CAJ | 학술논문

目的了解类风湿关节炎(RA)患者的残疾及功能受限情况,分析RA导致残疾及功能受限的影响因素.方法应用问卷方式回顾性调查340例RA患者的残疾情况,应用健康评定量表残疾指数(HAQ-DI)评价患者功能受限情况.采用SPSS 13.0软件对残疾及HAQ-DI的影响因素进行单因素及多因素Logistic多元回归分析.结果 ①根据3种不同的标准,RA患者中残疾的发生率分别为50.3％(171/340)、36.8％(125/340)及18.8％(64/340),且均随病程的延长而增加.最常见的受累关节依次为腕关节(111/340,32.6％)、近端指间关节(82/340,24.1％)及肘关节(69/340,20.3％).对影响残疾的因素进行Logistic多元回归分析,结果显示女性[比值比(OR)=5.179,95％可信区间(CI):1.593～16.836,P=0.006]、病程较长(OR=1.104,95％CI:1.065～1.146,P=0.000)、存在关节外表现(OR=3.813,95％CI:1.814～8.011,P=0.000)及医生可视模拟评分(VAS)疾病活动评分较高(OR=1.392,95％CI:1.230～1.577,P=0.000)是RA患者发生残疾的独立危险因素(P＜0.05,R22=0.345).②RA患者中68.5％(233/340)存在不同程度的功能受限,其中31.3％(120/340)存在轻度功能受限,19.7％(67/340)中度功能受限,13.5％(46/340)重度功能受限.Logistic多元回归分析结果提示年龄较大(OR=1.028,95％CI:1.012～1.046,P=0.001)、医生VAS疾病活动评分较高(OR=1.603,95％CI:1.311～1.958,P=0.000)及从未规律应用过改善病情抗风湿药(DMARDs)(OR=1.721,95％CI:1.054～2.809,P=0.030)是导致患者功能受限的独立危险因素(P＜0.05,R2=0.384).结论 RA患者残疾及功能受限发生率高,且随病程延长而增加.高龄、女性、病程较长、存在关节外表现、医生疾病活动VAS评分较高及从未规律应用过DMARDs是导致RA患者残疾和(或)功能受限的独立危险因素.
목적 료해류풍습관절염(RA)환자적잔질급공능수한정황,분석RA도치잔질급공능수한적영향인소.방법 응용문권방식회고성조사340례RA환자적잔질정황,응용건강평정량표잔질지수(HAQ-DI)평개환자공능수한정황.채용SPSS 13.0연건대잔질급HAQ-DI적영향인소진행단인소급다인소Logistic다원회귀분석.결과 ①근거3충불동적표준,RA환자중잔질적발생솔분별위50.3％(171/340)、36.8％(125/340)급18.8％(64/340),차균수병정적연장이증가.최상견적수루관절의차위완관절(111/340,32.6％)、근단지간관절(82/340,24.1％)급주관절(69/340,20.3％).대영향잔질적인소진행Logistic다원회귀분석,결과현시녀성[비치비(OR)=5.179,95％가신구간(CI):1.593～16.836,P=0.006]、병정교장(OR=1.104,95％CI:1.065～1.146,P=0.000)、존재관절외표현(OR=3.813,95％CI:1.814～8.011,P=0.000)급의생가시모의평분(VAS)질병활동평분교고(OR=1.392,95％CI:1.230～1.577,P=0.000)시RA환자발생잔질적독립위험인소(P＜0.05,R22=0.345).②RA환자중68.5％(233/340)존재불동정도적공능수한,기중31.3％(120/340)존재경도공능수한,19.7％(67/340)중도공능수한,13.5％(46/340)중도공능수한.Logistic다원회귀분석결과제시년령교대(OR=1.028,95％CI:1.012～1.046,P=0.001)、의생VAS질병활동평분교고(OR=1.603,95％CI:1.311～1.958,P=0.000)급종미규률응용과개선병정항풍습약(DMARDs)(OR=1.721,95％CI:1.054～2.809,P=0.030)시도치환자공능수한적독립위험인소(P＜0.05,R2=0.384).결론 RA환자잔질급공능수한발생솔고,차수병정연장이증가.고령、녀성、병정교장、존재관절외표현、의생질병활동VAS평분교고급종미규률응용과DMARDs시도치RA환자잔질화(혹)공능수한적독립위험인소.
Objective To describe the condition of deformity and disability in rheumatoid arthritis patients in China,and to analyze the factors that may affect deformity and disability.Methods Data were obtained from a cross-section survey of 340 patients with rheumatoid arthritis (RA),selected from Department of Rheumatology in 21 general hospitals across China.Demographic data,clinical data and Stanford health assessment questionnaire disability index (HAQ-DI) scores were collected.Univariate analysis and Logistic multiple regression were performed to determine independent prognostic factors of deformity and disability.Results ① Occurrence of deformity differed by three different standards [50.3％ (171/340),36.8％ (125/340) and 18.8％(64/340) respectively],and increased with the disease course in rheumatoid arthritis patients.The most common joints involved were wrist (111/340,32.6％),proximal interphalangeal joint (82/340,24.1％) and elbow (69/340,20.3％).Multiple regression analysis showed that female gender (OR=5.179,95％CI:1.593-16.836,P=0.006),long disease course (OR=1.104,95％CI:1.065-1.146,P=0.000),presence of extra-articular manifestations (OR=3.813,95％CI:1.814-8.011,P=0.000) and high physician VAS disease activity score (OR=1.392,95％CI:1.230-1.577,P=0.000) were independent risk factors for deformity (P＜0.05).② The median HAQ-DI score for rheumatoid arthritis patients was 0.500 points (interquartile range,0 to 1.250).Ordinal Logistic regression showed that elder (OR=1.028,95％CI:1.012-1.046,P=0.001),higher physician VAS disease activity score (OR =1.603,95％ CI:1.311-1.958,P=0.000) and never used disease-modifying antirheumatic drugs (DMARDs) regularly (OR=1.721,95％CI:1.054-2.809,P=0.030) could predict severe disability independently (P＜0.05).Conclusion Rheumatoid arthritis patients are at high risk of deformity and disability.Deformity is associated with female gender,long disease course,presence of extra-articular manifestations and high physician VAS disease activity score.Disability could be predicted by elder,high physician VAS disease activity score and never used DMARDs regularly.