Investigation Of Fatigue Symptoms In Systemic Lupus Erythematosus And Its Correlation With TCM Syndrome Type

Objective:To investigate the fatigue and TCM syndromes of patients with systemic lupus erythematosus,this study explores the influencing factors of SLE fatigue and the relationship between SLE fatigue and TCM syndromes,and makes a preliminary exploration on SLE fatigue and its TCM etiology and pathogenesis,in order to improve the clinical workers’ attention to SLE fatigue,enrich the theoretical basis of TCM in the treatment of SLE fatigue,and enhance the dominant role of TCM in the treatment of SLE fatigue.Methods:A cross-sectional study was conducted to include 136 SLE patients who were treated in the outpatient and inpatient departments of the Rheumatism of Guang’anmen Hospital from January 1,2022 to January 31,2023.The researcher collects the general demographic characteristics,disease characteristics,TCM syndrome characteristics,laboratory examinations and Systemic Lupus Erythematosus Disease Activity Index-2000 of the patients.The patients fill in the Functional Assessment of Chronic Illness Therapy-Fatigue and Hospital anxiety and Depression scale.Results:①In this study,the incidence of fatigue in SLE patients was 56.62%,and the overall fatigue score was 34.99 ±10.92.There were 77 patients with fatigue,including 42 patients with some fatigue(31.00%),31 patients with quite a lot of fatigue(23.00%)and 4 patients with extreme fatigue(3.00%).②In this study,there were 120 female patients(88.23%)and 16 male patients(11.7%).The mean age was 37.10 ± 12.16 years,and the number of people in the age group of 30 to 39 years old was the most(41.91%).The median duration of disease was 2.04 years,and the largest number of patients(35.29%)had a disease duration≤1 year.There were 60 patients with anemia(44.12%),including 51 patients with mild anemia(85.00%)and 9 patients with moderate anemia(15.00%).A total of 107 patients were treated with glucocorticoids,with an average daily dose of ≤7.5mg in 33 cases(30.84%)and a daily dosage of ≥30mg in 25 cases(23.36%).The mean score of SLEDAI-2000 was 5.25±4.10.The patients with mild,moderate and severe activity were 93(68.38%),32(23.53%)and 11(8.09%),respectively.A total of 46 patients(33.82%)had anxiety,the incidence of anxiety was 33.82%,52 patients had depression(38.24%),and the incidence of depression was 38.24%.③In the correlation analysis,there was a positive correlation between lymphocyte level and fatigue score(r=0.200,P<0.05).The average daily dosage of glucocorticoid was negatively correlated with fatigue score(r=0.269,P<0.05).There was a negative correlation between SLEDAI-2000 and fatigue score(r=0.392,P<0.05).The fatigue score of patients with anemia was significantly lower than that of patients without anemia(P<0.01).The fatigue score of female patients with SLE was significantly lower than that of male patients.The fatigue score of the anxiety group was significantly lower than that of the non-anxiety group(P<0.01),and the fatigue score of the depression group was significantly lower than that of the nondepression group(P<0.01).The lower the fatigue score,the more serious the fatigue.④In multivariate analysis,55.9%of the variation in fatigue score could be explained by SLEDAI-2000,anxiety and depression(corrected R2=0.559),high disease activity score(β:0.693,95%CI[-1.068,-0.319],P<0.001),anxiety(β:-9.183,95%CI[-12.610,-5.756],P<0.001)and depression(β:-6.741,95%CI[-9.866,-3.616],P<0.001)affected the decrease of fatigue score.⑤In this study,the distribution of TCM syndromes were syndrome of yin deficiency with internal heat in 45 cases(33.09%),syndrome of qi and blood depletion in 33 cases(24.26%),syndrome of wind-dampness with heat impediment in 17 cases(12.5%),syndrome of yang deficiency in spleen and kidney in 16 cases(11.76%),syndrome of blood stasis due to liver depression in 8 cases(5.88%),syndrome of phlegm and stasis obstructing the lung in 6 cases(4.41%),syndrome of intense exuberant heat toxin in 4 cases(2.94%),syndrome of water intimidating the heart in 4 cases(2.94%),and syndrome of wind phlegm stirring the internal in 3 cases(2.21%).⑥The fatigue scores of nine TCM syndromes were significantly different,and the difference was statistically significant(P<0.01).After multiple comparison,it was found that the fatigue score of patients with syndrome of intense exuberant heat toxin was significantly lower than that of syndrome of yin deficiency with internal heat,syndrome of blood stasis due to liver depression,syndrome of wind-dampness with heat impediment,syndrome of qi and blood depletion,syndrome of phlegm and stasis obstructing the lung and syndrome of wind phlegm stirring the internal(P<0.05).The fatigue score of patients with syndrome of yang deficiency in spleen and kidney was significantly lower than that of syndrome of yin deficiency with internal heat,syndrome of blood stasis due to liver depression and syndrome of winddampness with heat impediment(P<0.05).There was no significant difference in fatigue score between syndrome of qi and blood depletion and syndrome of yin deficiency with internal heat(P>0.05).⑦There were significant differences in the distribution of fatigue degree among different TCM syndromes(P<0.05).Among the patients with fatigue of yin deficiency with internal heat syndrome,the patients with mild,moderate and severe fatigue were 20(80.00%),4(16.00%)and 1(4.00%)respectively.Among the patients with fatigue of qi and blood depletion syndrome,the patients with mild,moderate and severe fatigue were 10(47.62%),9(42.86%)and 2(9.52%)respectively.Conclusions:①Fatigue is common in patients with SLE,and the average score of overall fatigue is between 27 and 39,which belongs to some fatigue.②Fatigue in SLE patients was related to sex,anemia,lymphocyte level,daily glucocorticoid dosage,lupus disease activity,anxiety and depression.The fatigue degree of SLE patients with anxiety and depression was more serious,and the fatigue degree of SLE patients was aggravated with the increase of lupus disease activity.③In this study,the common TCM syndromes of SLE are syndrome of yin deficiency with internal heat,syndrome of qi and blood depletion,syndrome of wind-dampness with heat impediment and syndrome of yang deficiency in spleen and kidney,among which syndrome of yin deficiency with internal heat is the most common.The number of patients with syndrome of blood stasis due to liver depression,syndrome of phlegm and stasis obstructing the lung,syndrome of intense exuberant heat toxin,syndrome of water intimidating the heart,and syndrome of wind phlegm stirring the internal are relatively small.④In this study,the fatigue degree of SLE patients with syndrome of intense exuberant heat toxin is the heaviest.Patients with syndrome of yin deficiency with internal heat are common to some fatigue.Patients with syndrome of qi and blood depletion are common to some and quite a lot of fatigue.The overall fatigue level between patients with syndrome of yin deficiency with internal heat and qi and blood depletion is equivalent.