强直性脊柱炎患者功能性动作筛查对达标治疗结局的影响研究

Influence of function movement on the outcome of ankylosing spondylitis under the treat-to-target stratery

目的探讨AS基线期功能性动作筛查(FMS)对其达标治疗结局的影响。方法收集我院符合成都市大病医疗保险资助并完成治疗周期24周的AS患者90例,并以24周时强直性脊柱炎疾病活动度(ASDAS)<1.3为达标标准,分为达标组和未达标组。分别收集2组治疗前后临床资料,基于CRP计算的ASDAS(ASDAS-CRP),并采用功能性动作筛查评估患者运动功能情况,采用t检验、χ^(2)检验比较2组差异,并用Logistic回归模型分析基线期功能性动作筛查对患者达标治疗结局的影响。结果①基线期,达标组和未达标组AS患者在FMS测试值[(15.8±2.3)和(12.6±2.5),t=6.17,P<0.001]、深蹲[(2.2±0.6)和(1.7±0.5),t=3.57,P=0.001]、栏架跨[(2.2±0.7)和(1.8±0.6),t=2.11,P=0.038]、直线弓步[(2.3±0.7)和(1.7±0.5),t=4.23,P<0.001]、肩部灵活性[(2.5±0.6)和(2.2±0.8),t=2.21,P=0.037]、主动直腿抬高[(2.1±0.6)和(1.8±0.6),t=2.35,P=0.021]、脊柱稳定俯卧撑[(2.4±0.7)和(1.8±0.6),t=3.76,P<0.001]、体旋稳定性[(2.2±0.7)和(1.6±0.8),t=3.42,P=0.001]差异有统计学意义;②出组时,2组AS患者在ASDAS评分[(0.96±0.28)和(2.19±0.52),t=14.69,P<0.001],FMS测试值[(17.4±1.9)和(12.7±2.8),t=9.77,P<0.001]、深蹲[(2.6±0.5)和(1.5±0.5),t=9.09,P<0.001]、栏架跨[(2.2±0.6)和(1.8±0.8),t=2.80,P=0.006]、直线弓步[(2.6±0.6)和(1.8±0.9),t=4.85,P<0.001]、肩部灵活性[(2.8±0.4)和(2.5±0.5),t=2.10,P=0.038]、主动直腿抬高[(2.2±0.6)和(1.9±0.8),t=2.46,P=0.016]、脊柱稳定俯卧撑[(2.8±0.4)和(1.6±0.7),t=10.36,P<0.001]、体旋稳定性[(2.3±0.7)和(1.6±0.8),t=4.76,P<0.001]差异有统计学意义;③基线期预测AS患者是否达标的FMS测试值的截点值为14.25分(灵敏度0.733,特异度0.800);④Logistic回归结果显示,基线期FMS系列动作测试中,深蹲[OR值(95%CI)=0.155(0.035,0.677),P=0.013]、直线弓步[OR值(95%CI)=0.375(0.148,0.953),P=0.039]、脊柱稳定俯卧撑[OR值(95%CI)=0.136(0.043,0.436),P=0.001]、体旋稳定性[OR值(95%CI)=0.308(0.121,0.780),P=0.013]是患者达标治疗结局的影响因素(P<0.05)。结论达标组AS患者基线期和出组时FMS测试均优于未达标组,基线期AS患者FMS总分,深蹲、直线弓步、脊柱稳定俯卧撑、体旋稳定性是其达标治疗结局的影响因素。

Objective To investigate the effect of baseline function movement assessment of ankylosing spondylitis(AS)on treatment outcomes.Methods The clinical data of 90 patients with AS who met the medical insurance treatment for major disease in Chengdu were collected including clinical symptoms,functional movement screen(FMS)and ankylosing spondylitis disease activity score(ASDAS)after 24 weeks adalimumab treatment.They were divided into the non-treat-to-target group and the non-treat-to target group based on the ASDAS score,t-test orχ^(2) test was used to compare the differences between the two groups.Logistic regression model was used to analyze the influence of baseline FMS on the outcome of patients reaching the treatment target.Results①The two groups were different in the FMS[(15.8±2.3)vs(12.6±2.5),t=6.17,P<0.001],squat[(2.2±0.6)vs(1.7±0.5),t=3.57,P=0.001],hurdle spanning[(2.2±0.7)vs(1.8±0.6),t=2.11,P=0.038],straight lunge[(2.3±0.7)vs(1.7±0.5),t=4.23,P<0.001],shoulder flexibility[(2.5±0.6)vs(2.2±0.8),t=2.21,P=0.037],active straight leg raise[(2.1±0.6)vs(1.8±0.6),t=2.35,P=0.021],spinal stabilization pushups[(2.4±0.7)vs(1.8±0.8),t=3.76,P<0.001],body rotation stability[(2.2±0.7)vs(1.6±0.8),t=3.42,P=0.001]at baseline.②The two groups were different in ASDAS score[(0.96±0.28)vs(2.19±0.52),t=14.69,P=0.000],FMS[(17.4±1.9)vs(12.7±2.8),t=9.77,P<0.001],deep squat[(2.6±0.5)vs(1.5±0.5),t=9.09,P<0.001],hurdle step[(2.2±0.6)vs(1.8±0.8),t=2.80,P=0.006],straight lunge[(2.6±0.6)vs(1.8±0.9),t=4.85,P<0.001],shoulder flexibility[(2.8±0.4)vs(2.5±0.5),t=2.10,P=0.038],active straight leg raise[(2.2±0.6)vs(1.9±0.8),t=2.46,P=0.016],spinal stability push-ups[(2.8±0.4)vs(1.6±0.7),t=10.36,P<0.001],and body rotation stability[(2.3±0.7)vs(1.6±0.8),t=4.76,P<0.001]at the end of the observation.③The cut-off value of the FMS for predicting whether AS patients meet the standard at baseline was 14.25 points(Sensitivity 0.733,specificity 0.800).④Logistic regression results showed that in the baseline,FMS series of action tests,squat[OR(95%CI)=0.155(0.035,0.677),P=0.013],straight lunge[OR(95%CI)=0.375(0.148,0.953),P=0.039],spinal stability push-ups[OR(95%CI)=0.136(0.043,0.436),P=0.001],and body rotation stability[OR(95%CI)=0.308(0.121,0.780),P=0.013]were the influencing factors of the AS patient's treatment outcome(P<0.05).Conclusion The AS patients in the non-treat-to-target group have better FMS tests at baseline and at the end of the study than the non-treat-to-target group.Squats,straight lunges,remember stable push-ups,and body rotation stability are the influencing factors for the treatment outcomes of AS patients at baseline.