脊柱关节病流行病学调查问卷参数的筛选和验证

Screening and verification of questionnaire indexes for epidemiological studies on spondyloarthropathy

目的 筛选国内脊柱关节病（SpA）流行病学调查的问卷参数,预测、评价该问卷的应用价值和意义。方法 对533例被调查者（193例为SpA,166例为其他风湿病,健康志愿者174例）选用法国布雷塔尼脊柱关节病流行病学调查中针对SpA有关12个问题的问卷进行调查。结果 （1）与法国文献相比,对12个问题应答的敏感性和特异性均有所差别。其中敏感性相差较大的有发病年龄、银屑病、炎性肠病或者慢性腹泻等;特异性差异大的有脊柱疼痛、缓慢发病、脊柱晨僵、病程超过3个月、放射学指标等。（2）剔除放射学指标,对余下各参数应用logistic回归方法进行分析,发现可把脊柱疼痛是否40岁前发病、有无脊柱晨僵、有无强直性脊柱炎家族史、臀部痛及足跟痛5个指标组成一个具有独立预测SpA可能性有统计学意义的简便参数组。（3）根据问卷中各个问题的应答情况,以最优的区分病例组与对照组为原则,提出一个今后对国内普通人群SpA流行病学调查中有较高应用价值并可供参考使用的调查流程图。结论 验证的问卷对SpA流行病学调查、筛查可疑SpA患者有较高的应用价值。

Objective To screen the parameters of questionnaire in prevalence survey of spondyloarthropathy（SpA） in China, and to evaluate the value and feasibility of questionnaire used in prevalence survey. Methods A questionnaire study on SpA with 12 questions involved was performed which came from a epidemiological survey on SpA in Brittany, France. Results （ 1 ） We found difference on the sensitivity and specificity of some indexes in the questionnaires between the French study and the one developed by ourselves. The sensitivity differed between the published French paper and ours in the following indexes：onset age,psoriasis and inflammatory bowel disease. The specificity of the indexes would include spinal pain, insidious onset, morning stiffness, duration more than 3 months and radiographic manifestation also showed differences. （2） Excluding the radiographic abnormality, we ran the logistic regression and concluded that the following parameters were the independent indexes which suggesting the existence of the disease： spinal pain onset before 40 years of age, having spinal stiffness in the morning having positive family history and having buttock pain and heel pain. （3） Based on the result of each question of the questionnaire, indices of distinguishing the cases and controls were identified. Conclusion The questionnaire verified in our study was a new, simple, valuable and feasible one for SpA prevalence study and in screening the potential SpA patients.