汶川地震前后绵阳地区羌族人群风湿性疾病谱变化的调查分析

Spectrum of rheumatoid diseases of Qiang in Mianyang before and after Wenchuan earthquake

目的研究汶川地震前后绵阳羌族人群风湿免疫疾病的疾病谱变化情况。方法对地震前接受风湿性疾病流行病学调查的896例绵阳地区羌族居民进行震后的随访,参照修订的中国-国际抗风湿联盟(China-ILAR)风湿病调查表对这部分人群进行详细的问卷调查与相应检查,根据美国风湿病协会的疾病诊断标准做出诊断。同时使用美国精神病学会《诊断与统计手册:精神障碍》(DSM-Ⅳ)标准来诊断患者是否有创伤后应激障碍(PTSD)。并留取血标本以备IL-6、皮质醇及T细胞亚群检查。结果地震后随访成功823例,男性441例,女性382例,随访成功率为91.85%,脱失73例,其中死亡8例。地震前被调查人员风湿性疾病以骨关节炎最多,其次为软组织风湿病、痛风、类风湿关节炎、红斑狼疮和干燥综合症。地震后骨关节炎、痛风、类风湿关节炎、软组织风湿病较地震前均有明显增多,差异具有统计学意义(P<0.05)。地震后有79人发生PTSD,发病率为9.6%,类风湿关节炎人群中PTSD患病率较高。通过对PTSD阳性及阴性各40份血标本的检查发现,PTSD阳性人群皮质醇均值较阴性组低,IL-6水平阳性组较阴性组高,TCD4/TCD8比值较PTSD阴性人群低。结论羌族人群常见风湿性疾病与其它地区相应疾病的发病率相似,地震使骨关节炎、痛风、类风湿关节炎、软组织风湿病较地震前明显增多,类风湿关节炎与PTSD的发生有关。

Objective To investigate the spectrum change of rheumatoid diseases of Qiang in Mianyang before and after Wenchuan earthquake.Methods 896 Qiang residents were investigant with the epidemiological survey about rheumatic diseases.The questionnaire depended on the revised China-International League of Association of Rheumatology（ILAR）.If the answer was positive,The subject would carry out the following process such as inquest medical history,body examination,assistant examination,and making a diagnosis according to the American Constitution of Rheumatology（ACR）,Posttraumatic stress disorder（PTSD） according to the Diagnostic and statistical manual of mental disorder（DSM-Ⅳ）.IL-6,cortisol,and T-cell sub-group examination were detected.Results After the earthquake,823 resident were followed up successfully.Osteoarthritis（OA） was the most common diseases before and after the earthquake.The followed were soft tissue diseases（STD）,gout,rheumatoid arthritis（RA）,systemic lupus erythematosus（SLE）,and Sjogren＇s syndrome（pSS）.The morbidity of OA,gout,RA,and STD after earthquake was higher than that after earthquake.Conclusion The morbidity of common rheumatoid arthritis of Qiang is similar with other region of our country,the morbidity of OA,gout,RA,and STD increases after Wenchuan earthquake.