强直性脊柱炎患者消化功能的影响因素分析及临床意义

Influence factors and clinical significance of digestive disturbance in ankylosing spondylitis patients

目的 ：评估强直性脊柱炎（ankylosing spondylitis,AS）患者的消化功能,探讨其消化功能紊乱的影响因素及临床意义。方法：2014年7月~2015年4月,101例AS患者纳入本研究,其中门诊患者84例、住院患者17例。收集患者年龄、病程、服用非甾体类抗炎药（NSAIDs）和抗风湿药（DMARD）情况、烟酒嗜好、合并症等临床资料,记录血红细胞沉降率（ESR）、C反应蛋白（CRP）等检查结果,在X线片上测量脊柱最大后凸Cobb角（global kyphosis,GK）。采用食品效益评估调查问卷（FBA）和功能性消化不良生存质量量表（FDDQL）评估患者消化功能。根据GK将患者分为轻度后凸组（GK〈60°,67例）和重度后凸组（GK≥60°,34例）。采用Spearman相关性分析和多元线性回归分析探讨AS患者消化功能的影响因素。结果：101例患者FBA评分为63.2±13.5分,FDDQL评分为77.4±13.1分,ESR 26.6±20.2mm/h,CRP 32.0±22.7mg/L,GK 52.1°±23.5°,48例有服用NSAIDs药物史,23例有服用DMARD药物史,52例有吸烟嗜好,40例有饮酒嗜好,3例合并有贫血。除了FDDQL＂疾病控制＂维度外,两组患者消化功能评分差异无统计学意义（P〉0.05）。Spearman相关分析显示,轻度后凸组FBA总分与患者年龄、CRP和饮酒相关（均P〈0.05）,FDDQL总分与CRP呈负相关（P〈0.05）;重度后凸组FBA总分与各影响因素均无相关性（均P〉0.05）,FDDQL总分与GK和贫血呈负相关（均P〈0.05）;101例AS患者FBA总分与年龄、服用NSAIDs和饮酒相关（均P〈0.05）,而与病程、ESR、CRP、GK、吸烟、服用DMARD、贫血无相关性（均P〉0.05）;FDDQL总分与GK、服用NSAIDs、服用DMARD和贫血呈负相关（均P〈0.05）,而与年龄、病程、ESR、CRP、吸烟和饮酒无相关性（均P〉0.05）。101例AS患者多元线性回归分析显示服用NSAIDs和饮酒致FBA总分减少;服用NSAIDs和贫血致FDDQL总分减少。结论 ：轻、重度胸腰椎后凸畸形AS患者消化功能无明显差异。AS患者消化功能下降与年龄、脊柱最大后凸Cobb角、服用NSAIDs、服用DMARD、饮酒和贫血有关,而与病程、炎症活动程度和吸烟无相关性,服用NSAIDs、饮酒和贫血是AS患者消化功能紊乱的重要因素。

Objectives： To investigate the digestive disturbance in ankylosing spondylitis（AS） patients, and to analyze its influence factors and clinical significance. Methods： From July 2014 to April 2015, 101 AS patients were included in this study, consisting of 84 outpatients and 17 inpatients. The parameters of patients,including age, disease duration, history of taking non steroidal anti inflammatory drugs（NSAIDs） and disease modifying anti rheumatic drugs（DMARD）, smoking and alcohol history, comorbidities, erythrocyte sedimentation rate（ESR）, C reactive protein（CRP） and global kyphosis（GK） were collected. Digestive function was assessed by the Food and Benefits Assessment（FBA） and Functional Digestive Disorders Quality of Life（FDDQL） questionnaires. The patients were divided into mild kyphosis group（GK 〈60°, n=67） and severe kyphosis group（GK ≥60°, n=34）. Correlations of FBA, FDDQL with the influencing factors were calculated by the Spearman coefficients of correlations. Multiple regression analysis was used to investigate the influence factors which impaired digestive function of AS patients. Results： The score of FBA and FDDQL was 63.2±13.5 and 77.4±13.1. The average GK of patients was 52.1°±23.5°. Additionally, the ESR and CRP were 26.6 ±20.2mm/h and 32.0 ±22.7mg/L. History of smoking, alcohol, taking NSAIDs and DMARD were found in 52, 40, 48 and 23 patients, respectively. Among them, 3 patients were companied with anemia. There was no significant difference between two groups in questionnaire scores except for the score of coping with disease domain of FDDQL questionnaire. Spearman correlation analysis revealed that FBA was significantly correlated with age, CRP and alcohol（P〈0.05）, while FDDQL was significantly related to anemia（P〈0.05） in mild kyphosis group. Moreover,in severe kyphosis group, no significant correlation was found between FBA and influence factors, and FDDQL was significantly associated with GK and anemia（P〈0.05）. For all 101 AS patients, significant correlations were observed between FBA and age, NSAIDs as well as alcohol history（P 〈0.05）. Similarly, FDDQL significantly correlated with GK, NSAIDs, DMARD, and anemia（P〈0.05）. Multiple regression analysis revealed that NSAIDs and alcohol history resulted in lower FBA score, while NSAIDs and anemia leaded to lower FDDQL score. Conclusions： There is no significant difference between AS patients with mild and severe kyphosis in digestive function. The digestive function of AS patients is impaired, which is related to age, GK, NSAIDs,DMARD, alcohol and anemia. Digestive disturbance is not correlated with disease duration, ESR, CRP and smoking. Among them, NSAIDs, alcohol and anemia are the most important factors impairing the digestive function in AS patients.