类风湿关节炎患者睡眠障碍中医证型特征及影响因素分析

Analysis of TCM Syndrome Characteristics and Influencing Factors of Sleep Disorders in Patients with Rheumatoid Arthritis

目的:分析并探讨类风湿关节炎(RA)患者睡眠障碍中医证型特点以及相关影响因素。方法:将125例RA患者按照睡眠障碍诊断标准分为RA睡眠障碍组与RA非睡眠障碍组。收集2组RA患者性别、年龄、病程等一般资料,同时进行中医辨证分型、睡眠质量评估、疾病活动度评价、功能状况以及焦虑抑郁状态评估,并对所收集的相关数据进行统计分析。结果:125例RA患者中,RA睡眠障碍组77例(61.60%),RA非睡眠障碍组48例(38.40%)。RA睡眠障碍组平均年龄显著大于RA非睡眠障碍组(P <0.05),其中RA睡眠障碍组在45~59岁以及≥60岁这2个年龄段的患者数显著多于RA非睡眠障碍组(P <0.05)。RA睡眠障碍组痰瘀痹阻证、风湿痹阻证人数显著多于RA非睡眠障碍组(P <0.05)。与RA非睡眠障碍组比较,RA睡眠障碍组匹兹堡睡眠质量指数评分、DAS28-CRP评分、健康评估问卷评分、焦虑抑郁量表(HADs)评分、HADs-焦虑状态及HADs-抑郁状态评分更高(P <0.05)。2组患者在性别、病程、疼痛视觉模拟评分法评分,以及血清红细胞沉降率、C反应蛋白、类风湿因子水平等方面比较,差异无统计学意义(P> 0.05)。结论:睡眠障碍是RA患者常见的并发症,尤其以45岁及以上年龄段患者更为多见,而痰瘀痹阻证、风湿痹阻证是合并睡眠障碍RA患者的主要中医证型。与RA非睡眠障碍患者相比,RA睡眠障碍患者疾病活动度更高,整体功能状况更差,且伴发焦虑抑郁状态的风险更高。

Objective:To analyze and explore the TCM characteristics of sleep disorders in patients with rheumatoid arthritis(RA)and related influencing factors.Methods:One hundred and twenty-five RA patients were divided into an RA sleep disorder group and an RA non-sleep disorder group according to the diagnostic criteria for sleep disorders.General information on the gender,age,and course of disease of both groups of RA patients was collected.TCM syndrome differentiation and classification,sleep quality evaluation,disease activity evaluation,functional status,anxiety and depression status evaluation,and statistical analysis on the collected relevant data were conducted.Results:Among 125 RA patients,there were 77 cases(61.60%)in the RA sleep disorder group and 48 cases(38.40%)in the RA non-sleep disorder group.The average age of the RA sleep disorder group was significantly higher than that of the RA non-sleep disorder group(P<0.05),with the RA sleep disorder group having significantly more patients in the age groups of 45~59 years and more than 60 years old than the RA non-sleep disorder group(P<0.05).The number of patients in the RA sleep disorder group with phlegm stasis obstruction syndrome and rheumatic obstruction syndrome was significantly higher than that in the RA non-sleep disorder group(P<0.05).Compared with the RA non-sleep disorder group,the RA sleep disorder group had higher Pittsburgh Sleep Quality Index scores,DAS28-CRP scores,Health Assessment Questionnaire scores,HADs scores,HADs-anxiety state,and HADs-depression state scores(P<0.05).There was no statistically significant difference(P>0.05)between the two groups of patients in terms of gender,disease course,pain visual simulation evaluation score,as well as serum red blood cell sedimentation rate,C-reactive protein,and rheumatoid factor levels.Conclusion:Sleep disorders are a common complication in RA patients,especially in patients aged 45 and above.Phlegm stasis obstruction syndrome and rheumatic obstruction syndrome are the main TCM syndromes of RA patients with combined sleep disorders.Compared with non-sleep disorder patients with RA,RA sleep disorder patients have higher disease activity,poorer overall functional status,and a higher risk of accompanying anxiety and depression.