强直性脊柱炎患者疾病活动度影响因素的有序多分类Logistic回归分析

Ordinal logistic regression analysis of influencing factors of disease activity in ankylosing spondylitis

目的探索影响强直性脊柱炎(AS)患者疾病活动度的相关影响因素及其临床意义。方法共收集风湿免疫门诊新确诊的AS患者723例。相关影响因素的收集采用自编式AS流行病学调查表,疾病活动度的评估采用巴斯强直性脊柱炎疾病活动度指数。运用有序多分类Logistic回归模型识别AS患者疾病活动度的相关影响因素。结果单因素分析结果显示,AS患者疾病活动度的高低与年龄、低等教育水平、较差的睡眠质量、ESR、BASFI及症状持续时间有关(P<0.05)。多因素分析表明,较差及一般的睡眠质量和较差的功能结局是影响AS患者疾病活动度高低的主要因素(P<0.05)。结论睡眠障碍及功能受限是影响AS患者疾病活动度的主要因素。临床医师应注重改善AS确诊患者的功能状态及睡眠质量,控制炎症进展,提高患者预后。

Objective To explore variables associated with a severe disease activity in patients with AS and its clinical significance. Methods 723 out-patients were selected. The self-designed epidemiological questionnaire was used to collect relevant information of all patients. Disease activity was assessed using Bath ankylosing spondylitis disease activity index（ BASDAI）. An ordinal logistic regression model was conducted to identify the influencing factors of disease activity in patients with AS. Results Age（ P〈0. 001）,poor educational level（ P = 0. 015）,poor sleep quality（ P〈0. 001）,ESR（ P〈0. 001）,BASFI（ P〈0. 001） and symptoms duration（ P〈0. 001） were correlated with BASDAI in univariate regression analysis. The results of multivariate regression analysis showed that poor and normal sleep quality（ P = 0. 002,0. 045） and bad functional outcomes（ P〈0. 001） may be risk factors for a severe disease activity in AS patients. Conclusion Sleep disorders and functional impairment may be risk factors for a severe disease activity in AS patients. Consequently,clinicians should pay attention to improving the functional status and sleep quality of established AS,to controlling the development of inflammation and preventing the exacerbation,and improving the overall outcome for individual patients.