强直性脊柱炎胸腰椎后凸畸形患者睡眠质量的影响因素分析

Influencing factors of sleep disturbance in ankylosing spondylitis patients with thoracolumbar kyphosis

目的通过对强直性脊柱炎（AS）胸腰椎后凸畸形患者睡眠质量的评估，探讨其睡眠障碍的影响因素。方法收集32例AS患者年龄、发病年龄、病程和胸腰椎后凸病史等临床资料，血细胞沉降率（ESR）、C反应蛋白（CRP）等实验室检查结果，以及站立位全脊柱正侧位片上测量胸腰椎后凸Cobb角。采用匹兹堡睡眠质量指数（PSQI）量表评估患者睡眠质量，汉密尔顿焦虑量表（HAMA）评估患者焦虑程度，同时采用Bath AS疾病活动指数（BASDAI）量表、Bath AS功能指数（BASFI）量表、Oswestry功能障碍指数（ODI）评估患者生活质量。采用Spearman相关分析AS胸腰椎后凸畸形患者睡眠质量的影响因素。结果32例患者PSQI评分为（6．8±4．2）分，HAMA评分为（9．7±8．0）分，BASDAI评分为（3．5±1．6）分，BASFI评分为（3．1±2．0）分，ODI评分为33．0±16．8，后凸畸形Cobb角59．5°±22．1°，ESR（25．4±15．5）mm／h，CRP（22．7±21．7）mg／L。Spearman相关分析显示，PSQI总分与患者年龄、病程长短、ODI、BASFI及HAMA评分呈正相关（P值均〈0．05），与发病年龄、后凸病史长短、ESR、CRP、BASDAI及胸腰椎后凸Cobb角无明显相关性（P值均〉0．05）。结论AS胸腰椎后凸畸形患者睡眠质量显著下降，与患者年龄、病程长短、疼痛、功能受损程度以及焦虑情绪等相关，主要影响因素为疼痛和焦虑情绪；而与ESR、CRP及胸腰椎后凸Cobb角无相关性，其不是影响患者睡眠质量的关键因素。

Objective To investigate the sleep disturbance in ankylosing spondylitis （AS） patients with thoracolumbar kyphosis and to analyze its influencing factors. Methods The parameters of thirty-two AS patients with thoracolumbar kyphosis were collected in this study, which included age, age of onset, disease duration, kyphotic duration, erythrocyte sedimentation rate （ESR）, C reactive protein （CRP） and thoracolumbar kyphotic Cobb angle. Sleep quality was assessed by the Pittsburgh sleep quality index （PSQI） and anxiety by the Hamilton anxiety scale （ HAMA ）. The quality of life was evaluated by the Bath ankylosing spondylitis disease activity index （BASDAI）, Bath ankylosing spondylitis functional index （BASFI） and Oswetry disability index （ODI）. Correlations between the PSQI and the influencing factors were calculated by the Spearman coefficients of correlations. Results The average kyphotic Cobb angle of patients in this study was 59.5 °± 22.1 °. The scores of PSQI, HAMA, BASDAI, BASFI and ODI were 6.8 ± 4.2, 9.7 ± 8. 0, 3.5 ± 1.6, 3.1 ± 2.0 and 33.0 ± 16.8, respectively. The kyphotic Cobb angle averaged 9. 7 ±8.0. Additionally, the ESR and CRP were （25. 4 ± 15. 5） mm/h and （22. 7 ± 21.7） mg/L. Significant correlation was observed between PSQI and age, disease duration, ODI, BASFI as well as HAMA （ all P values 〈 0.05 ）. However, no significant correlation was found between PSQI and age of onset, kyphotic duration, ESR, CRP, BASDAI as well as Cobb angle （ all P values 〉 0. 05 ）. Conclusions Sleep disturbance is a common problem in AS patients with thoracolumbar kyphosis, which is related to age, disease duration, pain, functional damage and anxiety, of which the pain and anxiety are the main factors. Sleep disturbance is not correlated with the ESR, CPR and kyphotic Cobb angle.