基于Wilson-Cleary模型的系统性红斑狼疮患者生活质量影响因素结构方程分析

Structural equation analysis of factors influencing quality of life in systemic lupus erythematosus patients based on Wilson-Cleary model

目的调查系统性红斑狼疮患者的生活质量现状及其影响因素,利用Wilson-Cleary模型分析各影响因素对系统性红斑狼疮患者生活质量的作用路径。方法选取云南省第一人民医院风湿免疫科2021年12月—2022年6月收治的207例系统性红斑狼疮患者,使用患者一般情况调查表、中文版慢性病治疗功能评估-疲劳量表、Morisky服药依从性量表、医院用焦虑抑郁量表、SF-12生活质量量表及系统性红斑狼疮疾病活动性评分(SLEDAI-2000)进行调查。使用SPSS、AMOS软件进行统计分析。结果本组患者SLEDAI-2000得分7.55±4.86分,疲劳得分39.44±7.62分,焦虑得分5.43±3.63分,抑郁得分3.95±3.36分,服药依从性得分7.10±1.20分,生活质量得分56.83±19.17分。疲劳对生活质量有直接正向预测作用(β=1.516,P<0.05);抑郁对生活质量有直接负向预测作用(β=-1.030,P<0.05);年龄对生活质量具有直接负向预测作用(β=-0.154,P<0.05),SLEDAI-2000评分通过疲劳对生活质量有间接负向预测作用(β=-0.477,P<0.05);焦虑通过疲劳、抑郁对生活质量有间接负向预测作用(β=-1.277、-0.633,P<0.05);服药依从性通过SLEDAI-2000评分和疲劳对生活质量有间接正向预测作用(β=0.414,P<0.05),病程通过服药依从性、SLEDAI-2000评分和疲劳对生活质量有间接负向预测作用(β=-0.096,P<0.05)。结论随着年龄的增长与病程的延长,SLE患者生活质量会逐渐下降。对于改善SLE患者生活质量,提升服药依从性是前提,SLE病情活动是首要改善指标,疲劳和抑郁是重要指标,焦虑位居其次。

Objective To investigate the status quo and influencing factors of quality of life in systemic lupus erythematosus patients,and to analyze the pathways of influencing factors on quality of life in patients with systemic lupus erythematosus by Wilson-Cleary model.Methods 207 patients with systemic lupus erythematosus admitted to the Department of Rheumatology and Immunology of the First People's Hospital of Yunnan Province from December 2021 to June 2022 were selected.The patients'general situation questionnaire,Chinese version of Chronic Disease Function Assessment-Fatigue Scale,Morisky Medication Compliance Scale,hospital anxiety and depression scale,SF-12 Quality of Life Scale and Systemic Lupus Erythematosus Disease Activity Index Score(SLEDAI-2000)were used for investigation.SPSS and AMOS were used for statistical analysis.Results SLEDAI-2000 score was 7.55±4.86 points,fatigue score was 39.44±7.62 points,anxiety score was 5.43±3.63 points,depression score was 3.95±3.36 points,medication compliance score was 7.10±1.20 points,and quality of life score was 56.83±19.17 points.Fatigue positively predicted the quality of life(β=1.516,P<0.05).Depression had a direct negative predictive effect on quality of life(β=-1.030,P<0.05).Age had a direct negative predictive effect on quality of life(β=-0.154,P<0.05),and SLEDAI-2000 score had an indirect negative predictive effect on quality of life through fatigue(β=-0.477,P<0.05).Anxiety had an indirect negative predictive effect on life quality through fatigue and depression(β=-1.277,-0.633,P<0.05).Medication compliance was an indirect positive predictor of quality of life by SLEDAI-2000 score and fatigue(β=0.414,P<0.05),and disease course was an indirect negative predictor of quality of life by medication compliance,SLEDAI-2000 score and fatigue(β=-0.096,P<0.05).Conclusion With the increase of age and the prolongation of disease course,the quality of life of SLE patients will gradually decline.To improve the quality of life of SLE patients,improving medication compliance is the premise.SLE disease activity is the primary improvement indicator,fatigue and depression are important indicators,followed by anxiety.