoms of this disease. The revised fibromyalgia impact questionnaire, fibromyalgia symptom scale (FS) and quality of life assessment scale (36 item short-form health survey, SF-36) were used to evaluate the overall condition and quality of life of the FMS patients. At the same time, 50 healthy volunteers matched in gender and age were recruited as the control group. Covariance analysis was used to explore the effects of overweight/obesity on the FMS patients after adjusting for age and gender. Results: According to the Chinese body mass index (BMI) standard, there were 242 (59%) and 170 (41%) FMS patients in the normal weight group and overweight/obesity group, respectively, with average BMI of (21.66±1.42) kg/m2 and (26.25±1.83) kg/m2, respectively. Compared with the normal weight FMS patients, the overweight/obesity patients had higher PSS scores (P=0.010), PSQI sub-dimension sleep efficiency scores (P < 0.001) and FS scores (P=0.025), and lower SF-36 sub-dimension physical functioning scores (P=0.041). However, there were no statistical differences in the above indicators between normal weight and overweight/obesity patients in the healthy control group (P > 0.05). Conclusion: Compared with normal-weight FMS patients, overweight/obesity patients have higher levels of perceived stress, lower sleep efficiency, and more severe fibromyalgia symptoms, as well as a low quality of life characterized by decreased physiological function. It is important for overweight/obesity FMS patients to control BMI actively in order to improve sleep efficiency, psychological state, physical functioning, and the overall condition.

Key words: Fibromyalgia syndrome, Chronic pain, Weight, Weight loss

中图分类号: 

  • R593.2

表1

BMI标准"

Group Chinese BMI Asia BMI WHO BMI
Underweight/(kg/m2) < 18.5 < 18.5 < 18.5
Normal weight/(kg/m2) 18.5-23.9 18.5-22.9 18.5-24.9
Overweight/(kg/m2) 24.0-27.9 23.0-24.9 25.0-29.9
Obesity/(kg/m2) ≥28.0 ≥25.0 ≥30.0

表2

FMS患者和健康志愿者的中国、亚洲和WHO BMI标准分布情况"

Chinese BMI Asia BMI WHO BMI χ2 P P
China vs. Asia China vs.WHO Asia vs.WHO
Fibromyalgia (n=435) 167.609 ＜0.001 ＜0.001 ＜0.001 ＜0.001
   Underweight 23(5) 23(5) 23(5)
   Normal weight 242(56) 188(43) 296(68)
   Overweight 144(33) 108(25) 109(25)
   Obesity 26(6) 116(27) 7(2)
Health volunteers (n=50) 20.940 ＜0.001 0.037 0.048 ＜0.001
   Underweight 0(0) 0(0) 0(0)
   Normal weight 28(56) 24(48) 35(70)
   Overweight 17(34) 11(22) 15(30)
   Obesity 5(10) 15(30) 0(0)
   χ2 3.865 3.209 0.722
   P 0.262 0.361 0.354

表3

FMS患者和健康志愿者人口学和疾病指标比较"

Items Fibromyalgia syndrome (n=412) Health volunteers (n=50) t/Z/χ2 P
Women, n(%) 352 (85) 4 3(86) 0.011 0.915
Age/years 50.00 (40.00，58.00) 49.5 (35.00，58.50) -0.474 0.635
BMI/(kg/m2) 23.34 (21.45，25.39) 23.08 (21.47，25.81) -0.376 0.707
TPC score 12.00 (9.50，15.00) 0.00 (0.00，3.25) -10.900 < 0.001
WPI score 11.00 (7.00，15.00) 0.00 (0.00，1.00) -11.473 < 0.001
SSS score 7.00 (5.00，9.00) 1.00 (0.00，2.00) -10.938 < 0.001
Pain VAS score 6.00 (4.00，7.00) 0.00 (0.00，1.00) -11.464 < 0.001
BDI score 6.00 (3.00，12.00) 0.50 (0.00，2.25) -8.505 < 0.001
PSS score 27.00 (21.00，32.00) 26.50 (21.75，29.00) -1.160 0.246
PSQI total score 12.00 (9.00，14.00) 3.00 (2.00，6.00) -9.776 < 0.001
MFI-20 total score 68.00 (56.25，79.00) 35.5 (29.25，42.25) -10.799 < 0.001
FIQR total score 31.17 (19.00，48.42) 2.50 (0.75，6.88) -10.661 < 0.001
   Function 3.67 (0.00，10.33) 0.00 (0.00，0.00) -8.769 < 0.001
   Overall impact 5.00 (0.00, 10.00) 0.00 (0.00, 0.00) -8.677 < 0.001
   Symptoms 23.73±8.92 4.56±6.24 18.751 < 0.001
FS score 17.00 (13.00，22.00) 2.00 (0.00，0.25) -11.364 < 0.001
SF-36 score
   PCS 36.75 (26.50，53.25) 87.50 (74.63，91.75) -10.539 < 0.001
   MCS 46.92 (31.97，68.44) 86.63 (63.26，89.81) -8.823 < 0.001

表4

正常体重者与超重和肥胖者核心症状指标比较"

Items Fibromyalgia syndrome(n=412) Health volunteers(n=50)
BMI＜24 kg/m2(n=242) BMI≥24 kg/m2(n=170) P BMI＜24 kg/m2(n=28) BMI≥24 kg/m2(n=22) P
Pain VAS score 6.00 (5.00，7.00) 6.00 (4.75，7.00) 0.263 0.00 (0.00，0.88) 0.00 (0.00，1.00) 0.692
BDI score 7.00 (4.00，13.00) 6.50 (4.00，12.25) 0.377 0.50 (0.00，2.00) 0.50 (0.00，3.00) 0.206
PSS score 26.00 (20.00，31.00) 27.00 (22.00，33.00) 0.010 27.00 (22.50，29.00) 25.00 (21.00，28.25) 0.581
PSQI total score 12.00 (10.00，15.00) 12.00 (9.00，15.00) 0.774 3.00 (1.00，5.75) 3.00 (2.00，7.25) 0.647
   Subjective sleep quality 2.00 (1.00，2.50) 2.00 (1.00，2.00) 0.134 0.00 (0.00，1.00) 1.00 (0.00，1.00) 0.636
   Sleep latency 2.00 (1.00，3.00) 2.00 (1.00，3.00) 0.087 1.00 (0.00，1.00) 0.50 (0.00，1.00) 0.775
   Sleep duration 1.00 (1.00，2.00) 1.00 (1.00，2.00) 0.966 0.00 (0.00，1.00) 0.00 (0.00，1.00) 0.882
   Habitual sleep efficiency 2.00 (2.00，2.00) 3.00 (2.00，3.00) ＜0.001 0.00 (0.00，0.00) 0.00 (0.00，0.25) 0.652
   Sleep disturbances 2.00 (1.00，2.00) 2.00 (1.00，2.00) 0.948 1.00 (0.00，1.00) 1.00 (1.00，1.25) 0.206
   Use of sleep medication 0.00 (0.00，0.00) 0.00 (0.00，0.00) 0.807 0.00 (0.00，0.00) 0.00 (0.00，0.00) 1.000
   Daytime dysfunction 3.00 (2.00，3.00) 3.00 (2.00，3.00) 0.118 1.00 (0.00，1.75) 1.00 (0.00，1.25) 0.854
MFI-20 total score 72.00 (63.00，80.00) 71.00 (63.00，80.00) 0.976 33.21±7.73 39.05±9.19 0.060

表5

FMS和健康志愿者正常体重与超重和肥胖者整体病情和生活质量指标比较"

Items Fibromyalgia syndrome(n=412) Health volunteers(n=50)
BMI＜24 kg/m2(n=242) BMI≥24 kg/m2(n=170) P BMI＜24 kg/m2(n=28) BMI≥24 kg/m2(n=22) P
FIQR total score 34.25 (24.38，50.17) 37.00 (24.33，52.33) 0.201 2.00 (0.00，5.00) 4.42 (1.00，10.00) 0.257
   Function 5.00 (1.00，10.33) 6.33 (1.67，11.83) 0.053 0.00 (0.00，0.00) 0.00 (0.00，0.00) 0.887
   Overall impact 6.50 (2.00，10.25) 7.00 (3.00，12.00) 0.309 0.00 (0.00，0.00) 0.00 (0.00，0.25) 0.435
   Symptoms 23.40±8.60 24.18±9.36 0.367 1.75 (0.00，4.75) 3.00 (0.88，9.25) 0.255
FS score 18.00 (15.00，22.00) 19.50 (15.00，24.00) 0.025 1.00 (0.00，2.00) 2.00 (1.00，3.50) 0.112
SF-36 score
   PF 65.00 (45.00，80.00) 55.00 (40.00，80.00) 0.041 100.00 (95.00，100.00) 95.00 (85.00，100.00) 0.164
   RP 0.00 (0.00，25.00) 0.00 (0.00，25.00) 0.061 100.00 (81.25，100.00) 100.00 (37.50，100.00) 0.792
   BP 41.00 (31.00，52.00) 41.00 (22.00，51.00) 0.175 90.00 (80.00，90.00) 84.00 (74.00，90.00) 0.502
   GH 30.00 (20.00，42.00) 30.00 (18.75，45.00) 0.674 74.79±19.94 62.14±17.40 0.098
   VT 40.00 (30.00，50.00) 40.00 (30.00，55.00) 0.344 75.00 (65.00，88.75) 70.00 (58.75，76.25) 0.077
   SF 62.5 (37.50，75.00) 62.50 (37.50，75.00) 0.867 100.00 (87.5，100.00) 100.00 (75.00，100.00) 0.080
   RE 33.33 (0.00，100.00) 33.00 (0.00，100.00) 0.566 100.00 (100，100.00) 100.00 (25.00，100.00) 0.243
   MH 44.00 (29.00，56.00) 44.00 (27.00，56.00) 0.381 80.00 (65.00，87.00) 78.00 (67.00，84.00) 0.542
   PCS 34.00 (27.75，47.25) 32.75 (21.75，44.25) 0.057 88.75 (84.19，94.81) 85.88 (68.94，89.50) 0.329
   MCS 43.69 (31.25，65.69) 42.63 (31.06，64.41) 0.507 87.25 (74.72，91.00) 84.38 (53.55，89.50) 0.114
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