类风湿关节炎患者生活质量与疾病活动度的横断面研究

doi:10.19723/j.issn.1671-167X.2022.06.005

摘要/Abstract

摘要：

目的: 调查类风湿关节炎(rheumatoid arthritis，RA)患者健康相关生活质量(health related quality of life，HR-QoL)以及身体机能情况，分析疾病活动度对于HR-QoL以及各个维度身体机能的影响，并比较不同疾病活动判断标准下患者生活质量的差异。方法: 选择2021年1—7月于北京大学第三医院风湿免疫科门诊规律随诊的RA患者进行横断面调查，收集患者人口学资料、类风湿关节炎特异性生活质量(RA-specific quality of life，RA-QoL)评分以及36项简明健康调查问卷(the medical outcome 36-item short form health survey，SF-36)评分。符合正态分布的定量资料以${\bar x}$±s表示，两组间差异的比较采用t检验。结果: 共纳入RA患者207例，RA-QoL评分7.8±7.1，躯体功能汇总(physical component summary，PCS)评分63.8±23.8，心理功能汇总(mental component summary，MCS)评分71.7±21.0。以基于红细胞沉降率(erythrocyte sedimentation rate, ESR)的28个关节疾病活动度(disease activity score 28，DAS28)评分(DAS28-ESR)为标准，病情缓解、低疾病活动度的患者共119例(59.5%)，以简明类风湿关节炎疾病活动指数(simplified disease activity index, SDAI)为标准，上述患者共125例(62.5%)。病情缓解或低疾病活动度的患者各个维度HR-QoL均显著优于治疗未达标的患者。以DAS28-ESR为评估标准，低疾病活动度组的生理功能评分(76.7±17.2 vs. 86.4±15.0, t=2.855, P < 0.01)、身体疼痛评分(67.8±8.5 vs. 77.7±15.6, t=4.277, P < 0.01)均低于完全缓解组，健康变化得分低于缓解组(52.8±22.3 vs. 63.9±24.1, t=2.134, P < 0.05)，其他各个维度生活质量评分两组间差异无统计学意义。低疾病活动组PCS评分低于缓解组(68.3±15.2 vs. 77.3±15.2, t=2.716, P < 0.01)，两组间MCS评分、RA-QoL评分差异无统计学意义。以SDAI为评估标准，低疾病活动度组RA-QoL评分显著高于缓解组(9.4±7.1 vs. 6.0±4.8, t=-2.260, P < 0.05)，SF-36评分中躯体功能的各个维度以及PCS评分(69.9±16.4 vs. 81.4±15.1, t=3.879, P < 0.05)均低于缓解组，MCS评分低于缓解组(67.9±19.3 vs. 74.5±18.8, t=2.721, P < 0.01)。结论: 门诊就诊RA患者的RA-QoL以及SF-36评分情况较好，心理健康汇总评分高于躯体健康汇总评分，达标治疗对于提高HR-QoL至关重要。SDAI标准在缓解及低疾病活动度的RA患者中可以更好提示各个维度HR-QoL情况。

关键词: 类风湿关节炎, 生活质量, 疾病活动度, SF-36

Abstract:

Objective: To analyze health related quality of life (HR-QoL) and physical function of outpatient department patients with rheumatoid arthritis (RA), and to analyze disease activity influence in HR-QoL and functional capacity as well as the divergences between different disease activity standards. Methods: The demographic and clinical data of 207 RA cases from Department of Rheumatology and Immunology, Peking University Third Hospital from Jan 2021 to Jul 2021 were collected. RA-specific quality of life (RA-QoL) and the medical outcome 36-item short form health survey (SF-36)were collected to estimate the quality of life. The t test was used for the quantitative data in accordance with normal distribution. Results: A total of 207 cases were included, with RA-QoL score of 7.8±7.1, physical component summary (PCS) score of 63.8±23.8, and mental component summary (MCS) score of 71.7±21.0. According to disease activity score 28-erythrocyte sedimentation rate (DAS28-ESR), there were 119 patients (59.5%) with remission and low disease activity, and 125 patients (62.5%) with simplified disease activity index (SDAI). The HR-QoL of the patients with remission or low disease activity was significantly better than that of the patients with moderate or high disease activity. The physical function (76.7±17.2 vs. 86.4±15.0, t=2.855, P < 0.01), bodily pain (67.8±8.5 vs. 77.7±15.6, t=4.277, P < 0.01) and health transition (52.8±22.3 vs. 63.9±24.1, t=2.134, P < 0.05) in the low disease activity (LDA) group were lower than those in the complete remission (REM) group according to DAS28-ESR. Other domains of SF-36 and RA-QoL had no differences between these two groups. PCS in the LDA group was lower than that in the REM group (68.3±15.2 vs. 77.3±15.2, t=2.716, P < 0.01), but MCS was not different between the two groups. Determined by SDAI, the RA-QoL score in the LDA group was significantly higher than that in the REM group (9.4±7.1 vs. 6.0±4.8, t=-2.260, P < 0.05), the various dimensions of physical function in the SF-36 score and the PCS score (69.9±16.4 vs. 81.4±15.1, t=3.879, P < 0.05) were lower than that in the REM group, and the MCS score was lower than that in the REM group (67.9±19.3 vs. 74.5±18.8, t=2.721, P < 0.01). Conclusion: The RA-QoL and SF-36 scores of RA patients in outpatient clinics were better, and the MCS was higher than the PCS. Treat-to-target is essential to improve HR-QoL. SDAI can better indicate the HR-QoL of each domain in REM and LDA RA patients.

Key words: Rheumatoid arthritis, Quality of life, Disease activity score, SF-36

中图分类号:

R593.22

张警丰,金银姬,魏慧,姚中强,赵金霞. 类风湿关节炎患者生活质量与疾病活动度的横断面研究[J]. 北京大学学报（医学版）, 2022, 54(6): 1086-1093.

Jing-feng ZHANG,Yin-ji JIN,Hui WEI,Zhong-qiang YAO,Jin-xia ZHAO. Cross-sectional study on quality of life and disease activity of rheumatoid arthritis patients[J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1086-1093.

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参考文献 22

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Items	Patients (n=207)
Age/years	52.3±15.6
Age at diagnosis/years	44.1±16.1
Female	80.2%
Disease duration/years	6 (8)
Antibodies
RF+ anti-CCP+	49.0%
RF+ anti-CCP-	17.5%
RF- anti-CCP+	19.0%
RF- anti-CCP-	14.5%
Anemia	22.5%
Thrombocytosis	10.0%
Hyperglobulinemia	23.7%
Decreased 25(OH)VD₃	63.8%
Positive ANA	30.7%
TJC	1 (4)
SJC	0 (3)
ESR/(mm/h)	13.0 (14.8)
CRP/(mg/L)	3.8 (8.0)
Treated with biologics	11.2%
Treated with 1 cDMARD	18.9%
Treated with 2 cDMARDs	42.2%
Treated with 3 cDMARDs	18.4%
Treated with tDMARDs	9.2%

Items	DAS28-ESR	DAS28-CRP	CDAI	SDAI
REM	92 (46.0)	106 (53.0)	43 (21.5)	46 (23.0)
LDA	27 (13.5)	22 (11.0)	83 (41.5)	79 (39.5)
MDA	51 (25.5)	51 (25.5)	43 (21.5)	49 (24.5)
HDA	30 (15.0)	21 (10.5)	31 (15.5)	26 (13.0)

Items	DAS28-ESR	SDAI	Age	Duration of disease	TJC	SJC	ESR	CRP
G-VAS	r= 0.736^**	r=0.744^**	r=0.290^**	r=0.081	r=0.586^**	r=0.545^**	r=0.511^**	r=0.391^**
P-VAS	r=0.742^**	r=0.734^**	r=0.230^**	r=-0.003	r=0.599^**	r=0.586^**	r=0.482^**	r=0.356^**
RA-QoL	r=0.637^**	r=0.617^**	r=0.306^**	r=0.125	r=0.524^**	r=0.552^**	r=0.482^**	r=0.342^**
SF-36
PF	r=-0.663^**	r=-0.643^**	r=-0.453^**	r=-0.025	r=-0.522^**	r=-0.526^**	r=-0.562^**	r=-0.461^**
RP	r=-0.574^**	r=-0.537^**	r=-0.241^**	r=0.016	r=-0.477^**	r=-0.467^**	r=-0.398^**	r=-0.324^**
BP	r=-0.718^**	r=-0.689^**	r=-0.299^**	r=-0.018	r=-0.573^**	r=-0.579^**	r=-0.542^**	r=-0.402^**
GH	r=-0.501^**	r=-0.450^**	r=-0.248^**	r=-0.077	r=-0.347^**	r=-0.322^**	r=-0.346^**	r=-0.284^**
VT	r=-0.448^**	r=-0.454^**	r=-0.255^**	r=0.002	r=-0.349^**	r=-0.328^**	r=-0.385^**	r=-0.303^**
SF	r=-0.514^**	r=-0.488^**	r=-0.307^**	r=0.013	r=-0.403^**	r=-0.373^**	r=-0.438^**	r=-0.312^**
RE	r=-0.371^**	r=-0.360^**	r=-0.152^*	r=0.117	r=-0.317^**	r=-0.321^**	r=-0.296^**	r=-0.151^*
MH	r=-0.361^**	r=-0.372^**	r=-0.140^*	r=0.020	r=-0.273^**	r=-0.291^**	r=-0.339^**	r=-0.260^**
HT	r=-0.532^**	r=-0.482^**	r=-0.216^**	r=0.004	r=-0.435^**	r=-0.404^**	r=-0.390^**	r=-0.252^**
PCS	r=-0.710^**	r=-0.668^**	r=-0.349^**	r=-0.021	r=-0.561^**	r=-0.553^**	r=-0.527^**	r=-0.421^**
MCS	r=-0.492^**	r=-0.484^**	r=-0.243^**	r=0.064	r=-0.396^**	r=-0.389^**	r=-0.417^**	r=-0.279^**