系统性硬化病患者生活质量的影响因素分析
发布时间：2018-08-09 14:27
【摘要】：目的:研究系统性硬化病(Systemic sclerosis,SSc)患者的生活质量的影响因素,及其与疾病活动度和严重程度的相关性,为改善SSc患者的生活质量,全面评估SSc病情,选择适当的治疗措施提供理论依据。方法:收集2015年11月至2016年10月在广西医科大学第一附属医院风湿免疫科住院或门诊就诊的SSc患者68例,再将SSc患者分为弥漫皮肤型SSc(dcSSc)和局限皮肤型SSc(IcSSc),选取30名健康对照者,采用横断面调查问卷的方法,进行健康状况调查问卷SF-36、健康评估问卷(HAQ)、视觉模拟疼痛评分(VAS)及圣乔治呼吸问卷(SGRQ)调查,并收集患者一般资料、临床生化指标、系统受累、胸部高分辨CT(HRCT)评分及改良的罗德曼皮肤评分(MRSS),评估SSc患者的生活质量,并分析其与临床指标的相关性。结果:1、总共收集68例SSc患者人口学及临床特点如下:患者平均年龄(52.26±10.66)岁,平均病程(35.25±47.79)月,女性38(55.9%)例,8(11.7%)例吸烟,54(79.4%)例为dcSSc。其中59(87.8%)例患者存在雷诺现象,9(13.2%)例存在指端溃疡。16(23.5%)例存在PAH。血沉(ESR)(41.38±28.79)mm/H,CRP(25.78±38.81)mg/L,ANA阳性64(94.1%)例,抗Scl-70抗体阳性59(87.8%)例。2、SSc患者在SF-36量表评分生理机能(63.97±28.71)分、生理职能(53.31±33.15)分、躯体疼痛(66.06±19.38)分、社会功能(53.31±19.52)分、一般情况(58.03±23.71)分、精力(52.87±17.92)分、情感职能(46.58±35.11)分、精神健康(45.29±20.90)分均低于健康对照组,均P0.05,但健康变化一项无差异。ssc患者haq量表得分(1.13±0.79)分、vas量表得分(3.22±1.31)分,sgrq量表中症状分(44.39±19.16)、活动分(50.26±14.30)、影响分(53.69±19.03)、总均分(49.39±15.67),均明显高于健康对照组,均p0.05。3、与icssc患者相比,dcssc患者在sf-36量表中生理机能(p=0.030)、生理职能(p=0.033)、躯体疼痛(p=0.032)、精力(p=0.008)等领域得分均降低;在一般情况、社会功能、情感职能、精神健康、健康变化等领域两组无统计学差异。dcssc患者在haq、vas量表得分明显高于icssc患者(均p=0.000),sgrq量表的症状分、活动分、影响分、总均分领域,两组间得分基本相等(均p0.05)。4、多元逐步回归分析,ssc患者在sf-36量表评中分别以生理机能、生理职能,躯体疼痛,社会功能,一般情况,精力,情感职能,精神健康作为因变量,临床和实验室指标与上述相关性比较密切指标为自变量,发现影响ssc患者sf-36量表评分中生理机能的因素依次为:hrct评分、mrss、c3;影响生理职能的因素依次为:mrss、hrct评分、c3;影响躯体疼痛的因素依次为:雷诺现象、mrss;影响社会功能的因素依次为:hrct评分、mrss、c3;影响一般情况的因素依次为:hrct评分、mrss、吸烟;影响精力的因素依次为:mrss、hrct评分、c3;影响情感职能的因素依次为:hrct评分、mrss;影响精神健康的因素依次为:hrct评分、mrss、c3。5、ssc患者haq量表评分,vas量表评分,sgrq量表评分中症状分,影响分和活动分均为因变量,与上述指标相关密切的临床和实验室指标为自变量,发现1)影响ssc患者haq量表评分的因素依次为:雷诺现象、mrss;2)影响vas量表评分的因素依次为:mrss、雷诺现象、关节疼痛;3)影响ssc患者sgrq量表评分中症状分的因素依次为:hrct评分、病程、吸烟,活动分的因素依次为:hrct评分、吸烟,影响分的因素依次为:HRCT评分、吸烟。结论:1、SSc患者在生理健康和心理健康领域的生活质量方面较正常人明显下降,活动能力受限,躯体疼痛增多,呼吸道症状亦较正常人明显增多。2、与IcSSc患者相比,dcSSc患者在生理机能、生理职能、躯体疼痛、精力等生活质量下降,肢体活动能力下降,躯体疼痛明显增加,而在呼吸道症状方面无明显差别。3、SSc患者生活质量下降与吸烟、病程、ILD,皮肤硬化程度,补体C3水平降低有明显关系;躯体疼痛与雷诺现象、皮肤硬化程度和关节痛相关。
[Abstract]:Objective: To study the factors affecting the quality of life of patients with systemic sclerosis (Systemic sclerosis, SSc), and their correlation with the degree of disease activity and severity, and to provide a theoretical basis for improving the quality of life of SSc patients, comprehensively assessing the condition of SSc, and choosing appropriate treatment measures. Methods: from November 2015 to October 2016, the Guangxi medicine was collected. 68 SSc patients who were hospitalized in the Department of Rheumatology, the First Affiliated Hospital of the University of science, and then divided SSc patients into diffuse skin type SSc (dcSSc) and localized skin type SSc (IcSSc), selected 30 healthy controls and used a cross-sectional questionnaire to conduct health status questionnaire SF-36, health assessment questionnaire (HAQ) and visual analogue pain. Score (VAS) and St Georges Respiratory Questionnaire (SGRQ) survey, and collect patients' general information, clinical biochemical indexes, systemic involvement, chest high resolution CT (HRCT) score and improved Rodman skin score (MRSS), evaluate the quality of life of SSc patients, and analyze the correlation with the clinical bed indicators. Results: 1, a total of 68 cases of SSc patients were collected and collected in total. The characteristics of the bed were as follows: the average age of the patients (52.26 + 10.66), the average course (35.25 + 47.79) months, 38 (55.9%) women, 8 (11.7%) cases of smoking, 54 (79.4%) cases of dcSSc. among the 59 (87.8%) patients had Renault phenomenon, while the 9 (13.2%) cases had PAH. ESR (ESR) mm/H, CRP (mg/L), ANA positive (ANA) mg/L. 94.1%) 59 (87.8%) cases of anti Scl-70 antibody positive (63.97 + 28.71), physiological function (53.31 + 33.15), body pain (66.06 + 19.38), social function (53.31 + 19.52), general (58.03 + 23.71), energy (87.8%), emotional function (53.31), mental health 20.90) the scores were all lower than that in the healthy control group (P0.05), but the score of the HAQ scale (1.13 + 0.79), the vas scale score (3.22 + 1.31), the SGRQ scale (44.39 + 19.16), the activity score (50.26 + 14.30), the impact score (53.69 + 19.03), and the total average score (49.39 + 15.67) were significantly higher than those in the healthy control group, which were all significantly higher than those in the healthy control group, all p0.05.3, all p0.05.3. Compared with icssc, dcSSc patients had lower scores in physiological function (p=0.030), physiological function (p=0.033), physical pain (p=0.032), and energy (p=0.008) in the SF-36 scale. In general, there were no statistical differences between the two groups of social function, emotional function, mental health, health change and other fields. The score of.Dcssc patients was significantly higher than that of I. CSSC patients (all p=0.000), the symptom scores of the SGRQ scale, the activity scores, the impact points and the total average score field, the scores of the two groups were basically equal (all P0.05).4, multiple stepwise regression analysis, and the SSc patients in the SF-36 scale evaluation were respectively physiological function, physiological function, somatic pain, social function, general condition, energy, emotional function and mental health as the dependent variable, The index of clinical and laboratory indexes was closely related to the above correlation as an independent variable. It was found that the factors affecting the physiological function of the SF-36 scale of SSc patients were HRCT score, MRSS, C3, and the factors affecting physiological functions were MRSS, HRCT score, C3, and the factors affecting somatic pain were Reynolds phenomenon, MRSS, and the cause of social function. The factors in turn were HRCT score, MRSS, C3, and the factors affecting the general situation were HRCT score, MRSS, and smoking. The factors affecting energy were MRSS, HRCT score, C3, and the factors affecting the emotional function were HRCT score, MRSS. The symptom scores in the scale score, the influence points and the activity scores were all dependent variables, the clinical and laboratory indexes closely related to the above indexes were independent variables, and 1) the factors affecting the HAQ scale score of SSc patients were Reynolds phenomenon, MRSS; 2) the factors affecting the vas scale score were followed by MRSS, Reynolds, joint pain, and 3) affecting the SGRQ of the SSc patients. The factors of symptom score in the scale score were: HRCT score, course of disease, smoking and activity score in turn: HRCT score, smoking, and the factors affecting the score were HRCT score, smoking. Conclusion: 1, the quality of life in the physiological and psychological health areas of SSc patients decreased significantly, activity limited, physical pain increased, Respiratory symptoms were also significantly more.2 than those of normal people. Compared with IcSSc patients, dcSSc patients had a decline in physical function, physiological functions, physical pain, energy and other quality of life, decreased physical activity, physical pain, and no significant difference in respiratory symptoms,.3, the decline in quality of life with smoking, the course of disease, ILD, and hard skin in dcSSc. There was a significant correlation between the degree of melting and the decrease of complement C3 level, and body pain was associated with Reynolds phenomenon, skin sclerosis and joint pain.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.2
本文编号：2174370
[Abstract]:Objective: To study the factors affecting the quality of life of patients with systemic sclerosis (Systemic sclerosis, SSc), and their correlation with the degree of disease activity and severity, and to provide a theoretical basis for improving the quality of life of SSc patients, comprehensively assessing the condition of SSc, and choosing appropriate treatment measures. Methods: from November 2015 to October 2016, the Guangxi medicine was collected. 68 SSc patients who were hospitalized in the Department of Rheumatology, the First Affiliated Hospital of the University of science, and then divided SSc patients into diffuse skin type SSc (dcSSc) and localized skin type SSc (IcSSc), selected 30 healthy controls and used a cross-sectional questionnaire to conduct health status questionnaire SF-36, health assessment questionnaire (HAQ) and visual analogue pain. Score (VAS) and St Georges Respiratory Questionnaire (SGRQ) survey, and collect patients' general information, clinical biochemical indexes, systemic involvement, chest high resolution CT (HRCT) score and improved Rodman skin score (MRSS), evaluate the quality of life of SSc patients, and analyze the correlation with the clinical bed indicators. Results: 1, a total of 68 cases of SSc patients were collected and collected in total. The characteristics of the bed were as follows: the average age of the patients (52.26 + 10.66), the average course (35.25 + 47.79) months, 38 (55.9%) women, 8 (11.7%) cases of smoking, 54 (79.4%) cases of dcSSc. among the 59 (87.8%) patients had Renault phenomenon, while the 9 (13.2%) cases had PAH. ESR (ESR) mm/H, CRP (mg/L), ANA positive (ANA) mg/L. 94.1%) 59 (87.8%) cases of anti Scl-70 antibody positive (63.97 + 28.71), physiological function (53.31 + 33.15), body pain (66.06 + 19.38), social function (53.31 + 19.52), general (58.03 + 23.71), energy (87.8%), emotional function (53.31), mental health 20.90) the scores were all lower than that in the healthy control group (P0.05), but the score of the HAQ scale (1.13 + 0.79), the vas scale score (3.22 + 1.31), the SGRQ scale (44.39 + 19.16), the activity score (50.26 + 14.30), the impact score (53.69 + 19.03), and the total average score (49.39 + 15.67) were significantly higher than those in the healthy control group, which were all significantly higher than those in the healthy control group, all p0.05.3, all p0.05.3. Compared with icssc, dcSSc patients had lower scores in physiological function (p=0.030), physiological function (p=0.033), physical pain (p=0.032), and energy (p=0.008) in the SF-36 scale. In general, there were no statistical differences between the two groups of social function, emotional function, mental health, health change and other fields. The score of.Dcssc patients was significantly higher than that of I. CSSC patients (all p=0.000), the symptom scores of the SGRQ scale, the activity scores, the impact points and the total average score field, the scores of the two groups were basically equal (all P0.05).4, multiple stepwise regression analysis, and the SSc patients in the SF-36 scale evaluation were respectively physiological function, physiological function, somatic pain, social function, general condition, energy, emotional function and mental health as the dependent variable, The index of clinical and laboratory indexes was closely related to the above correlation as an independent variable. It was found that the factors affecting the physiological function of the SF-36 scale of SSc patients were HRCT score, MRSS, C3, and the factors affecting physiological functions were MRSS, HRCT score, C3, and the factors affecting somatic pain were Reynolds phenomenon, MRSS, and the cause of social function. The factors in turn were HRCT score, MRSS, C3, and the factors affecting the general situation were HRCT score, MRSS, and smoking. The factors affecting energy were MRSS, HRCT score, C3, and the factors affecting the emotional function were HRCT score, MRSS. The symptom scores in the scale score, the influence points and the activity scores were all dependent variables, the clinical and laboratory indexes closely related to the above indexes were independent variables, and 1) the factors affecting the HAQ scale score of SSc patients were Reynolds phenomenon, MRSS; 2) the factors affecting the vas scale score were followed by MRSS, Reynolds, joint pain, and 3) affecting the SGRQ of the SSc patients. The factors of symptom score in the scale score were: HRCT score, course of disease, smoking and activity score in turn: HRCT score, smoking, and the factors affecting the score were HRCT score, smoking. Conclusion: 1, the quality of life in the physiological and psychological health areas of SSc patients decreased significantly, activity limited, physical pain increased, Respiratory symptoms were also significantly more.2 than those of normal people. Compared with IcSSc patients, dcSSc patients had a decline in physical function, physiological functions, physical pain, energy and other quality of life, decreased physical activity, physical pain, and no significant difference in respiratory symptoms,.3, the decline in quality of life with smoking, the course of disease, ILD, and hard skin in dcSSc. There was a significant correlation between the degree of melting and the decrease of complement C3 level, and body pain was associated with Reynolds phenomenon, skin sclerosis and joint pain.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.2
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