背景:持续的风湿性症状及其对健康相关生活质量(QoL)的影响,由印度洋谱系(IOL)引起的基孔肯雅病毒(CHIKV)基因型已被广泛研究。2014年,库拉索岛发生了亚洲基因型的主要CHIKV爆发,之后,我们在2015年建立了一个纵向队列,以追踪长期的CHIKV后遗症.目前,亚洲CHIKV基因型的长期临床表现及其对QoL的影响,随着时间的推移,以及年龄和合并症与风湿病症状持续的关系,发病后60个月(M60)未知。
方法:在3-16个月(M3-16)时,对304例实验室确诊患者进行前瞻性随访,30个月(M30),和疾病发作后的M60。人口统计学和临床特征,并通过问卷收集36项简短调查(SF-36)QoL状况。在M60时,将QoL评分与一般人群(CHIK-)标准进行比较。
结果:共有169名(56%)患者参加(74.6%为女性,平均年龄56.1岁)在所有时间点,107(63%)被归类为恢复,62(37%)被归类为受影响。受影响的患者报告关节痛(P.001)和下肢关节痛(P<.001)的患病率增加,与M3-16相比,M30。在M60时,与康复患者相比,受影响的患者报告了中度至重度疼痛的复发性风湿性症状的患病率较高,无论年龄和合并症,非风湿性症状的患病率较高(P<.001)。上肢关节痛(比值比(OR):4.79;置信区间(CI):2.01-11.44;P<.001)和下肢(OR:8.68;CI:3.47-21.69;P<.001),头痛(OR:3.85;CI:1.40-10.54;P=.009)与受累相关。与受影响患者的QoL评分相比,康复患者的SF-36QoL评分随时间的损害较少。在M60时,康复患者的QoL评分与CHIK-QoL评分相当。
结论:风湿性和非风湿性症状,QoL受损可能会持续,感染亚洲CHIKV基因型60个月后,与IOL基因型疾病后遗症相似。需要进一步的研究来跟踪每个CHIKV基因型的临床表现和QoL影响。
BACKGROUND: Persistent
rheumatic symptoms and its impact on health-related quality of life (QoL), induced by the Indian Ocean Lineage (IOL) chikungunya virus (CHIKV) genotype have been widely studied. In 2014, a major CHIKV outbreak of the Asian genotype occurred in Curaçao, after which we established a longitudinal cohort in 2015, to follow the long-term CHIKV sequalae. Currently, the long-term clinical manifestations and its impact on QoL induced by the Asian CHIKV genotype, followed prospectively through time, and the association of age and comorbidities with
rheumatic symptoms persistence, 60 months (M60) after disease onset is unknown.
METHODS: The cohort of 304 laboratory confirmed patients were followed prospectively in time at 3-16 months (M3-16), 30 months (M30), and M60 after disease onset. Demographic and clinical characteristics, and the 36-item short-form survey (SF-36) QoL status were collected through questionnaires. At M60, QoL scores were compared to general population (CHIK-) norms.
RESULTS: A total of 169 (56%) patients participated (74.6% female, mean age 56.1 years) at all time points, 107 (63%) were classified as recovered and 62 (37%) as affected. The affected patients reported an increase in the prevalence of arthralgia (P .001) and arthralgia in the lower extremities (P < .001), at M30 compared to M3-16. At M60, in comparison to recovered patients, affected patients reported a higher prevalence of recurrent
rheumatic symptoms of moderate to severe pain, irrespective of age and comorbidities, and a higher prevalence of non-
rheumatic symptoms (P < .001). Arthralgia in the upper (odds ratio (OR): 4.79; confidence interval (CI): 2.01-11.44; P < .001) and lower (OR: 8.68; CI: 3.47-21.69; P < .001) extremities, and headache (OR: 3.85; CI: 1.40-10.54; P = .009) were associated with being affected. The SF-36 QoL scores of the recovered patients were less impaired over time compared to the QoL scores of the affected patients. At M60, the QoL scores of the recovered patients were comparable to the CHIK- QoL scores.
CONCLUSIONS: Rheumatic and non-
rheumatic symptoms, and QoL impairment may persist, 60 months following infection with the Asian CHIKV genotype, similar to the IOL genotype disease sequelae. Further research is needed to follow the clinical manifestations and QoL impact of each CHIKV genotype.