综合管理对类风湿关节炎患者疾病控制及生存质量的影响

Efficacy of chronic disease management in the treatment and quality of life for rheumatoid arthritis

目的探讨实施慢性病管理对类风湿关节炎患者病情控制和生存质量的影响。方法将2011年6月—2012年8月期间选取的160例活动期类风湿关节炎患者以便利取样方法分为对照组与试验组，各80例，两组在常规口服药物基础上，试验组施以6个月的慢性病管理，比较两组疾病活动度（DAS28）评分、ESR、ACR50（美国风湿病学会标准）和生存质量。结果两组规律服药人数的差异有统计学意义（68例和37例，x2=26．625，P=0．000）；组间DAS28评分降低的差异有统计学意义[（2．46±1．09）分和（3．68±1．65）分，t=1．655，P=0．002]。试验组管理前后ESR差异有统计学意义[（66．09±41．98）分和（21．27±19．61）分，t=1．655，P=0．029]，对照组并无统计学意义（t=1．976，P=0．059）。两组ACR50达标人数（60例和44例，χ2=4．314，P=0．038）差异有统计学意义；试验组生存质量得分管理前后差异有统计学意义[（56．58±20．24）分和（63．71±18．35）分，t=1．655，P=0．013]，干预后显著高于对照组[（63．71±18．35）分和（48．76±19．88）分，t=1．906，P=0．020]。结论慢性病管理能改善类风湿关节炎患者的相关临床指标和生存质量，可作为类风湿关节炎的一种辅助治疗方法加以推广。

Objective To explore the effects of chronic disease management in the treatment and quality of life for rheumatoid arthritis （RA）. Methods A total of 160 patients with active RA were selected from June 2011 to August 2012 and randomly assigned into experimental and control groups （ n = 80 each）. Based upon oral medication, the experimental group had chronic disease management for 6 months. Before and after therapy, DAS28 score, erythrocyte sedimentation rate （ESR） , ACRS0 and quality of life score were measured. Results The number of regular medication in experimental group was significantly more than that in the control group （68 vs. 37, χ2 = 26. 625, P = 0. 000）. The inter-group difference of DAS28 score reduction was statistically significant （2. 46 ± 1.09 vs. 3.68 ± 1.65, t = 1. 655, P = 0. 002）. After intervention, ESR significantly decreased in experimental group （ 66.09 ± 41.98 vs. 21.27 ± 19. 61, t = 1. 655, P = 0. 029 ） and the reduction of control group was not statistically significant （ t = 1. 976, P = 0. 059）. The number of ACRS0 in experimental group was more than that in control group （60 vs. 44, χ2 = 4. 314, P =0. 038）. The score of life quality of experimental group increased dramatically （56. 58 ±20. 24 vs. 63.71 ± 18.35, t = 1. 655, P = 0. 013） and it was significantly higher than control group （63.71 ± 18.35 vs. 48.76 ± 19. 88, t = 1. 906, P =0. 020）. Conclusion Chronic disease management can improve the life quality and clinical indices of RA patients. Thus it may be widely applied clinically as an adjunct treatment.