本文選題：中軸型脊柱炎關(guān)節(jié)炎　切入點(diǎn)：炎性腰背痛　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：研究背景疼痛是中軸型脊柱關(guān)節(jié)炎(Axial Spondyloarthritis,axSpA)患者最主要的癥狀之一。準(zhǔn)確的疼痛評(píng)估能有效反映患者的病情活動(dòng)程度,有助于指導(dǎo)臨床治療及觀察療效。炎性腰背痛(Inflammatory Back Pain,IBP)是axSpA患者的典型特征,近年來(lái)發(fā)現(xiàn)還存在神經(jīng)病理性疼痛(Neuropathic Pain,NP)成分。但患者IBP、NP的疼痛特征及其與疾病活動(dòng)度和功能狀況相關(guān)性未見(jiàn)報(bào)道。研究目的1.評(píng)估患者IBP、NP發(fā)生率及相關(guān)因素;2.明確患者IBP、NP的疼痛強(qiáng)度及其影響、性質(zhì)和災(zāi)難化程度;3.識(shí)別IBP、NP與疾病活動(dòng)度和功能狀況相關(guān)性。研究方法(一)研究對(duì)象2016年6月至2017年4月,采用便利抽樣法選取某三級(jí)醫(yī)院風(fēng)濕免疫科132例axSpA患者進(jìn)行問(wèn)卷調(diào)查。(二)研究工具1.疼痛評(píng)估(1)2006年柏林標(biāo)準(zhǔn)(the Berlin Criteria):包括4個(gè)標(biāo)準(zhǔn),至少符合2條診斷為 IBP。(2)神經(jīng)病理性疼痛 4 問(wèn)卷(Douleur Neuropathique 4 questionnaire,DN4):共10個(gè)條目,總分≥4分診斷為NP。(3)簡(jiǎn)明疼痛量表(Brief Pain Inventory,BPI):測(cè)量疼痛強(qiáng)度和疼痛影響,每個(gè)條目使用0-10計(jì)分,疼痛治療或服用藥物后疼痛緩解程度使用0-100%評(píng)估。(4)簡(jiǎn)明 McGill 疼痛問(wèn)卷(Short-Form McGill Pain Questionnaire,SF-MPQ):共15個(gè)描述詞,其中1-11為感覺(jué)描述詞,12-15為情感描述詞,每項(xiàng)采用0-4計(jì)分。(5)疼痛災(zāi)難化量表(Pain Catastrophizing Scale,PCS):共13個(gè)條目,每個(gè)條目0-4分,總分≥30分表明患者存在疼痛災(zāi)難化傾向。2.疾病活動(dòng)度和功能狀況評(píng)估巴斯強(qiáng)直性脊柱炎疾病活動(dòng)度評(píng)分(Bath Ankylosing Spondylitis Disease Activity Index,BASDAI)用于評(píng)估患者疾病活動(dòng)度,總分0-10分,總分越高,疾病活動(dòng)度越高。巴斯強(qiáng)直性脊柱炎功能指數(shù)(Bath Ankylosing Spondylitis Functional Index,BASFI)用于評(píng)價(jià)患者功能狀況,總分0-10分,總分越高,功能狀況越差。巴斯強(qiáng)直性脊柱炎測(cè)量學(xué)指數(shù)(Bath Ankylosing Spondylitis Metrology Index,BASMI)用來(lái)量化患者中軸骨活動(dòng)程度,總分0-10分,總分越高,脊柱活動(dòng)度越差。(三)研究步驟患者填寫(xiě)疼痛評(píng)估、疾病活動(dòng)度和功能狀況評(píng)估問(wèn)卷。DN4中體格檢查和BASMI由研究者測(cè)量完成。同時(shí)收集人口統(tǒng)計(jì)學(xué)和臨床資料,如年齡、性別、體質(zhì)指數(shù)、吸煙史、飲酒史、病程、最近一次的實(shí)驗(yàn)室檢查結(jié)果(C反應(yīng)蛋白和血沉)和抗炎藥的使用等。研究結(jié)果1.患者疼痛發(fā)生率及相關(guān)因素分析37.9%患者有IBP,16.7%患者有NP。IBP的患者中體質(zhì)指數(shù)≥24kg/m2、未用抗炎藥頻率顯著高于無(wú)IBP患者;NP患者的吸煙史、飲酒史頻率顯著高于無(wú)NP 患者(P0.05)。2.IBP、NP患者的疼痛特征IBP患者經(jīng)歷輕、中度疼痛及疼痛影響,其疼痛強(qiáng)度及影響、BASDAI、BASFI得分高于無(wú)IIBP患者,主要表現(xiàn)感覺(jué)描述詞中的“痙攣牽扯痛”以及情感描述詞的“軟弱無(wú)力”;NP患者經(jīng)歷中度疼痛及影響,其疼痛強(qiáng)度及影響、BASDAI、BASFI和BASMI得分顯著高于無(wú)NP患者,主要表現(xiàn)感覺(jué)描述詞中的“跳痛”、“刺痛”、“銳痛”和“熱灼痛”(P0.05)。兩組患者C反應(yīng)蛋白、血沉和疼痛災(zāi)難化程度無(wú)顯著性差異。3.疼痛與疾病活動(dòng)度、功能狀況相關(guān)性IBP 與 BASDAI 相關(guān),NP 與 BASFI 相關(guān)(P0.05)。研究結(jié)論有IBP或NP的axSpA患者,其疼痛強(qiáng)度及其影響較重、疾病活動(dòng)度較高、功能受限明顯。IBP與疾病活動(dòng)度相關(guān),可對(duì)情緒有影響;NP與功能受限相關(guān),主要表現(xiàn)為自發(fā)性疼痛。對(duì)患者疼痛特征的評(píng)估可為疾病活動(dòng)度、功能狀況評(píng)估及療效判斷提供依據(jù)。
[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.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R473.5

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相關(guān)期刊論文 前1條

1 汪玉平,王興林,梁曉鏞,胡杰;強(qiáng)直性脊柱炎患者疼痛調(diào)查分析[J];中國(guó)康復(fù)醫(yī)學(xué)雜志;2002年02期

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本文編號(hào)：1560749