摘要
目的探讨中国汉族类风湿关节炎(RA)患者的疾病活动度对其心理状态和认知功能的影响。方法入组100名RA住院患者,收集受试者的一般资料及生化指标,包括姓名、年龄、性别、病程、吸烟、饮酒、教育水平、红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)及抗环瓜氨酸肽(CCP)抗体,进行健康评估问卷(HAQ)、疾病活动度评分(DAS28)、心理状态评分(抑郁、广泛性焦虑障碍(GAD)、睡眠质量、日间嗜睡)、蒙特利尔认知评估量表等一系列测评,并采用相关统计学方法分析数据。结果 1)HAQ<2组与HAQ≥2组在性别、吸烟、饮酒、病程方面无明显差异。2)HAQ≥2的患者在中重度抑郁、中重度GAD、低睡眠质量和认知损害方面的发病率分别为74.07%、55.56%、70.37%、92.59%,均较HAQ<2组明显增高(P<0.05)。3)在抑郁、GAD、睡眠质量、白天嗜睡和认知损害方面,RF、抗CCP抗体双阴性和阳性组之间相比较无显著性差异(P>0.05)。基于DAS28的分析,具有高疾病活动度的RA患者易患中重度抑郁(P=0.010)、中重度GAD(P=0.012)和低睡眠质量(P=0.007)。认知损害发病率与疾病活动度无关。4)在抑郁、GAD、睡眠质量和日间嗜睡与RA患者的认知功能之间,正常组和认知损害组没有显著差异(P>0.05)。5)具有认知损害的RA患者在视觉空间和执行功能、命名、计算能力、语言、抽象和延迟回忆中表现更差(P<0.05)。结论伴关节功能障碍或高疾病活动度的RA患者,更易出现中重度抑郁、中重度广泛性焦虑障碍、睡眠质量差等异常心理状态。RA患者的认识功能损害与关节功能障碍有关,与疾病活动度无关。我们应高度重视RA患者在视觉空间和执行功能、命名、计算能力、语言、抽象和记忆等方面可能的损害。
The objective of this study was to explore the effects of rheumatoid arthritis (RA)severity on cognitive and psychological functions in a Chinese Han population.A total of 100RA patients were enrolled in this study.The continuous variables comparison was conducted by t-test and classified variables were compared using X2 test.The results were adjusted using logistic regression analysis.Data showed that RA patients with self-care difficult easily appeared moderate-severe depression and generalized anxiety disorder (GAD),bad sleep quality,and cognitive impairment (P<0.05).Moreover,the frequencies of moderate-severe depression and GAD cases in RA patients with high disease activity were significantly higher than that in moderate activity RA patients (P<0.05),and high activity RA patients had poor sleep quality (P=0.007).But we failed to detect the association between disease activity of RA and cognitive impairment (P>0.05).In MoCA test,RA patients with cognitive impairment showed poor performance in major subitems,except attention 1,2and orientation (P<0.05 for all).In conclusion,the joint function and disease activity of RA patients are significantly associated with cognitive and psychological functions.
作者
石颖
邹庆华
张艳
胡春蓉
方勇飞
SHI Ying;ZOU Qinghua;ZHANG Yan;HU Chunrong;FANG Yongfei(Department of Rheumatology and Immunology,First Hospital Affiliated to Third Military Medical University (Army Medical University),Chongqing 400038,China;Department of Psychosomatic Medicine,Ninth People's Hospital of Chongqing,Chongqing 400700,China)
出处
《免疫学杂志》
CAS
CSCD
北大核心
2018年第12期1082-1089,共8页
Immunological Journal
基金
国家自然科学基金(81373180)
作者简介
通信作者:方勇飞.E-mail:fangyongfei@qq.com.
