类风湿关节炎患者合并焦虑抑郁危险因素分析及与中医证型关系

Risk Factors Analyses of Anxiety and Depression in Rheumatoid Arthritis Patients and Correlation with Chinese Medical Syndrome Types

目的探究类风湿关节炎(RA)患者合并焦虑抑郁的危险因素及与中医证型的相关性。方法采用回顾性调查的方法,收集就诊于安徽中医药大学第二附属医院风湿科的216例RA患者的一般资料、中医证型及焦虑、抑郁评分。按照有无合并焦虑抑郁将RA患者分为单纯RA组和RA合并焦虑抑郁组。危险因素采用二元Logistic回归分析;焦虑自评量表(SAS)和抑郁自评量表(SDS)评分与中医证型、各项指标间相关性采用Spearman或Pearson相关性分析。结果(1)二元Logistic回归分析显示:年龄>50岁、疾病活动度(DAS28)>5.1、贫血、抗环瓜氨酸肽(CCP)抗体阳性及白细胞介素-6(IL-6)异常升高是RA发生焦虑、抑郁的危险因素;(2)相关性分析发现:两组RA患者SAS、SDS评分与贫血指标均存在负相关(P<0.05),与DAS28、免疫、炎症指标均存在正相关(P<0.05);(3)不同中医证型焦虑、抑郁分布规律如下:RA合并焦虑抑郁以湿热痹阻证最为常见,但肝肾亏虚证焦虑、抑郁程度最重,肝肾亏虚证患者SAS、SDS评分高于湿热痹阻证、痰瘀痹阻证(P<0.05)。结论不同中医证型RA患者焦虑、抑郁分布存在差异,轻度焦虑抑郁好发于湿热痹阻证、痰瘀痹阻证;中、重度焦虑抑郁好发于肝肾亏虚证。高龄、高疾病活动度、贫血、免疫炎症亢进可能是RA并发焦虑抑郁的高危因素。

Objective To study the risk factors for comorbid anxiety and depression in rheumatoid arthritis(RA)patients and its correlation with Chinese medicine(CM)syndrome types.Methods A retrospective survey was used to collect the general data,CM syndrome types,and anxiety and depression scores of 216 RA patients treated at Department of Rheumatics,Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine.RA patients were assigned to RA group and RA complicated anxiety/depression group according to whether complicated with anxiety/depression.Risk factors were analyzed by binary Logistic regression.The correlations between Self-rating Anxiety Scale(SAS)/Self-rating Depression Scale(SDS)scores and CM syndrome types/various indicators were analyzed by Spearman or Pearson correlation.Results(1)Binary Logistic regression analysis showed that age>50 years old,disease activity score(DAs28)>5.1,anemia,anti-cyclic peptide containing citrulline(anti-CCP)positive and abnormal increased IL-6 were risk factors of anxiety/depression in RA.(2)Correlation analyses found that SAS and SDS scores of RA patients were negatively correlated with anemia indicators(P<0.05),and positively correlated with DAS28,immunity and inflammation indicators(P<0.05).(3)The distribution rules of anxiety/depression in different CM syndromes types were as follows:Damp-heat obstruction syndrome was the most commonly seen in RA complicated with anxietyl depression.Gan-Shen deficiency syndrome was the most severe.The SAS and SDS scores in patients with Gan-Shen deficiency syndrome were higher than those of patients with damp-heat obstruction syndrome and phlegm stasis obstruction syndrome(P<0.05).Conclusions Anxiety and depression were differently distributed in RA patients with different CM syndromes.Mild anxiety and depression were liable to occur in patients with dampheat obstruction syndrome and phlegm stasis obstruction syndrome.Moderate and severe anxiety and depression were liable to occur in patients with Gan-Shen deficiency syndrome.Elderly age,high disease activity,anemia,and hyperimmune inflammation were possibly high risk factors for RA patients complicated with anxiety and depression.