系統(tǒng)性硬化病患者生活質(zhì)量的影響因素分析
發(fā)布時(shí)間：2018-08-09 14:27
【摘要】：目的:研究系統(tǒng)性硬化病(Systemic sclerosis,SSc)患者的生活質(zhì)量的影響因素,及其與疾病活動(dòng)度和嚴(yán)重程度的相關(guān)性,為改善SSc患者的生活質(zhì)量,全面評(píng)估SSc病情,選擇適當(dāng)?shù)闹委煷胧┨峁├碚撘罁?jù)。方法:收集2015年11月至2016年10月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院風(fēng)濕免疫科住院或門診就診的SSc患者68例,再將SSc患者分為彌漫皮膚型SSc(dcSSc)和局限皮膚型SSc(IcSSc),選取30名健康對(duì)照者,采用橫斷面調(diào)查問(wèn)卷的方法,進(jìn)行健康狀況調(diào)查問(wèn)卷SF-36、健康評(píng)估問(wèn)卷(HAQ)、視覺(jué)模擬疼痛評(píng)分(VAS)及圣喬治呼吸問(wèn)卷(SGRQ)調(diào)查,并收集患者一般資料、臨床生化指標(biāo)、系統(tǒng)受累、胸部高分辨CT(HRCT)評(píng)分及改良的羅德曼皮膚評(píng)分(MRSS),評(píng)估SSc患者的生活質(zhì)量,并分析其與臨床指標(biāo)的相關(guān)性。結(jié)果:1、總共收集68例SSc患者人口學(xué)及臨床特點(diǎn)如下:患者平均年齡(52.26±10.66)歲,平均病程(35.25±47.79)月,女性38(55.9%)例,8(11.7%)例吸煙,54(79.4%)例為dcSSc。其中59(87.8%)例患者存在雷諾現(xiàn)象,9(13.2%)例存在指端潰瘍。16(23.5%)例存在PAH。血沉(ESR)(41.38±28.79)mm/H,CRP(25.78±38.81)mg/L,ANA陽(yáng)性64(94.1%)例,抗Scl-70抗體陽(yáng)性59(87.8%)例。2、SSc患者在SF-36量表評(píng)分生理機(jī)能(63.97±28.71)分、生理職能(53.31±33.15)分、軀體疼痛(66.06±19.38)分、社會(huì)功能(53.31±19.52)分、一般情況(58.03±23.71)分、精力(52.87±17.92)分、情感職能(46.58±35.11)分、精神健康(45.29±20.90)分均低于健康對(duì)照組,均P0.05,但健康變化一項(xiàng)無(wú)差異。ssc患者h(yuǎn)aq量表得分(1.13±0.79)分、vas量表得分(3.22±1.31)分,sgrq量表中癥狀分(44.39±19.16)、活動(dòng)分(50.26±14.30)、影響分(53.69±19.03)、總均分(49.39±15.67),均明顯高于健康對(duì)照組,均p0.05。3、與icssc患者相比,dcssc患者在sf-36量表中生理機(jī)能(p=0.030)、生理職能(p=0.033)、軀體疼痛(p=0.032)、精力(p=0.008)等領(lǐng)域得分均降低;在一般情況、社會(huì)功能、情感職能、精神健康、健康變化等領(lǐng)域兩組無(wú)統(tǒng)計(jì)學(xué)差異。dcssc患者在haq、vas量表得分明顯高于icssc患者(均p=0.000),sgrq量表的癥狀分、活動(dòng)分、影響分、總均分領(lǐng)域,兩組間得分基本相等(均p0.05)。4、多元逐步回歸分析,ssc患者在sf-36量表評(píng)中分別以生理機(jī)能、生理職能,軀體疼痛,社會(huì)功能,一般情況,精力,情感職能,精神健康作為因變量,臨床和實(shí)驗(yàn)室指標(biāo)與上述相關(guān)性比較密切指標(biāo)為自變量,發(fā)現(xiàn)影響ssc患者sf-36量表評(píng)分中生理機(jī)能的因素依次為:hrct評(píng)分、mrss、c3;影響生理職能的因素依次為:mrss、hrct評(píng)分、c3;影響軀體疼痛的因素依次為:雷諾現(xiàn)象、mrss;影響社會(huì)功能的因素依次為:hrct評(píng)分、mrss、c3;影響一般情況的因素依次為:hrct評(píng)分、mrss、吸煙;影響精力的因素依次為:mrss、hrct評(píng)分、c3;影響情感職能的因素依次為:hrct評(píng)分、mrss;影響精神健康的因素依次為:hrct評(píng)分、mrss、c3。5、ssc患者h(yuǎn)aq量表評(píng)分,vas量表評(píng)分,sgrq量表評(píng)分中癥狀分,影響分和活動(dòng)分均為因變量,與上述指標(biāo)相關(guān)密切的臨床和實(shí)驗(yàn)室指標(biāo)為自變量,發(fā)現(xiàn)1)影響ssc患者h(yuǎn)aq量表評(píng)分的因素依次為:雷諾現(xiàn)象、mrss;2)影響vas量表評(píng)分的因素依次為:mrss、雷諾現(xiàn)象、關(guān)節(jié)疼痛;3)影響ssc患者sgrq量表評(píng)分中癥狀分的因素依次為:hrct評(píng)分、病程、吸煙,活動(dòng)分的因素依次為:hrct評(píng)分、吸煙,影響分的因素依次為:HRCT評(píng)分、吸煙。結(jié)論:1、SSc患者在生理健康和心理健康領(lǐng)域的生活質(zhì)量方面較正常人明顯下降,活動(dòng)能力受限,軀體疼痛增多,呼吸道癥狀亦較正常人明顯增多。2、與IcSSc患者相比,dcSSc患者在生理機(jī)能、生理職能、軀體疼痛、精力等生活質(zhì)量下降,肢體活動(dòng)能力下降,軀體疼痛明顯增加,而在呼吸道癥狀方面無(wú)明顯差別。3、SSc患者生活質(zhì)量下降與吸煙、病程、ILD,皮膚硬化程度,補(bǔ)體C3水平降低有明顯關(guān)系;軀體疼痛與雷諾現(xiàn)象、皮膚硬化程度和關(guān)節(jié)痛相關(guān)。
[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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R593.2
本文編號(hào)：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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R593.2
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