Pulmoner arteriyel hipertansiyon ön tanısı olan ve olmayan sistemik skleroz hastalarında dispne, yorgunluk ve yaşam kalitesinin karşılaştırılması
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2020
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info:eu-repo/semantics/openAccess
Özet
Sistemik skleroz hastalarında pulmoner sistem tutulumu önemli morbidite ve mortalite sebebidir. İnterstisyel akciğer hastalığı ve pulmoner arteriyel hipertansiyon başta gelen tutulum şeklidir. Bu hastalarda nefes darlığı, halsizlik, yorgunluk yaygın semptomlardır. Bu çalışmadaki amacımız pulmoner arteriyel hipertansiyon ön tanısı olan ve olmayan sistemik skleroz hastalarında dispne, yorgunluk ve yaşam kalitesinin karşılaştırılmasıdır. GEREÇ VE YÖNTEM Çalışmaya Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon ve Dahiliye Anabilim Dalları Romatoloji Bilim Dalı, poliklinik ve servislerinde takipli 2013 ACR/EULAR klasifikasyon kriterlerine göre tanısı konmuş 49 sistemik sklerozlu hasta dahil edildi. Hastaların yaş, cinsiyet, vücut kitle indeksi, hastalık süresi gibi demografik bilgileri alındıktan sonra anamnez ve fizik muayene ile hastalığın tutulum tipi diffüz yada sınırlı olarak belirlendi. Hastane kayıtlarından yüksek çözünürlüklü bilgisayarlı tomografi raporlarına göre interstisyel akciğer hastalığı var veya yok şeklinde kaydedildi. Hastalar son bir yılda yapılmış olan ekokardiyografilerindeki pulmoner arter basıncına (PAB) göre iki gruba ayrıldı. Grup 1, PAB ≥25 mmHg olup pulmoner arteriyel hipertansiyon (PAH) ön tanısı olan grup; Grup 2 ise PAB <25mmHg olup PAH ön tanısı olmayan grup şeklindeydi. Her iki grup dispnenin değerlendirilmesi için Medical Research Council Scale (MRCS, Medikal Araştırma Kurulu Skalası), yorgunluğun değerlendirilmesi için Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F,Kronik Hastalık Tedavisi-Yorgunluğun Fonksiyonel Değerlendirmesi) ve yaşam kalitesinin değerlendirilmesi için de Short Form-36 (SF-36,Kısa Form-36) kullanılarak karşılaştırıldı. BULGULAR Karşılaştırılan gruplar arasında yaş, cinsiyet, vücut kitle indeksi, hastalık süresi, tutulum tipi ve akciğer tutulumu açısından istatistiksel olarak anlamlı fark yoktu. Hastalar dispne açısından karşılaştırıldığında ise iki grup arasında MRCS skorları benzer olup istatistiksel olarak anlamlı farklılık bulunmadı(p=0,424). Aynı zamanda dispne skorları ile yorgunluk ve SF-36 fiziksel komponent skalası (FKS) ve mental komponent skalası (MKS) skorları arasında istatistiksel olarak anlamlı korelasyon mevcuttu.(sırasıyla p=0,003, p<0,001, p=0,012) Gruplar arasında yorgunluk ve yaşam kalitesi açısından istatistiksel olarak anlamlı farklılık vardı;Grup 1'de yorgunluk değerleri daha yüksek, yaşam kalitesi değerleri daha düşüktü. Yorgunluk ve SF-36 FKS ve MKS skorları arasında istatistiksel olarak anlamlı korelasyon mevcuttu. (p<0.001) SONUÇLAR Yaptığımız çalışma sonucunda artan pulmoner arter basınçlarının yorgunluk düzeyinde artışa sebep olduğu ve yaşam kalitesini olumsuz yönde etkilediği görüldü. Hissedilen nefes darlığı derecesi ve pulmoner arter basınçları arasında istatistiksel olarak anlamlı bir ilişki saptanmadı. Gözardı edilebilecek, genel bir semptom olan yorgunluğun sistemik skleroz hastalarında önemli bir komplikasyon olan pulmoner arteriyel hipertansiyon için uyarıcı olabilecegini düşünmekteyiz. Ayrıca hastaların yaşam kalitesini de oldukça düşürmektedir. Bu sebeple hastaların yorgunluk şikayetinin dikkate alınması ve bu açıdan gözlemlenmelerini önermekteyiz. Anahtar kelimeler: Sistemik skleroz, Pulmoner arteriyel hipertansiyon, Yorgunluk, Yaşam kalitesi
Objectives Pulmonary system involvement is an important cause of morbidity and mortality in patients with systemic sclerosis. Interstitial lung disease and pulmonary arterial hypertension are the leading forms of involvement. Shortness of breath, weakness and fatigue are common symptoms in these patients. In this study, it was aimed to compare dyspnea, fatigue and quality of life in patients with systemic sclerosis with and without a pre-diagnosis of pulmonary arterial hypertension. Material and Methods Forty-nine patients with systemic sclerosis, diagnosed according to the 2013 ACR / EULARclassification criteria, who were followed up in the Necmettin Erbakan University, Meram Faculty of Medicine department of Physical Medicine and Rehabilitation and Internal Medicine Rheumatologydivision outpatient clinics and services were included in the study. Demographic information of the patients such as age, gender, body mass index, and duration of disease was obtained. Then, with the history and physical examination, the type of involvement of the disease was determined as diffuse or limited. According to high resolution computed tomography reports from hospital records, interstitial lung involvement was recorded as present or absent. The patients were divided into two groups according to their pulmonary artery pressure (PAP) in their echocardiography performed in the last year.Group 1, the group with PAP ≥25 mmHg and pre-diagnosis of pulmonary arterial hypertension (PAH); Group 2 was the group with PAP <25mmHg without a pre-diagnosis of PAH.Both groups were compared using the Medical Research Council Scale for the assessment of dyspnea, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) for the assessment of fatigue, and the Short Form-36 (SF-36) for the assessment of quality of life. Results There was no statistically significant difference between the compared groups in terms of age, gender, BMI, disease duration, involvement type and lung involvement. When the patients were compared in terms of dyspnea, the MRCS scores were similar between the two groups, and no statistically significant difference was found. (p = 0.424) There was also a statistically significant correlation between dyspnea scores and fatigue and SF-36 physical component scale (PCS) and mental component scale (MCS) scores. (p = 0.003, p <0.001, p = 0.012) There was a statistically significant difference between the groups in terms of fatigue and quality of life, and the Group 1 had higher fatigue values and lower quality of life values. There was a statistically significant correlation between fatigue and SF-36 PCS and MCS scores. (p <0.001) Conclusion As a result of our study, it was seen that increased pulmonary artery pressures caused an increase in fatigue and negatively affected the quality of life. There was no statistically significant relationship between the degree of dyspnea and pulmonary artery pressures. We think that fatigue, which is a general symptom that can be ignored, may be a warning for pulmonary arterial hypertension, which is an important complication in patients with systemic sclerosis. It also significantly reduces the quality of life of patients. For this reason, we recommend that patients' complaints of fatigue should be taken into consideration and observed in this respect. Keywords: Systemic sclerosis, Pulmonary arterial hypertension, Fatigue, Quality of life
Objectives Pulmonary system involvement is an important cause of morbidity and mortality in patients with systemic sclerosis. Interstitial lung disease and pulmonary arterial hypertension are the leading forms of involvement. Shortness of breath, weakness and fatigue are common symptoms in these patients. In this study, it was aimed to compare dyspnea, fatigue and quality of life in patients with systemic sclerosis with and without a pre-diagnosis of pulmonary arterial hypertension. Material and Methods Forty-nine patients with systemic sclerosis, diagnosed according to the 2013 ACR / EULARclassification criteria, who were followed up in the Necmettin Erbakan University, Meram Faculty of Medicine department of Physical Medicine and Rehabilitation and Internal Medicine Rheumatologydivision outpatient clinics and services were included in the study. Demographic information of the patients such as age, gender, body mass index, and duration of disease was obtained. Then, with the history and physical examination, the type of involvement of the disease was determined as diffuse or limited. According to high resolution computed tomography reports from hospital records, interstitial lung involvement was recorded as present or absent. The patients were divided into two groups according to their pulmonary artery pressure (PAP) in their echocardiography performed in the last year.Group 1, the group with PAP ≥25 mmHg and pre-diagnosis of pulmonary arterial hypertension (PAH); Group 2 was the group with PAP <25mmHg without a pre-diagnosis of PAH.Both groups were compared using the Medical Research Council Scale for the assessment of dyspnea, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) for the assessment of fatigue, and the Short Form-36 (SF-36) for the assessment of quality of life. Results There was no statistically significant difference between the compared groups in terms of age, gender, BMI, disease duration, involvement type and lung involvement. When the patients were compared in terms of dyspnea, the MRCS scores were similar between the two groups, and no statistically significant difference was found. (p = 0.424) There was also a statistically significant correlation between dyspnea scores and fatigue and SF-36 physical component scale (PCS) and mental component scale (MCS) scores. (p = 0.003, p <0.001, p = 0.012) There was a statistically significant difference between the groups in terms of fatigue and quality of life, and the Group 1 had higher fatigue values and lower quality of life values. There was a statistically significant correlation between fatigue and SF-36 PCS and MCS scores. (p <0.001) Conclusion As a result of our study, it was seen that increased pulmonary artery pressures caused an increase in fatigue and negatively affected the quality of life. There was no statistically significant relationship between the degree of dyspnea and pulmonary artery pressures. We think that fatigue, which is a general symptom that can be ignored, may be a warning for pulmonary arterial hypertension, which is an important complication in patients with systemic sclerosis. It also significantly reduces the quality of life of patients. For this reason, we recommend that patients' complaints of fatigue should be taken into consideration and observed in this respect. Keywords: Systemic sclerosis, Pulmonary arterial hypertension, Fatigue, Quality of life
Açıklama
Anahtar Kelimeler
Sistemik skleroz, Pulmoner arteriyel hipertansiyon,, Yorgunluk, Yaşam kalitesi, Systemic sclerosis, Fatigue,, Quality of life, Pulmonary arterial hypertension
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Künye
Özdemir, Zeynep. (2020). Pulmoner arteriyel hipertansiyon ön tanısı olan ve olmayan sistemik skleroz hastalarında dispne, yorgunluk ve yaşam kalitesinin karşılaştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Konya.
