强直性脊柱炎患者临床特征与抑郁及人格的关系分析

发布时间：2018-05-17 09:38

本文选题：强直性脊柱炎 + 抑郁　；参考：《郑州大学》2017年硕士论文

【摘要】：目的了解强直性脊柱炎(AS)患者抑郁情绪的现状、特点,分析抑郁与临床特征、人格特征和生存质量之间的相互关系。为AS与抑郁共病的识别和干预提供理论依据,为合理用药、减轻患者痛苦、提高身心健康水平提供支持。方法以2015年8月~2016年5月在三所三甲医院相关门诊被确诊为AS的411名患者为研究对象,男性329人,女性82人。抑郁自评量表(SDS)、艾森克人格问卷(EPQ)和世界卫生组织生存质量简表(WHOQOL-BREF)测评抑郁状态、人格特征和生存质量,收集人口学特征(性别、年龄、家庭月收入、职业、受教育程度等),病程,晨僵时间,HLA-B27,指地距,红细胞沉降率(ESR),C反应蛋白(CRP),Bath AS测量学指标(BASMI);视觉模拟标尺评分法和Bath功能指数表(BASFI)以及疾病活动性指数表(BASDAI)评价主观疼痛感和疾病参数。并对抑郁和各因素之间的关系进行分析。结果1.AS患者年龄在16~56岁;16~34岁青年占77.1%;病情活动和功能状态差者占58.9%和15.8%;50.6%和51.8%的患者有夜间痛和总体背痛。2.患者抑郁评分为(47.46±10.54)分,高于中国常模(t=9.67,P0.001),34.5%患者伴有抑郁状态;女性抑郁评分和检出率高于男性(P0.05);随着年龄增高和受教育程度降低,抑郁评分和检出率均随之升高(P0.05);家庭收入低于2000元者抑郁评分和检出率均高于收入在2000元及以上者(P0.001);务农患者抑郁评分最高(P0.001)。3.伴抑郁状态患者临床指标均高于不伴有抑郁状态者(P0.05);ESR、CRP异常者、病情活动者和功能较差者伴抑郁检出率高(P0.05);夜间痛和总体痛明显者伴抑郁检出率高(P0.001)。4.患者精神质、内外倾维度评分均小于中国常模,神经质维度大于中国常模(P0.001);伴抑郁患者的精神质维度评分小于不伴抑郁者,内外倾和神经质维度评分大于不伴抑郁者(P0.001)。5.患者生理领域评分低于中国常模,伴抑郁患者生存质量各领域评分均低于不伴抑郁者(P0.001)。6.患者抑郁评分和临床指标呈正相关(r=0.11~0.54);与精神质和神经质维度呈正相关(r=0.24、0.61),与内外倾呈负相关(r=0.38);夜间痛、总体痛、BASDAI和BASFI主观临床指标与内外倾呈负相关(r=0.25~0.33),与神经质呈正相关(r=0.34~0.43)。7.分层回归分析并控制人口学特征后,患者临床特征、心理特征分别对抑郁的解释量增加21.0%和37.0%,三者共同解释量为62.0%;非条件Logistic回归分析显示年龄、BASDAI和神经质是抑郁发生的危险因素(OR=1.06、1.10和1.14,P0.01),家庭月收入和心理领域为保护因素(OR=0.44和0.70,P0.05);而且,抑郁是患者夜间痛的危险因素(OR=1.04,P0.05);心理学特征对夜间痛和总体痛的解释量为33.0%和42.0%,低于临床特征。结论1、抑郁情绪在AS患者中较普通人群更为常见,年龄、家庭月收入、疾病活动性以及神经质人格特征对抑郁有明显影响。2、疾病的临床病症与抑郁情绪相互影响,抑郁是患者夜间痛的危险因素,疼痛感也受到心理因素影响。3、伴有抑郁状态患者人格特质属于高精神质、内倾型和高神经质型;并且,疼痛感、BASDAI、BASFI主观临床特征与内外倾和神经质人格特征关系更为密切。4、AS患者的生存质量总体尚可,但生理领域较差;伴有抑郁状态患者生存质量水平则更为低下;心理领域是抑郁的保护因素。5、AS治疗中,应重视患者的抑郁、人格等心理因素,需制定合理药物和心理干预来提高身心健康水平。
[Abstract]:Objective to understand the status and characteristics of depression in patients with ankylosing spondylitis (AS), to analyze the relationship between depression and clinical characteristics, personality characteristics and quality of life, and to provide a theoretical basis for the identification and intervention of AS and depressive comorbidity, and to provide support for rational use of drugs, alleviated sufferings and improving the level of physical and mental health. Methods of August 2015 ~201 In May 6, 411 patients were diagnosed as AS in three three a hospital related clinics, 329 men and 82 women. The depression self rating scale (SDS), Eysenck Personality Questionnaire (EPQ) and the WHO quality of life simple table (WHOQOL-BREF) were used to evaluate the depression state, human characteristics and quality of life, and collect demographic characteristics (sex, age, home). Monthly income, occupation, education level, morning stiffness, morning stiffness, HLA-B27, ground distance, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), Bath AS measurement index (BASMI), visual analogue scale scoring and Bath function index table (BASFI), and disease active index table (BASDAI) to evaluate subjective pain and disease parameters. Results the relationship between the factors was analyzed. Results the age of 1.AS patients was 16~56 years, 77.1% years old, 58.9% and 15.8%, 50.6% and 51.8% of patients with nocturnal pain and total back pain (47.46 + 10.54), higher than the Chinese norm (t=9.67, P0.001), and 34.5% patients with depression. The depression score and detection rate of women were higher than that of men (P0.05). With the increase of age and education, the score and detection rate of depression were all higher (P0.05). The depression score and detection rate of family income below 2000 yuan were higher than those of 2000 yuan and above (P0.001), and the highest (P0.001).3. with depression in the patients with agricultural depression. All the clinical indexes were higher than those without depression (P0.05); ESR, CRP abnormal, patients with disease activity and poor function were high (P0.05) with depression, while nocturnal pain and overall pain were higher (P0.001).4. patients with higher (P0.001) mental quality than Chinese norm, and the neuroticism dimension was larger than the Chinese norm (P0.001). The mental quality score of patients with depression was less than those without depression, the score of internal and external dipping and neuroticism was greater than that of non depression (P0.001).5. patients were lower than the Chinese norm, and the scores of the quality of life in the patients with depression were lower than those without depression (P0.001).6. patients' depression score and clinical indicators (r=0.11~ 0.54); positive correlation with psychoticism and neuroticism (r=0.24,0.61), negative correlation with introversion (r=0.38), nocturnal pain, total pain, negative correlation between BASDAI and BASFI subjective clinical indicators (r=0.25~0.33), positive correlation with neuroticism (r=0.34~0.43).7. stratified regression analysis and control of demographic characteristics, patients' clinical characteristics, psychological characteristics. The interpretation of depressive symptoms increased by 21% and 37%, with a common interpretation of 62%, and unconditional Logistic regression analysis showed that age, BASDAI and neuroticism were risk factors for depression (OR=1.06,1.10 and 1.14, P0.01), family monthly income and psychological domain were protective factors (OR=0.44 and 0.70, P0.05), and depression was nocturnal pain in patients. The risk factors (OR=1.04, P0.05); psychological characteristics for nocturnal pain and total pain were 33% and 42%, lower than clinical characteristics. Conclusion 1, depression is more common in AS patients than those of the general population. Age, family monthly income, disease activity and neuroticism have significant influence on depression,.2, clinical symptoms and suppression of disease. Depression is mutual influence, depression is a risk factor for nocturnal pain, and pain is also influenced by psychological factors in.3. The personality traits of patients with depression are high psychotic, introverted and high neuroticism, and the subjective clinical features of pain, BASDAI, BASFI are more closely related to internal extroversion and neuroticism,.4, and AS patients. The quality of life is generally acceptable, but the physiological field is poor; the level of life quality of patients with depression is lower; psychological field is the protective factor of depression.5. In the treatment of AS, the psychological factors such as depression and personality should be paid attention to, and rational drug and psychological intervention should be formulated to improve the level of physical and mental health.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.23

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