中轴型脊柱关节炎患者疼痛特征及其与疾病活动度和功能状况的关系

发布时间：2018-03-03 11:01

本文选题：中轴型脊柱炎关节炎　切入点：炎性腰背痛　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景疼痛是中轴型脊柱关节炎(Axial Spondyloarthritis,axSpA)患者最主要的症状之一。准确的疼痛评估能有效反映患者的病情活动程度,有助于指导临床治疗及观察疗效。炎性腰背痛(Inflammatory Back Pain,IBP)是axSpA患者的典型特征,近年来发现还存在神经病理性疼痛(Neuropathic Pain,NP)成分。但患者IBP、NP的疼痛特征及其与疾病活动度和功能状况相关性未见报道。研究目的1.评估患者IBP、NP发生率及相关因素;2.明确患者IBP、NP的疼痛强度及其影响、性质和灾难化程度;3.识别IBP、NP与疾病活动度和功能状况相关性。研究方法(一)研究对象2016年6月至2017年4月,采用便利抽样法选取某三级医院风湿免疫科132例axSpA患者进行问卷调查。(二)研究工具1.疼痛评估(1)2006年柏林标准(the Berlin Criteria):包括4个标准,至少符合2条诊断为 IBP。(2)神经病理性疼痛 4 问卷(Douleur Neuropathique 4 questionnaire,DN4):共10个条目,总分≥4分诊断为NP。(3)简明疼痛量表(Brief Pain Inventory,BPI):测量疼痛强度和疼痛影响,每个条目使用0-10计分,疼痛治疗或服用药物后疼痛缓解程度使用0-100%评估。(4)简明 McGill 疼痛问卷(Short-Form McGill Pain Questionnaire,SF-MPQ):共15个描述词,其中1-11为感觉描述词,12-15为情感描述词,每项采用0-4计分。(5)疼痛灾难化量表(Pain Catastrophizing Scale,PCS):共13个条目,每个条目0-4分,总分≥30分表明患者存在疼痛灾难化倾向。2.疾病活动度和功能状况评估巴斯强直性脊柱炎疾病活动度评分(Bath Ankylosing Spondylitis Disease Activity Index,BASDAI)用于评估患者疾病活动度,总分0-10分,总分越高,疾病活动度越高。巴斯强直性脊柱炎功能指数(Bath Ankylosing Spondylitis Functional Index,BASFI)用于评价患者功能状况,总分0-10分,总分越高,功能状况越差。巴斯强直性脊柱炎测量学指数(Bath Ankylosing Spondylitis Metrology Index,BASMI)用来量化患者中轴骨活动程度,总分0-10分,总分越高,脊柱活动度越差。(三)研究步骤患者填写疼痛评估、疾病活动度和功能状况评估问卷。DN4中体格检查和BASMI由研究者测量完成。同时收集人口统计学和临床资料,如年龄、性别、体质指数、吸烟史、饮酒史、病程、最近一次的实验室检查结果(C反应蛋白和血沉)和抗炎药的使用等。研究结果1.患者疼痛发生率及相关因素分析37.9%患者有IBP,16.7%患者有NP。IBP的患者中体质指数≥24kg/m2、未用抗炎药频率显著高于无IBP患者;NP患者的吸烟史、饮酒史频率显著高于无NP 患者(P0.05)。2.IBP、NP患者的疼痛特征IBP患者经历轻、中度疼痛及疼痛影响,其疼痛强度及影响、BASDAI、BASFI得分高于无IIBP患者,主要表现感觉描述词中的“痉挛牵扯痛”以及情感描述词的“软弱无力”;NP患者经历中度疼痛及影响,其疼痛强度及影响、BASDAI、BASFI和BASMI得分显著高于无NP患者,主要表现感觉描述词中的“跳痛”、“刺痛”、“锐痛”和“热灼痛”(P0.05)。两组患者C反应蛋白、血沉和疼痛灾难化程度无显著性差异。3.疼痛与疾病活动度、功能状况相关性IBP 与 BASDAI 相关,NP 与 BASFI 相关(P0.05)。研究结论有IBP或NP的axSpA患者,其疼痛强度及其影响较重、疾病活动度较高、功能受限明显。IBP与疾病活动度相关,可对情绪有影响;NP与功能受限相关,主要表现为自发性疼痛。对患者疼痛特征的评估可为疾病活动度、功能状况评估及疗效判断提供依据。
[Abstract]:Backgroundpain is axial spondyloarthritis (Axial Spondyloarthritis, axSpA) of the patients with the main symptoms. Accurate pain assessment can effectively reflect the disease activity of patients, help to guide the clinical treatment and curative effect observation. Inflammatory back pain (Inflammatory Back, Pain, IBP) is a typical feature of patients with axSpA in recent years. To find there is neuropathic pain (Neuropathic Pain, NP). But IBP patients reported pain features of NP and its correlation degree and no functional status and disease activity. Objective assessment of 1. patients with IBP, the incidence and related factors of NP; 2. patients with clear IBP, pain intensity and the influence of NP, nature and disaster 3. degree; the identification of IBP, NP and the disease activity and functional status. The correlation research method (a) the research object from June 2016 to April 2017, selected from a grade three hospital rheumatism immunity by convenient sampling method A questionnaire survey was conducted in 132 cases of axSpA patients. (two) research on pain assessment tools 1. (1) 2006 Berlin standard (the Berlin Criteria): including 4 standards, at least 2 IBP. (2) for the diagnosis of neuropathic pain questionnaire (Douleur 4 Neuropathique 4 questionnaire, DN4): a total of 10 items, the total is more than 4 diagnosed as NP. (3) Brief Pain Inventory (Brief Pain, Inventory, BPI): the effect of measuring pain intensity and pain, each entry with 0-10 score, pain treatment or taking pain relief to assess the degree of 0-100% drug use. (4) concise McGill pain questionnaire (Short-Form McGill Pain Questionnaire, SF-MPQ): 15 description, of which 1-11 were feeling adjectives, 12-15 emotional adjectives, each with 0-4 points. (5) the pain catastrophizing scale (Pain Catastrophizing Scale, PCS): a total of 13 entries, each entry score of 0-4 points, 30 points more than that in patients Pain catastrophizing tendency of.2. disease activity and functional status assessment of the Bath Ankylosing Spondylitis Disease Activity Score (Bath Ankylosing Spondylitis Disease Activity Index, BASDAI) were used to assess disease activity, a total of 0-10 points, the higher the score, the higher the degree of disease activity. The Bath Ankylosing Spondylitis Functional Index (Bath Ankylosing Spondylitis Functional Index. BASFI) for the evaluation of patients with functional status, a total of 0-10 points, the higher the score, the worse the situation. The function of measuring Bath Ankylosing Spondylitis index (Bath Ankylosing Spondylitis Metrology, Index, BASMI) were used to quantify the degree of axial bone activity, a total of 0-10 points, the higher the score, the worse spine pain assessment (three). Fill out the research steps of patients, disease activity and functional status assessment of physical examination and questionnaire BASMI.DN4 by researchers measured. Meanwhile the population statistics collection Family and clinical data, such as age, gender, body mass index, smoking history, drinking history, disease course, laboratory examination results of a recent (C C-reactive protein and erythrocyte sedimentation rate) and the use of anti-inflammatory drugs. The results of analysis of 37.9% patients with IBP incidence and related factors of 1. patients with pain, 16.7% patients with BMI more than NP.IBP in patients with 24kg/m2, without the use of anti-inflammatory drugs frequency was significantly higher than that of non IBP patients; NP patients with smoking history, drinking history frequency was significantly higher than that in patients without NP (P0.05).2.IBP, features of IBP patients with NP pain experience light, moderate the effects of pain and pain, the pain intensity and effect, BASDAI, BASFI were higher than that of no IIBP patients, mainly describe the feeling words "spasm of pain" and "emotion description experience moderate pain and weak and feeble"; influence of NP patients, the pain intensity and effect, BASDAI, BASFI and BASMI scores were significantly higher than those without NP Patients, mainly describe the feeling words "pain", "pain", "sharp pain" and "hot burning" (P0.05). Two groups of patients with C reactive protein, ESR and pain catastrophizing level had no significant difference.3. pain and disease activity, functional status between IBP and BASDAI, NP BASFI (P0.05). Conclusion IBP NP or axSpA patients, the pain intensity and the influence is heavy, high disease activity, functional limitation of.IBP significantly correlated with disease activity, can have effect on mood; NP and functional limitation, mainly for spontaneous pain. Assessment of patient characteristics the pain for disease activity, functional status assessment and therapeutic evaluation provides the basis.

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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