肥胖对银屑病关节炎患者生活质量影响的研究

Effect of Obesity on Quality of Life in Patients With Psoriatic Arthritis

目的 探讨肥胖对银屑病关节炎(psoriatic arthritis,PsA)患者生活质量、心理状态和其他临床变量的可能影响。方法 选取2012年6月—2022年6月在连云港市第一人民医院灌南分院诊断为银屑病关节炎的1 033例患者纳入研究。患者的身体质量指数(body mass index,BMI),BMI≥30 kg/m~2定义为肥胖,BMI<30 kg/m~2为非肥胖,根据BMI分为两组。收集记录两组患者的人口统计学数据(年龄、性别和吸烟状况)、症状持续时间、血脂水平、红细胞沉降率(erythrocyte sedimentation rate,ESR)和C-反应蛋白(C-reactive protein,CRP)等指标,并对患者是否有手指类风湿关节炎、周围性关节炎、髋关节疼痛和脊柱炎进行评判。使用临床结果指标对患者进行检查和评估,包括健康相关生活质量指标(PsA生活质量问卷,PsA quality of life questionnaire,PsAQoL),心理状态(医院焦虑和抑郁量表,hospital Anxiety and depression scale,HADS),疾病活动参数(银屑病关节炎疾病活动指数,psoriatic arthritis disease activity index,DAPSA)、疾病活动评分28-C反应蛋白(disease activity score 28-c-reactive protein,DAS28-CRP),健康评估问卷(health assessment questionnaire,HAQ)。银屑病的严重程度由银屑病面积和严重程度指数(psoriasis area and severity index,PASI)确定。使用视觉模拟疼痛量表(visual analog pain scale,VAS-P)评估患者的疼痛。应用Mann-Whitney U检验、χ~2检验比较各组人群不同指标之间的关系。结果 共有1 033例Ps A患者,650例(62.9%)非肥胖患者和383例(37.1%)肥胖患者被纳入研究。肥胖组的PsAQoL、HADS焦虑、HADS抑郁、DAPSA、DAS28-CRP、HAQ评分均高于非肥胖组(P<0.05)。肥胖组和非肥胖组的VAS-P评分相似。线性回归分析表明,BMI影响患者生活质量、抑郁和疾病活动。结论 肥胖与较高的疾病活动、较低的生活质量、焦虑和抑郁的风险显著相关。因此,在管理Ps A患者时,应考虑肥胖的治疗。

Objective To explore the possible effects of obesity on the quality of life,psychological status and other clinical variables in patients with psoriatic arthritis (PsA).Methods A total of 1 033 patients diagnosed with psoriatic arthritis in Guannan Hospital,Lianyungang First People’s Hospital from June 2012 to June2022 were included in the study.The body mass index (BMI) of the patients was calculated.BMI≥30 kg/m~2 was de?ned as obese,and BMI<30 kg/m~2 was non obese.The patients were divided into two groups according to the body mass index.The demographic data (age,sex,smoking status),symptom duration,blood lipid level,erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) of the two groups of patients were collected and recorded,and the patients were judged whether they had rheumatism,peripheral arthritis,hip pain and spondylitis.Patients were examined and evaluated using clinical outcome indicators,including health-related quality of life indicators (PsA quality of life questionnaire,psaqol),psychological status (Hospital Anxiety and depression scale,HADS),disease activity parameters (psoriatic arthritis disease activity index,DAPSA),disease activity score 28-c-reactive protein (das28-crp),and health assessment questionnaire (HAQ).The severity of psoriasis was determined by the psoriasis area and severity index(PASI).Patients’pain was assessed using the visual analog pain scale (vas-p).Mann Whitney U test and chi square test were used to compare the relationship between different indicators in each group.Results A total of 1 033 PsA patients,650 cases (62.9%) non obese patients and 383 cases (37.1%) obese patients were included in the study.The scores of psaqol,hads anxiety,hads depression,dapsa,das28-crp and HAQ in obese group were higher than those in non obese group (P<0.05).Vas-p scores were similar in obese and non obese groups.Linear regression analysis showed that BMI affected quality of life,depression and disease activity.Conclusion Obesity is significantly associated with higher disease activity,lower quality of life,anxiety and depression risk.Therefore,the treatment of obesity should be considered when managing PsA patients.