本文選題：強(qiáng)直性脊柱炎 + 抑郁��； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的了解強(qiáng)直性脊柱炎(AS)患者抑郁情緒的現(xiàn)狀、特點(diǎn),分析抑郁與臨床特征、人格特征和生存質(zhì)量之間的相互關(guān)系。為AS與抑郁共病的識(shí)別和干預(yù)提供理論依據(jù),為合理用藥、減輕患者痛苦、提高身心健康水平提供支持。方法以2015年8月~2016年5月在三所三甲醫(yī)院相關(guān)門診被確診為AS的411名患者為研究對(duì)象,男性329人,女性82人。抑郁自評(píng)量表(SDS)、艾森克人格問(wèn)卷(EPQ)和世界衛(wèi)生組織生存質(zhì)量簡(jiǎn)表(WHOQOL-BREF)測(cè)評(píng)抑郁狀態(tài)、人格特征和生存質(zhì)量,收集人口學(xué)特征(性別、年齡、家庭月收入、職業(yè)、受教育程度等),病程,晨僵時(shí)間,HLA-B27,指地距,紅細(xì)胞沉降率(ESR),C反應(yīng)蛋白(CRP),Bath AS測(cè)量學(xué)指標(biāo)(BASMI);視覺(jué)模擬標(biāo)尺評(píng)分法和Bath功能指數(shù)表(BASFI)以及疾病活動(dòng)性指數(shù)表(BASDAI)評(píng)價(jià)主觀疼痛感和疾病參數(shù)。并對(duì)抑郁和各因素之間的關(guān)系進(jìn)行分析。結(jié)果1.AS患者年齡在16~56歲;16~34歲青年占77.1%;病情活動(dòng)和功能狀態(tài)差者占58.9%和15.8%;50.6%和51.8%的患者有夜間痛和總體背痛。2.患者抑郁評(píng)分為(47.46±10.54)分,高于中國(guó)常模(t=9.67,P0.001),34.5%患者伴有抑郁狀態(tài);女性抑郁評(píng)分和檢出率高于男性(P0.05);隨著年齡增高和受教育程度降低,抑郁評(píng)分和檢出率均隨之升高(P0.05);家庭收入低于2000元者抑郁評(píng)分和檢出率均高于收入在2000元及以上者(P0.001);務(wù)農(nóng)患者抑郁評(píng)分最高(P0.001)。3.伴抑郁狀態(tài)患者臨床指標(biāo)均高于不伴有抑郁狀態(tài)者(P0.05);ESR、CRP異常者、病情活動(dòng)者和功能較差者伴抑郁檢出率高(P0.05);夜間痛和總體痛明顯者伴抑郁檢出率高(P0.001)。4.患者精神質(zhì)、內(nèi)外傾維度評(píng)分均小于中國(guó)常模,神經(jīng)質(zhì)維度大于中國(guó)常模(P0.001);伴抑郁患者的精神質(zhì)維度評(píng)分小于不伴抑郁者,內(nèi)外傾和神經(jīng)質(zhì)維度評(píng)分大于不伴抑郁者(P0.001)。5.患者生理領(lǐng)域評(píng)分低于中國(guó)常模,伴抑郁患者生存質(zhì)量各領(lǐng)域評(píng)分均低于不伴抑郁者(P0.001)。6.患者抑郁評(píng)分和臨床指標(biāo)呈正相關(guān)(r=0.11~0.54);與精神質(zhì)和神經(jīng)質(zhì)維度呈正相關(guān)(r=0.24、0.61),與內(nèi)外傾呈負(fù)相關(guān)(r=0.38);夜間痛、總體痛、BASDAI和BASFI主觀臨床指標(biāo)與內(nèi)外傾呈負(fù)相關(guān)(r=0.25~0.33),與神經(jīng)質(zhì)呈正相關(guān)(r=0.34~0.43)。7.分層回歸分析并控制人口學(xué)特征后,患者臨床特征、心理特征分別對(duì)抑郁的解釋量增加21.0%和37.0%,三者共同解釋量為62.0%;非條件Logistic回歸分析顯示年齡、BASDAI和神經(jīng)質(zhì)是抑郁發(fā)生的危險(xiǎn)因素(OR=1.06、1.10和1.14,P0.01),家庭月收入和心理領(lǐng)域?yàn)楸Ｗo(hù)因素(OR=0.44和0.70,P0.05);而且,抑郁是患者夜間痛的危險(xiǎn)因素(OR=1.04,P0.05);心理學(xué)特征對(duì)夜間痛和總體痛的解釋量為33.0%和42.0%,低于臨床特征。結(jié)論1、抑郁情緒在AS患者中較普通人群更為常見(jiàn),年齡、家庭月收入、疾病活動(dòng)性以及神經(jīng)質(zhì)人格特征對(duì)抑郁有明顯影響。2、疾病的臨床病癥與抑郁情緒相互影響,抑郁是患者夜間痛的危險(xiǎn)因素,疼痛感也受到心理因素影響。3、伴有抑郁狀態(tài)患者人格特質(zhì)屬于高精神質(zhì)、內(nèi)傾型和高神經(jīng)質(zhì)型;并且,疼痛感、BASDAI、BASFI主觀臨床特征與內(nèi)外傾和神經(jīng)質(zhì)人格特征關(guān)系更為密切。4、AS患者的生存質(zhì)量總體尚可,但生理領(lǐng)域較差;伴有抑郁狀態(tài)患者生存質(zhì)量水平則更為低下;心理領(lǐng)域是抑郁的保護(hù)因素。5、AS治療中,應(yīng)重視患者的抑郁、人格等心理因素,需制定合理藥物和心理干預(yù)來(lái)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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R593.23

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