女性类风湿关节炎患者述情障碍与心理健康状况研究

Alexithymia and psychological status in female rheumatoid arthritis patients

目的：探讨女性 RA 患者述情障碍与其心理健康状况之间的关系。方法采用多伦多述情障碍量表（TAS）-20、症状自评量表（SCL）-90分别对54例女性 RA 患者进行测查，记录并评估患者病程和 DAS28等临床资料，以50名健康女性作为对照，RA 组与对照组以及区组间数据比较采用 t 检验，患者述情障碍、SCL-90与病程及 DAS28之间的相关性采用 Spearman 相关分析。结果①女性 RA 患者TAS-20总分（57±9）高于健康对照组（51±7）（t=4.15，P〈0.01），各因子分也高于健康对照组（P 均〈0.01）；SCL-90总分（165±50）高于健康对照组（138±41）（t=3.06，P〈0.05），其余各因子分（偏执因子除外）也均高于健康对照组（P 均〈0.01））；② Tf1因子与 SCL-90的各项因子均呈正相关（P〈0.05），Tf3因子与强迫、人际敏感、恐怖、偏执因子呈正相关（P〈0.05），TAS-20总分与各因子均分呈正相关（躯体化因子除外）（P〈0.05）；③TAS-20高/低分组间 SCL-90结果比较：Tf1因子2组间强迫、焦虑和恐怖因子差异有统计学意义（P〈0.05），Tf3因子在强迫、人际敏感、抑郁、敌对、偏执、精神病性因子上差异有统计学意义（P〈0.05）；SCL-90总分高/低分组间 TAS-20结果比较：Tf1因子2组间差异有统计学意义（P〈0.01）；④病程与 SCL-90的抑郁和偏执因子呈正相关（P 均〈0.01）， DAS28与 SCL-90的焦虑和偏执因子呈正相关（P〈0.05）。结论女性 RA 患者存在较明显的述情障碍及多种心理问题，心理健康状况较差，且 TAS-20的 Tf1、Tf3因子、病程及疾病活动度都与其心理健康状况明显相关。

Objective To investigate the alexithymia, mental health condition and their relationship in female rheumatoid arthritis patients. Methods Fifty-four female patients with rheumatoid arthritis and 50 healthy women were enrolled and assessed with Chinese version of the 20-item Toronto Alexithymia Scale （TAS-20） and the symptom checklist-90（SCL-90）. Disease duration and DAS28 of the patients were also recorded and calculated. The data were statistical analyzed by t test between the two groups and other block groups. The association between TAS-20, SCL-90, duration and DAS28 was assessed using Spearman corre-lations. Results ① The TAS-20 total score and Tf1, Tf2, Tf3 factors score of female rheumatoid arthritis patients were significantly higher than those of the control group （57±9, 51±7, t=4.15, P〈0.01）; it was also the same with the total score and factors score of SCL-90 （beside the paranoid factor） between patients and control groups （165±50, 138±41, t=3.06, P〈0.05）. ② Correlation analysis showed significantly positive correlation between Tf1 factor and all factors of SCL-90, also between Tf3 factor and obsession-compulsion, interpersonal sensitivity, phobias and paranoid factors（P〈0.05）. ③ Only hostility factor was different between the higher TAS-20 total score group and the lower one. However, the obsession-compulsion, anxiety and phobias factors scores of the higher Tf1 score group were significantly higher than those of the lower one （P〈0.05）; The higher Tf3 score group was significantly different from the lower one in obsession-compulsion, interpersonal sensitivity, depression, hostility, paranoid and psychoticism factors （P〈0.05）. The Tf1 factor score of higher SCL-90 total score group was significant higher than that of the lower one （P〈0.05）. ④ There were significantly positive correlation between duration and depression and paranoid factors, also between 〈br〉 DAS28 and anxiety and paranoid factors （P 〈0.05）. Conclusion There is obvious alexithymia and psychological problems in female rheumatoid arthritis patients; the Tf1 and Tf3 factors of TAS-20, duration and DAS28 are all major factors related to the psychological state.