强直性脊柱炎患者生存质量调查研究
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摘要
强直性脊柱炎(Ankylosing Spondylitis，AS)作为一个发病机制尚不明确的疾病，因其病程普遍较长，病势缠绵反复，患者饱受疼痛、晨僵等症状发作时之苦，继而发生肢体强直，功能障碍，从而影响其身体机能、社交活动、精神状态等，生存质量(Quality of Life，QOL)普遍下降。本研究拟初步探讨影响强直性脊柱炎患者生存质量的主要因素，为临床治疗提出可行性建议。
目的：调查强直性脊柱炎患者的生存质量，分析其主要的影响因素，并初步探讨中医证候分型与生存质量的相关性，为临床治疗提出可行性建议，以期提高整个强直性脊柱炎人群的生存质量。
方法：在咨询专家和参考文献的基础上，拟定强直性脊柱炎患者生存质量调查表并中医证候分型表，对广州中医药大学附属骨伤科医院门诊及住院的48名强直性脊柱炎患者进行问卷调查，所得资料输入SPSS11．5数据库，采用方差分析、t检验及多元逐步回归等统计方法进行分析。
结果：本次调查共发放调查问卷71份，回收64份，回收率90.14％。通过对采集资料的选择，符合诊断标准、纳入标准和排除标准的病例共48例，其中男性44例，女性4例，男女比例为11：1，年龄14-60岁，平均29.45±1.663，病程2个月-21年，平均7.29±5.315年，体重指数(BMI)16.08-21.36，平均18.35±1.223。
本次调查的强直性脊柱炎患者生存质量总评分为66.266±7.657，各维度的得分情况分别为躯体疼痛59.364±12.476、身体疼痛68.789±9.238、日常活动67.246±9.563、社交活动75.327±5.989、健康观念62.375±10.211、精神状态64.498±7.082。其中，寒湿痹阻型总分为70.838±7.506，湿热痹阻型为68.264±6.402，肝肾不足型为64.677±8.547，瘀血痹阻型为67.047±5.998，肾阳亏虚型为58.930±5.272。
影响AS患者生存质量的主要因素为病程、患者依从性、合并病史、体重指数，其中，除患者依从性与生存质量成正相关外，其余各因素与生存质量均为负相关。中医证候分型与生存质量之间也存在相关性，不同辨证分型对患者生存质量的影响也各有侧重。其中，寒湿痹阻型和湿热痹阻型患者生存质量最好，其次是瘀血痹阻型、肝肾不足型，肾阳亏虚型患者生存质量最差。
结论：
1、62.50％的强直性脊柱炎患者生存质量处于中、低水平，在各种影响因素中，以病程、患者依从性、合并病史为主。
2、中医证候分型与强直性脊柱炎患者生存质量有相关性，辨证分型的不同对各维度的影响也各有侧重点。
3、对强直性脊柱炎患者生存质量的研究，不仅有利于采取有效的防治措施，也可为中医药的临床治疗效果提供客观的评价方法，有利于提高中医药治疗AS的效果，最终达到改善患者生存质量的目的。
4、对强直性脊柱炎患者的治疗不能只停留在常规的治疗手段上，还要从心理方面出发，对患者进行多层面的治疗。
Ankylosing Spondylitis(AS) is a still ambiguous morbidity mechanism disease, because of whose common course of disease relapse more lingering than strong point, patient's condition, that is bitter when the patient suffers pain to the fullest extent, the morning waits for a symptom to flare up in a deadlock, enginery, social contact activity, mindset affecting whose body later etc., survival mass comes down commonly. Mass major factor studying the scorching AS patient first step investigation and discussion is affected exists originally, be treat clinically submitting feasibility suggestion.
Objective: To lay the foundation of clinic health education and improve the quality of life of the whole AS patients, we inquire the quality of life of AS patients, analyze the major influencing factors and study on the distribution of different syndrome and the correlation between syndrome and its quality of life.
Method: 48 AS patients from Traumatic and Orthopaedics hospital affiliated to Guangzhou university of TCM were inquired by using the questionnaire of the life quality of AS. the date were inputed in SPSS11.5 and analyzed by using T-test, variance analysis and multivariant stepwise regression.
Results: Originally, together, time of investigation gives out 71 investigation questionnaires, reclaims 64 share, coefficients of recovery 90.14%. Pass to the choice collecting a data, accord with the 48 examples in total diagnosing a standard, being brought into standard and removing standard case. The male sex among them 44 examples, females 4 examples, men and women proportion are 11: 1, age 14-60-year-old, average 29.45±1.663, course of disease 2 months- 21 years, average 7.29±5.315 years, the BMI is 16.08-21.36, average 18.35±1.223.
In this survey, quality of life of AS patients get a total score of 66.266±7.657, the score of each dimension of quality of life as follows: pain is 59.364±12.476、the function of body is 68.789±9.238、domestic is 67.246±9.563、social intercourse is 75.327±5.989、health value is 62.375±10.211、mental condition is 64.498±7.082.
The score of syndromes of traditional Chinese medicine as follows: cold dampness blockage syndrome is 70.838±7.506, dampness heat blockage syndrome is 68.264±6.402, deficiency of liver and kidney syndrome is 64.677±8.547, acute cerebral infarction syndrome is 67.047±5.998, deficiency of kidney-Yang syndrome is 58.930±5.272.
The major factors that affect the score of patients'quality of life are course of disease, compliance of patients, have other diseases or not and body mass index. Except the compliance of patients has positive correlation with quatity life (P＜0.05), the other factors have negative correlation with quality of life (P＜0.05). the differentiation of symptoms and signs for classification of syndrome of traditional Chinese medicine has correlation with quality of life.
Conclusion:
1. The rate of the quality of life for AS which in middle、low level is 62.50%. The major factors that affect the score of patients'quality of life are course of disease, compliance of patients, have other diseases or not.
2. The pattern of syndrome of Chinese medicine is associated with the quality of life of AS. The difference of differentiation of symptoms and signs for classification of syndrome has different influence on each dimension.
3. It is helpful to take effective measure of prevention and cure, provid evaluation method for clinical therapeutic efficacy of Chinese medicine, raise the effect of treatment on AS using with Chinese medicine and eventually achieve to improve the quality of life of AS to study on the quality of life of AS.
4. The treatment on AS don't only retent on the routine method. We should still consider the mental aspect. We should treat on AS from multilayer.
目的：调查强直性脊柱炎患者的生存质量，分析其主要的影响因素，并初步探讨中医证候分型与生存质量的相关性，为临床治疗提出可行性建议，以期提高整个强直性脊柱炎人群的生存质量。
方法：在咨询专家和参考文献的基础上，拟定强直性脊柱炎患者生存质量调查表并中医证候分型表，对广州中医药大学附属骨伤科医院门诊及住院的48名强直性脊柱炎患者进行问卷调查，所得资料输入SPSS11．5数据库，采用方差分析、t检验及多元逐步回归等统计方法进行分析。
结果：本次调查共发放调查问卷71份，回收64份，回收率90.14％。通过对采集资料的选择，符合诊断标准、纳入标准和排除标准的病例共48例，其中男性44例，女性4例，男女比例为11：1，年龄14-60岁，平均29.45±1.663，病程2个月-21年，平均7.29±5.315年，体重指数(BMI)16.08-21.36，平均18.35±1.223。
本次调查的强直性脊柱炎患者生存质量总评分为66.266±7.657，各维度的得分情况分别为躯体疼痛59.364±12.476、身体疼痛68.789±9.238、日常活动67.246±9.563、社交活动75.327±5.989、健康观念62.375±10.211、精神状态64.498±7.082。其中，寒湿痹阻型总分为70.838±7.506，湿热痹阻型为68.264±6.402，肝肾不足型为64.677±8.547，瘀血痹阻型为67.047±5.998，肾阳亏虚型为58.930±5.272。
影响AS患者生存质量的主要因素为病程、患者依从性、合并病史、体重指数，其中，除患者依从性与生存质量成正相关外，其余各因素与生存质量均为负相关。中医证候分型与生存质量之间也存在相关性，不同辨证分型对患者生存质量的影响也各有侧重。其中，寒湿痹阻型和湿热痹阻型患者生存质量最好，其次是瘀血痹阻型、肝肾不足型，肾阳亏虚型患者生存质量最差。
结论：
1、62.50％的强直性脊柱炎患者生存质量处于中、低水平，在各种影响因素中，以病程、患者依从性、合并病史为主。
2、中医证候分型与强直性脊柱炎患者生存质量有相关性，辨证分型的不同对各维度的影响也各有侧重点。
3、对强直性脊柱炎患者生存质量的研究，不仅有利于采取有效的防治措施，也可为中医药的临床治疗效果提供客观的评价方法，有利于提高中医药治疗AS的效果，最终达到改善患者生存质量的目的。
4、对强直性脊柱炎患者的治疗不能只停留在常规的治疗手段上，还要从心理方面出发，对患者进行多层面的治疗。
Ankylosing Spondylitis(AS) is a still ambiguous morbidity mechanism disease, because of whose common course of disease relapse more lingering than strong point, patient's condition, that is bitter when the patient suffers pain to the fullest extent, the morning waits for a symptom to flare up in a deadlock, enginery, social contact activity, mindset affecting whose body later etc., survival mass comes down commonly. Mass major factor studying the scorching AS patient first step investigation and discussion is affected exists originally, be treat clinically submitting feasibility suggestion.
Objective: To lay the foundation of clinic health education and improve the quality of life of the whole AS patients, we inquire the quality of life of AS patients, analyze the major influencing factors and study on the distribution of different syndrome and the correlation between syndrome and its quality of life.
Method: 48 AS patients from Traumatic and Orthopaedics hospital affiliated to Guangzhou university of TCM were inquired by using the questionnaire of the life quality of AS. the date were inputed in SPSS11.5 and analyzed by using T-test, variance analysis and multivariant stepwise regression.
Results: Originally, together, time of investigation gives out 71 investigation questionnaires, reclaims 64 share, coefficients of recovery 90.14%. Pass to the choice collecting a data, accord with the 48 examples in total diagnosing a standard, being brought into standard and removing standard case. The male sex among them 44 examples, females 4 examples, men and women proportion are 11: 1, age 14-60-year-old, average 29.45±1.663, course of disease 2 months- 21 years, average 7.29±5.315 years, the BMI is 16.08-21.36, average 18.35±1.223.
In this survey, quality of life of AS patients get a total score of 66.266±7.657, the score of each dimension of quality of life as follows: pain is 59.364±12.476、the function of body is 68.789±9.238、domestic is 67.246±9.563、social intercourse is 75.327±5.989、health value is 62.375±10.211、mental condition is 64.498±7.082.
The score of syndromes of traditional Chinese medicine as follows: cold dampness blockage syndrome is 70.838±7.506, dampness heat blockage syndrome is 68.264±6.402, deficiency of liver and kidney syndrome is 64.677±8.547, acute cerebral infarction syndrome is 67.047±5.998, deficiency of kidney-Yang syndrome is 58.930±5.272.
The major factors that affect the score of patients'quality of life are course of disease, compliance of patients, have other diseases or not and body mass index. Except the compliance of patients has positive correlation with quatity life (P＜0.05), the other factors have negative correlation with quality of life (P＜0.05). the differentiation of symptoms and signs for classification of syndrome of traditional Chinese medicine has correlation with quality of life.
Conclusion:
1. The rate of the quality of life for AS which in middle、low level is 62.50%. The major factors that affect the score of patients'quality of life are course of disease, compliance of patients, have other diseases or not.
2. The pattern of syndrome of Chinese medicine is associated with the quality of life of AS. The difference of differentiation of symptoms and signs for classification of syndrome has different influence on each dimension.
3. It is helpful to take effective measure of prevention and cure, provid evaluation method for clinical therapeutic efficacy of Chinese medicine, raise the effect of treatment on AS using with Chinese medicine and eventually achieve to improve the quality of life of AS to study on the quality of life of AS.
4. The treatment on AS don't only retent on the routine method. We should still consider the mental aspect. We should treat on AS from multilayer.
引文
[1] 阎小萍等．强直性脊柱炎[M]．中国医药科技出版社，2004：3．
[2] WHO. The Development of the WHO Quality of life Assessment Instrument. Geneva,WHO,1993.
[3] 阎小萍等．强直性脊柱炎[M]．中国医药科技出版社，2004：5．
[4] 戴冽，汤美安．强直性脊柱炎的早期诊断和治疗进展[J]．新医学，2001，32(8)：495—496．
[5] 曾庆馀．强直性脊柱炎的诊断[J]．中国新药与临床杂志1999，18(6)：381～382．
[6] 孔繁华，陈兴国，金荔．中国健康人和AS患者的HLA-B27亚型分析[J]．中国中西医结合风湿病杂志，1998，7(1)：30—31．
[7] 阎小萍等．强直性脊柱炎[M]．中国医药科技出版社，2004：31．
[8] Hoehler Thomas,Schaeper Thomas,Schnerder Peter M,et al. Association of different tumor necrosis factor a promoterallele frequencies with ankylosing spondylitis in HLA-B27 positive individuals[J]. Arthritis Rheum,1998,41(8): 1489—1492.
[9] 阎小萍等．强直性脊柱炎[M]．中国医药科技出版社，2004：33．
[10] Uksila Jaakko,Gripenberg-lerche Christel,Toivanen,Raaro,etal. The rode of environmental factors and HLA-B27Der[J]. Spondyloarthoropathies,1997,127: 167—181.
[11] 阎小萍等．强直性脊柱炎[M]．中国医药科技出版社，2004：98．
[12] Calin A,Porta J,Fries JF,et al. The clinical history as a screening test for ankylosing spondylitis. JAMA,1997,237: 2613—2619.
[13] 阎小萍等．强直性脊柱炎[M]．中国医药科技出版社，2004：54．
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[16] 许文波．温针治疗强直性脊柱炎[J]．浙江中医学院学报，1994，48(2)：49．
[17] 姜萍，尹玉茹．治疗强直性脊柱炎经验[J]．河南中医，1998，18(3)：155—156．
[18] 高根德，程春葵．扶正化痰法为主治疗强直性脊柱炎[J]．上海中医药杂志，1991，(9)：15—16．
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[20] 陈永彬．辨证论治强直性脊柱炎21例疗效观察[J]．广西医科大学学报，1997，17(1)：106—107．
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[2] WHO. The Development of the WHO Quality of life Assessment Instrument. Geneva,WHO,1993.
[3] 阎小萍等．强直性脊柱炎[M]．中国医药科技出版社，2004：5．
[4] 戴冽，汤美安．强直性脊柱炎的早期诊断和治疗进展[J]．新医学，2001，32(8)：495—496．
[5] 曾庆馀．强直性脊柱炎的诊断[J]．中国新药与临床杂志1999，18(6)：381～382．
[6] 孔繁华，陈兴国，金荔．中国健康人和AS患者的HLA-B27亚型分析[J]．中国中西医结合风湿病杂志，1998，7(1)：30—31．
[7] 阎小萍等．强直性脊柱炎[M]．中国医药科技出版社，2004：31．
[8] Hoehler Thomas,Schaeper Thomas,Schnerder Peter M,et al. Association of different tumor necrosis factor a promoterallele frequencies with ankylosing spondylitis in HLA-B27 positive individuals[J]. Arthritis Rheum,1998,41(8): 1489—1492.
[9] 阎小萍等．强直性脊柱炎[M]．中国医药科技出版社，2004：33．
[10] Uksila Jaakko,Gripenberg-lerche Christel,Toivanen,Raaro,etal. The rode of environmental factors and HLA-B27Der[J]. Spondyloarthoropathies,1997,127: 167—181.
[11] 阎小萍等．强直性脊柱炎[M]．中国医药科技出版社，2004：98．
[12] Calin A,Porta J,Fries JF,et al. The clinical history as a screening test for ankylosing spondylitis. JAMA,1997,237: 2613—2619.
[13] 阎小萍等．强直性脊柱炎[M]．中国医药科技出版社，2004：54．
[14] 阎小萍，焦树德．治疗强直性脊柱炎的经验[J]．中医杂志，1994，35(7)：155—156．
[15] 刘耀升．强直性脊柱炎的中医药治疗现状与展望[J]．中医正骨，1999，11(6)：49—50．
[16] 许文波．温针治疗强直性脊柱炎[J]．浙江中医学院学报，1994，48(2)：49．
[17] 姜萍，尹玉茹．治疗强直性脊柱炎经验[J]．河南中医，1998，18(3)：155—156．
[18] 高根德，程春葵．扶正化痰法为主治疗强直性脊柱炎[J]．上海中医药杂志，1991，(9)：15—16．
[19] 郑筱萸主编．中药新药临床研究指导原则(试行)[M]．中国医药科技出版社，2002：120．
[20] 陈永彬．辨证论治强直性脊柱炎21例疗效观察[J]．广西医科大学学报，1997，17(1)：106—107．
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