系统性红斑狼疮女性患者精神障碍现况分析

袁飞飞; 王红; 戴子薇; 王智慧; 董媛媛; 顾明明; 李向培; 叶冬青; 王斌

doi:10.16462/j.cnki.zhjbkz.2019.03.016

系统性红斑狼疮女性患者精神障碍现况分析

doi: 10.16462/j.cnki.zhjbkz.2019.03.016

袁飞飞^{1, 2},
王红^{1, 2},
戴子薇^{1, 2},
王智慧^{1, 2},
董媛媛^{1, 2},
顾明明^{1, 2},
李向培³,
叶冬青^{1, 2},
王斌^{1, 2, ,}

1.
230032 合肥, 安徽医科大学公共卫生学院流行病与卫生统计学系
2.
230032 合肥, 安徽省重大自身免疫性疾病重点实验室
3.
230001 合肥, 中国科学技术大学附属第一医院风湿免疫科

基金项目:

国家自然科学基金资助 81573217

安徽医科大学博士科研资助项目 XJ201301

详细信息

通讯作者:
王斌, E-mail: wbrst@sina.com

中图分类号: R181.1
计量
- 文章访问数: 232
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- PDF下载量: 17
- 被引次数: 0
出版历程
- 收稿日期: 2018-07-26
- 修回日期: 2018-11-09
- 刊出日期: 2019-03-10

Situation analysis of mental disorders in females with systemic lupus erythematosus

YUAN Fei-fei^{1, 2},
WANG Hong^{1, 2},
DAI Zi-wei^{1, 2},
WANG Zhi-hui^{1, 2},
DONG Yuan-yuan^{1, 2},
GU Ming-ming^{1, 2},
Li Xiang-pei³,
Ye Dong-qing^{1, 2},
Wang Bin^{1, 2
, ,}

1.
Department of Epidemiology and Biostatiatics, School of Public Health, Anhui Medical University, Hefei 230032, China
2.
The Key Laboratory of Major Autoimmune Diseases, Hefei 230032, China
3.
Department of Rheumatology, First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China

摘要

摘要: 目的了解系统性红斑狼疮（systemic lupus erythematosus，SLE）女性患者精神障碍现状，探究其影响因素。方法以症状自评量表（symptom check list-90，SCL-90）作为判断精神障碍的依据，疾病活动度、社会支持、贬低-歧视是可能的影响因素，采用量表进行了调查，应用多因素非条件Logistic回归模型对精神障碍的影响因素进行分析。结果女性SLE患者SCL-90总分为（136.39±48.66）分，高于常模（129.96±38.76）分（t=2.247，P=0.025），289例SLE患者经过SCL-90检出有精神障碍的人数为128例（44.3%）。高月收入（OR=0.770，95%CI：0.604~0.981，P=0.034）是精神障碍的保护因素；高疾病活动度（OR=1.792，95%CI：1.023~3.138，P=0.042）、高贬低-歧视（OR=1.100，95%CI：1.035~1.169，P=0.002）是精神障碍的危险因素。结论女性SLE患者比一般人群具有更高精神障碍的风险，消除自我贬低、减少社会歧视、积极的就业、提高月收入、进行规范治疗、降低疾病活动度可能有效减轻SLE患者的精神障碍。
- 女性 /
- 系统性红斑狼疮 /
- 精神障碍 /
- 现况分析
Abstract: Objective To study the influences of mental disorders on female systemic lupus erythematosus(SLE)and analyze the factors. Methods We used symptom check list -90 (SCL-90) as a basis for judging mental disorders disease activity. Disease activity, social support and depreciation - discrimination were used as possible influencing factors. Social support and discomfort - discrimination were possible influencing factors. Multivariate unconditional logistic regression model was used to analyze the influencing factors of mental disorders. Results The total score of SCL-90 of patients with female SLE was significantly higher than that of norm models[(136.39±48.66) vs (129.96±38.76)] (P<0.05), in 289 SLE patients, the number of patients with mental disorders was 128 (44.3%). High monthly income(OR=0.770, 95% CI: 0.604-0.981, P=0.034) was a protective factor for mental disorders. High disease activity (OR=1.792, 95% CI: 1.023-3.138, P=0.042)and high discomfort-discrimination (OR=1.100, 95% CI: 1.035-1.169, P=0.002)were risk factors for mental disorders. Conclusions Female SLE patients have a higher risk of mental disorders than the general population. And eliminating self-depreciation, reducing social discrimination, active employment, increasing monthly income, standardizing treatment and reducing disease activity may effectively alleviate mental disorders in SLE patients.
- Female /
- Systemic lupus erythematosus /
- Mental disorders /
- Situation analysis

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表 1 女性SLE患者SCL-90评定与中国常模的比较(x±s)

Table 1. Comparison of SCL-90 assessment in female SLE patients with Chinese norm models (x±s)

SCL-90	女性SLE患者(n=289)	中国常模(n=1388)	t值	P值
总分	136.39±48.66	129.96±38.76	2.247	0.025
阳性项目数	29.21±22.86	24.92±18.41	3.187	0.002
躯体化	1.53±0.58	1.37±0.48	4.688	<0.001
强迫	1.68±0.64	1.62±0.58	1.534	0.058
人际关系	1.48±0.64	1.65±0.51	-4.901	<0.001
抑郁	1.58±0.63	1.50±0.59	2.028	0.043
焦虑	1.53±0.63	1.39±0.43	3.874	<0.001
敌对	1.56±0.66	1.48±0.56	2.159	0.032
恐怖	1.38±0.55	1.23±0.41	4.641	<0.001
偏执	1.38±0.55	1.43±0.57	-1.536	0.126
精神病性	1.36±0.51	1.29±0.42	2.331	0.020

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表 2 女性SLE患者精神障碍组和精神健康组社会支持和贬低-歧视得分比较(x±s)

Table 2. Comparison of social support scores discomfort-discrimination scores between mental disorders group and mental health group in female SLE patients(x±s)

社会支持	精神障碍组	精神健康组	t值	P值
社会支持总分	37.06±6.29	38.06±6.72	0.901	0.369
客观支持得分	7.91±2.55	8.02±2.51	0.370	0.712
主观支持得分	23.13±5.14	24.28±5.08	1.595	0.059
对支持的利用度	5.75±1.82	6.31±1.76	-2.638	0.009
贬低-歧视总分	27.59±5.95	24.63±5.58	-4.363	<0.001
贬低总分	11.09±3.00	9.59±2.48	-4.640	<0.001
歧视总分	16.51±3.60	15.04±3.51	-3.499	0.001

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表 3 人口学特征和疾病相关情况与精神障碍的关系[n(%)]

Table 3. The relationship between demographic characteristics and disease-related conditions and mental disorders [n(%)]

变量	精神健康组	精神障碍组	χ²/Z值	P值
年龄(岁)			1.108	0.292
<35	93(58.4)	66(41.6)
≥35	68(52.3)	62(47.7)
家庭所在地			0.073	0.787
农村	88(55.0)	72(45.0)
城镇	73(56.6)	56(43.4)
文化程度			1.786	0.410
小学及以下	25(54.3)	21(45.7)
初中或高中	75(52.4)	68(47.6)
大专及以上	61(61.0)	39(39.0)
婚姻状况			2.409	0.300
未婚	38(52.8)	34(47.2)
已婚	120(57.6)	88(42.4)
离异或丧偶	3(33.3)	6(66.7)
职业			5.755	0.331
农民	32(55.2)	26(44.8)
工人	13(54.2)	11(45.8)
学生	15(53.6)	13(46.4)
白领	23(67.6)	11(32.4)
自由职业	47(61.0)	30(39.0)
其他	31(45.6)	37(64.4)
月收入(元)			-2.340	0.019^a
<2000	74(49.3)	76(50.7)
2000~	36(62.1)	22(37.9)
3500~	28(57.1)	21(42.9)
≥5000	23(71.8)	9(28.2)
病程(年)			3.549	0.060
<4	65(63.1)	38(36.9)
≥4	96(51.6)	90(48.4)
激素用量(mg/d)			-1.140	0.254^a
≤5	52(32.3)	31(24.2)
7.5~	20(12.4)	20(15.6)
>10	89(55.3)	77(60.2)
血沉			2.452	0.117
阴性	96(60.0)	64(40.0)
阳性	66(51.2)	63(48.8)
免疫球蛋白			4.346	0.037
阴性	102(60.7)	66(39.3)
阳性	58(48.3)	62(51.7)
补体			0.181	0.671
阴性	77(57.0)	58(43.0)
阳性	84(54.5)	70(45.5)
活动度评分			6.830	0.009
稳定期	58(67.4)	28(32.6)
活动期	103(50.7)	100(49.3)
药效满意度			-2.227	0.026^a
不满意	4(40.0)	6(60.0)
一般	66(50.0)	66(50.0)
满意	91(61.9)	56(38.1)
医疗满意度			-2.218	0.027^a
不满意	1(50.0)	1(50.0)
一般	32(44.4)	40(65.6)
满意	128(59.5)	87(40.5)
注：^aMann-Whitney U检验。

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表 4 女性SLE患者精神障碍的多因素Logistic回归分析

Table 4. Multivariate Logistic regression analysis of mental disorders in female SLE patients

变量	β	sx	Wald值	P值	OR(95% CI)值
月收入	-0.262	0.124	4.482	0.034	0.770(0.604~0.981)
免疫球蛋白	0.363	0.260	1.954	0.162	1.437(0.864~2.390)
药物疗效满意度	-0.211	0.257	0.676	0.411	0.809(0.489~1.340)
医疗服务满意度	-0.263	0.316	0.693	0.405	0.769(0.414~1.428)
疾病活动度	0.583	0.286	4.155	0.042	1.792(1.023~3.138)
支持的利用度	-0.047	0.096	0.239	0.625	0.954(0.790~1.152)^a
贬低-歧视总分	0.096	0.031	9.504	0.002	1.100(1.035~1.169)^a
注：^a支持的利用度和贬低-歧视总分以连续型变量的形式纳入模型。

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