摘要
目的了解RA患者抑郁、焦虑障碍的发生率并探讨其影响因素。方法选取2015年9月至2016年4月就诊我院风湿免疫科住院及门诊的RA患者121例，详细记录患者基本信息及临床资料，并采用汉密尔顿抑郁量表和汉密尔顿焦虑量表分别对患者评分，了解RA患者中抑郁、焦虑的发生情况并分析相关因素。采用t检验、χ^2检验、Spearman相关性检验和Logistic回归分析对数据进行统计。结果① 121例RA患者中抑郁发生率为44.6%，焦虑发生率为32.2%，抑郁合并焦虑发生率为30.6%。②社会因素分析：抑郁组与非抑郁组在失业[14例（26.4%）和8例（11.9%），χ^2=4.14]，受教育水平[41例（83.7%）和37例（58.7%），χ^2=8.11]差异有统计学意义（P〈0.05）；焦虑组与非焦虑组在性别、失业、受教育水平因素中差异有统计学意义。③临床因素分析在关节疼痛数、关节肿胀数、健康评估问卷（HAQ）、视觉模拟疼痛评分（VAS）、DAS28、CRP水平均抑郁组高于非抑郁组[6（2，21）和1（0，14）；4（1，11）和2（0，8）；24.0（2.5，36.25）和2.5（0，19.5）；5（3，9）和4（0，7）；89.8%和9.7%；37.63（13.25，70.75）和11.29（2.05，36.78）]（P〈0.05）和焦虑组显著高于非焦虑组[6（3，25）和2（0，14）；6（1.5，12）和2（0，7.25）；25（5，36）和3（0，25）；8（5，10）和5（1.75，7）；91.4%和64.5%；33.4（11.0，63.0）和16.8（2.5，54.3）]（P〈0.05）。④细胞因子：抑郁组IL-6水平显著高于非抑郁组（P〈0.05），Janus的非受体酪氨酸激酶（JAK）-2，JAK-3，信号传导与转录激活因子（STAT）-3，MMP-3，MMP-13水平中抑郁组与非抑郁组差异无统计学意义。焦虑组与非焦虑组在IL-6，JAK-2，JAK-3，STAT-3，MMP-3，MMP-13水平中差异均无统计学意义。⑤相关性分析：抑郁严重程度与文化程度呈负相关（r=-0.288，P〈0.05），与关节疼痛数、关节肿胀数、VAS、HAQ、DAS28、关节功能分级、ESR、CRP、IL-6呈正相关（r=0.348，0.268，0.481，0.318，0.381，0.417，0.397，0.311，0.249，P〈0.05）；焦虑严重程度与文化程度呈负相关（r=-0.244，P〈0.05），与关节疼痛数、关节肿胀数、VAS、HAQ、DAS28、关节功能分级、ESR、CRP呈正相关（r=0.282，0.261，0.381，0.284，0.284，0.299，0.263，0.178，P均〈0.05）。⑥ Logistic多因素回归分析显示IL-6是RA合并抑郁的独立危险因素。结论抑郁、焦虑障碍在RA患者中高达44.6%和32.2%，且与RA疾病活动、关节疼痛肿胀、HAQ等相关；IL-6是RA并发抑郁障碍的高危因素。
ObjectiveTo survey the function and relation of cytokine interleukin-6 （IL-6） between depression, anxiety and rheumatoid arthritis （RA）.MethodsOne hundred and twenty-one patients with RA were investigated. All of them were assessed by Hamihon Depression Rating Scale and Hamihon Anxiety Rating Scale.Results① The rate of depression in RA patients was 44.6%, and the rate of anxiety was 32.2%,the rate of depression combined anxiety in RA patients was 30.6%. ② Social factors： Unemployment [14 cases （26.4%） vs8 cases （11.9%）, χ^2=4.14] and education [41 cases （83.7%） vs 37 cases （58.7%）, χ^2=8.11] was significantly different between depression and non-depression patients（P〈0.05） . Age, unemployment and education was significantly different between anxiety patients and non-anxiety patients（P〈0.05） . ③ Clinical factors： tender joint count, swollen joint count, disease activity score （DAS）28, health assessment questionnaire （HAQ）, VAS, function of joint and C-reactive protein （CRP） was significantly different between depression patients and non- depression patients [6（2, 21） vs 1（0, 14）; 4（1, 11） vs 2（0, 8）; 24.0（2.5, 36.25） vs 2.5（0, 19.5）; 5（3,9） vs 4（0,7）; 89.8% vs 9.7%; 37.63（13.25, 70.75） vs 11.29（2.05, 36.78）] （P〈0.05）. And anxiety patients and non-anxiety patients had the same results [6（3, 25） vs 2（0, 14）; 6（1.5, 12） vs 2（0, 7.25）; 25（5, 36） vs 3（0, 25）; 8（5, 10） vs 5（1.75, 7）; 91.4% vs 64.5%; 33.4（11.0, 63.0） vs 16.8（2.5, 54.3）]（P〈0.05）. ④ Cytokine： IL-6 was significantly different between depression patients and non-depression patients （P〈0.05） . JAK-2, JAK-3, Signal transducer and activator of transcription （STAT）-3, matrix Metalloproteinases （MMP）-3, MMP-13 were not different between depression patients and non-depression patients（P〉0.05） . IL-6, JAK-2, JAK-3, STAT-3, MMP-3, MMP-13 were not different between anxiety patients and non-anxiety patients （P〉0.05）. ⑤ Correlation analysis： Education level was negatively related with the severity of depression （r=0.288, P〈0.05）. Tender joint count, swollen joint count, DAS28, HAQ, VAS, function of joint, erythrocyte sedimentation rate （ESR）, CRP, IL-6 was positively related with the severity of depression（r=0.348, 0.268, 0.481, 0.318, 0.381, 0.417, 0.397, 0.311, 0.249; P〈0.05）. Education level was negatively related with the severity of anxiety. Tender joint count, swollen joint count（r=-0.244, P〈0.05）, DAS28, HAQ, VAS, function of joint, ESR, CRP was positively related with the severity of depression （r=0.282, 0.261, 0.381, 0.284, 0.284, 0.299, 0.263, 0.178; all P〈0.05）. ⑥ Risk factors： IL-6 was the only risk factor in RA patients with depression.ConclusionThe rate of depression and anxiety in RA is 44.6%. Depression and anxiety is related with disease activity, pain and HAQ. IL-6 is a high risk factor that makes patients prone to develop depression in RA patients.
出处
《中华风湿病学杂志》
CSCD
北大核心
2017年第5期342-347,共6页
Chinese Journal of Rheumatology
基金
国家自然科学基金（81302587）
