心力衰竭患者照顾者生活质量影响因素的路径分析

目的探讨压力源对心力衰竭患者照顾者生活质量的负面影响,以及社会心理资源的保护作用。方法采用中文版Zarit护理负担量表、社会支持评定量表、一般自我效能感量表、36条目简明量表对200名心力衰竭患者的家庭照顾者进行调查,根据压力过程理论和相关性分析结果提出假设,使用AMOS软件进行结构方程模型分析。结果照顾负担是照顾者生活质量的最强预测因子(路径系数为-0.58),社会支持和自我效能在压力源和照顾者健康之间起中介作用。结论采取干预措施降低照顾者的照顾负担、提高照顾者的社会支持水平和增强自我效能感,可提高照顾者的生活质量。     

类风湿关节炎患者并发吞咽障碍影响因素的研究进展

综述类风湿关节炎患者发生吞咽障碍的现状,类风湿关节炎患者发生吞咽障碍的影响因素包括疾病因素、合并干燥综合征、喉部受累、药物因素、心理因素等方面,研究者应综合考虑患者个体情况,制定针对性的干预措施,以减少类风湿关节炎患者发生吞咽障碍。     

老年类风湿关节炎患者吞咽障碍发生现状及影响因素分析

目的：调查老年类风湿关节炎患者发生吞咽障碍的现状及其影响因素。方法：选取2021年11月至2022年12月在贵州中医药大学第二附属医院风湿免疫科住院的400例老年类风湿关节炎患者作为调查对象,采用一般资料调查表、洼田饮水试验、健康评估问卷-残疾指数、微型营养评价精简表、老年抑郁量表,及疲劳严重度量表进行调查。结果：回收有效问卷387份。老年类风湿关节炎患者吞咽障碍发生率为23.00%,Logistic回归分析显示,年龄、躯体功能障碍、合并干燥综合征、营养状况、疾病活动度、晨僵时间是老年类风湿关节炎患者发生吞咽障碍的影响因素（P <0.05）。结论：老年类风湿关节炎患者吞咽障碍发生率较高,高龄、存在躯体功能障碍、合并干燥综合征、营养不良、疾病活动度、晨僵与老年RA患者吞咽障碍有相关性。临床医护人员应及时识别老年类风湿关节炎患者发生吞咽障碍的高危人群,并制订相应护理措施,降低吞咽障碍的发生率。     

基于结构方程模型的冠心病患者生活质量影响因素分析

目的探讨冠心病患者健康素养、自我效能、自我管理、社会支持对生活质量的影响,为其健康管理提供参考。方法采用便利抽样法,对280例冠心病住院患者采用一般情况调查表、冠心病健康素养调查问卷、冠心病自我管理量表、慢性病自我效能量表、社会支持评定量表、欧洲五维度量表进行调查,采用结构方程模型分析各影响因素之间的关系。结果影响冠心病患者生活质量的因素依次为自我管理、健康素养、自我效能、社会支持、文化程度、年龄、个人月收入、合并症种数。自我管理和社会支持对生活质量的直接效应系数分别为0.644和0.355。健康素养通过自我效能、自我管理、社会支持对生活质量产生间接影响,总效应系数为0.479;自我效能通过自我管理间接作用生活质量,总效应系数为0.414;文化程度、年龄、个人月收入、合并症种数对生活质量的总效应系数分别为0.167、-0.126、0.091、-0.058。结论冠心病患者的生活质量影响因素多而复杂,应加强针对性干预,以提高患者健康素养水平,增强自我效能感,从而提高自我管理能力,改善生活质量。     

慢性便秘患者生活质量及影响因素研究

目的研究慢性便秘患者生活质量的现状并分析其相关因素,以探讨提高患者生活质量的有效途径。方法采用患者便秘状况评估量表（PAC-QOL）、便秘症状积分量表、Zung焦虑自评量表、抑郁自评量表、社会支持量表对109例慢性便秘患者进行调查。结果慢性便秘患者PAC-QOL总均分1.78&#177;0.65,4个维度得分为1.09～3.14。症状积分、焦虑及抑郁状况、社会支持状况是影响慢性便秘患者生活质量的主要因素（P〈0.05,P〈0.01）。结论慢性便秘患者生活质量不高,便秘症状严重程度、心理状态及社会支持程度是主要影响因素。护理人员应针对生活质量的相关因素给予积极干预,从而提高其生活质量。     

慢性便秘患者生活质量及影响因素研究

目的研究慢性便秘患者生活质量的现状并分析其相关因素,以探讨提高患者生活质量的有效途径。方法采用患者便秘状况评估量表(PAC-QOL)、便秘症状积分量表、Zung焦虑自评量表、抑郁自评量表、社会支持量表对109例慢性便秘患者进行调查。结果慢性便秘患者PAC-QOL总均分1.78±0.65,4个维度得分为1.09～3.14。症状积分、焦虑及抑郁状况、社会支持状况是影响慢性便秘患者生活质量的主要因素(P0.05,P0.01)。结论慢性便秘患者生活质量不高,便秘症状严重程度、心理状态及社会支持程度是主要影响因素。护理人员应针对生活质量的相关因素给予积极干预,从而提高其生活质量。     

老年类风湿关节炎患者发生骨质疏松的危险因素分析

目的调查老年类风湿关节炎(RA)患者骨质疏松(OP)的发生情况并分析其危险因素,为有效预防和干预提供依据。方法选取2012年1月至2017年9月我院收治的老年RA患者684例,根据其发生OP的情况分为OP组(383例)和非OP组(301例),记录患者一般资料及OP的相关因素。应用二分类非条件Logistic回归分析老年RA患者发生OP的危险因素。结果在684例老年RA患者中383例发生OP,发生率高达56.0%。随着年龄的增长,男、女性骨质疏松症患病率均明显增加,差异有统计学意义(P0.05)。OP组的腰椎(-2.98±0.94 vs-0.85±0.62)、股骨颈(-2.53±0.76 vs-0.82±0.57)、全髋(-1.95±0.81 vs-0.29±0.24)骨密度T值均明显低于非OP组(P0.05)。二分类非条件Logistic回归分析显示,年龄[OR=1.805(95%CI:1.613~2.274)]、病程[OR=1.603(95%CI:1.431~1.968)]、ESR[OR=1.583(95%CI:1.286~1.815)]、DAS28评分[OR=1.729(95%CI:1.504~2.063)]是老年RA患者发生OP的独立危险因素,而BMI[OR=0.752(95%CI:0.674~0.926)]、摄入钙[OR=0.584(95%CI:0.318~0.720)]、ALB[OR=0.803(95%CI:0.725~0.993)]、25(OH)D[OR=0.713(95%CI:0.620~0.857)]可能是OP保护因素。结论老年RA患者OP的发生率较高,影响其发生的危险因素较多,应做到早预防、早发现,以减少或延缓OP的发生。     

Anxiety and depression are common in rheumatoid arthritis and correlate with poor quality of life in Indian patients

ObjectivesWe planned this study to assess the prevalence of anxiety and depression in rheumatoid arthritis (RA) patients and its correlation with quality of life (QOL) in these patients.Material and methodsEighty-eight patients (76 females) were included in this cross-sectional study. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. Quality of life was measured using the World Health Organization WHOQOL-BREF. The severity of pain was measured by 100-millimetre-long Visual Analogue Scale (VAS), and functional disability was measured by using the Indian version of the Health Assessment Questionnaire (HAQ). The disease activity was measured by Disease Activity Score for 28 joints with 3 variables.ResultsProbable anxiety and depression were seen in 61 (69%) and 68 (77%) of the patients, respectively. Patients with anxiety had more severe pain (VAS 53.8 ±26.4 vs. 39.7 ±26.1, p < 0.05), and significantly lower scores in all the 4 domains of the WHOQOL-BREF. Patients with depression had more pain (VAS 54.2 ±25.2 vs. 33.5 ±27.3, p < 0.01), higher HAQ scores (1.0 ±0.7 vs. 0.5 ±0.7, p < 0.01), and lower QOL scores. Both anxiety and depression scores had a negative correlation with all the 4 domains of the WHOQOL-BREF. Anxiety had a significant negative effect on psychological (β = –0.58, p < 0.001) and environmental domains (β = –0.39, p < 0.001), while depression had a significant negative effect on psychological (β = –0.57, p < 0.001) and environmental domains (β = –0.53, p < 0.001). Both anxiety and depression predicted more pain in RA patients (β = 0.24, p < 0.001 and β = 0.44, p < 0.001, respectively).ConclusionsAnxiety and depression correlated with poor QOL in all 4 domains of the WHOQOL-BREF. Higher HADS scores had a negative effect on all the domains of the WHOQOL-BREF and predicted more severe pain in RA patients. Thus, patients with RA need to be screened and treated for underlying anxiety and depression to improve their QOL, pain, and functional status.     

Predictive clinical factors in rheumatoid arthritis using disease activity and functional score

ObjectivesRheumatoid arthritis (RA) is a chronic inflammatory arthritis that may lead to severe joint pain. There are several scores to evaluate the disease activity of RA. This study aimed to evaluate if clinical factors which representing activity scores and health assessment score.Material and methodsThis study was conducted prospectively by including adult patients with RA. Clinical factors and 5 RA disease activity and health assessment scores were evaluated. Each activity score was executed for clinical predictors by using multivariate linear regression analysis.ResultsThere were 33 female adult patients in the study. The average (SD) age was 52.33 (11.11) years, while the duration of RA was 7.65 years. The DAS28 ESR had 1 predictor: RA duration with a coefficient of –0.04. For DAS28 CRP, CDAI, and SDAI scores, body mass index (BMI) and RA duration were independent factors for the scores with negative coefficient values. For the HAQ score, both age and rheumatoid duration were positively associated with the score. The coefficients of both factors were 0.02 and 0.03, respectively.ConclusionsAge, RA duration, and BMI were associated with RA activity and functional score. Body mass index is a potential modifiable factor that may be associated with RA activities.     

类风湿关节炎继发骨质疏松症相关影响因素的Logistic回归分析

目的探讨类风湿关节炎患者继发骨质疏松症(osteoporosis,OP)的情况及相关影响因素。方法选择80例类风湿关节炎(rheumatoid arthritis,RA)患者,采用双能X线骨密度仪测定前臂、腰椎L1～4、股骨颈、Ward’s区的骨密度(bone mineral density,BMD),根据BMD将患者分为骨量正常组35例、骨量减少组26例和骨质疏松组19例。采用放射免疫法测定骨代谢指标,包括骨钙素(osteocalcin,OC)、Ι型胶原交联蛋白羧基末端肽(sputum collagen cross-linking protein carboxy terminal peptide,SCTX)、骨特异性碱性磷酸酶(bone-specific alkaline phosphatase,BAP),并同时测定RA患者相关指标,包括C反应蛋白(Creactive protein,CRP)、类风湿因子(rheumatoid factor,RF)、血沉(erythrocyte sedimentation rate,ESR)。采用Logistic回归分析RA患者继发骨质疏松症的影响因素。结果女性、骨折史、老龄、使用糖皮质激素史、病程、RF为RA继发OP的危险因素,体重指数为RA继发OP的保护因素。结论性别、年龄、使用糖皮质激素史和既往骨折史为RA患者继发骨质疏松症的显著影响因素,且骨质疏松的严重程度与病程长短、疾病活动程度等有关。     

类风湿关节炎骨质疏松危险因素分析

目的类风湿关节炎(RA)是继发性骨质疏松的常见原因,本研究旨在通过分析比较RA患者血清类风湿因子(RF)、抗环瓜氨酸多肽抗体(anti-CCP)、C-反应蛋白(CRP)、血细胞沉降率(ESR)及骨代谢六项指标水平,探讨RA患者骨质疏松的危险因素。方法 133例RA患者根据双能X线检测的骨密度(BMD)结果分为骨质疏松组、骨量减低组和骨量正常组,检测各组受试者RF、anti-CCP、CRP、ESR及骨代谢六项等指标,分析比较各组受试者各指标水平差异,并比较各组患者糖皮质激素用药情况,多元logistic回归分析上述指标与RA患者骨质疏松的关系。结果①RA患者血清RF、anti-CCP、CRP及ESR水平相较于正常人群显著升高;②骨质疏松和骨量减低组CRP、ESR及骨碱性磷酸酶(BALP)、β胶原特殊序列(β-CTx)两项骨代谢指标水平较RA骨量正常组显著升高,且OP组糖皮质激素使用率明显高于骨量正常组,差异有统计学意义;③患者年龄、病程、疾病活动度及使用糖皮质激素是RA患者发生骨质疏松的独立危险因素OR(95%CI)分别为1.116(1.013-1.230)、1.775(1.191-2.645)、4.356(1.741-10.898)和9.448(1.040-85.802)。结论 RA患者血清自身抗体、炎症指标及骨代谢指标水平存在不同程度异常,患者年龄、病程、疾病活动度及糖皮质激素使用情况可作为判断RA患者骨质疏松风险的参考指标,有助于指导临床对RA患者疾病发展和病程进行监测,并进行及时的合理治疗。     

The relationship between kinesiophobia and health-related quality of life in patients with rheumatoid arthritis: A controlled cross-sectional study

ObjectivesTo evaluate the kinesiophobia and kinesiophobia-related factors in patients with rheumatoid arthritis (RA) and provide a better perspective on the relationship between kinesiophobia and patients’ health-related quality of life (HRQoL).MethodsA total of 88 patients (67 females, 21 males) with RA and 93 healthy volunteers (67 females, 26 males) were included in the study between March 2020 and July 2020. Kinesiophobia was evaluated using the Tampa Scale of Kinesiophobia (TSK) and HRQoL was evaluated using the 36-item Short-Form Health Survey (SF-36). The Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), Health Assessment Questionnaire Disability Index (HAQ-DI), International Physical Activity Questionnaire (IPAQ) (Short Form) were completed by all participants.ResultsThe median age was 52.0 (IQR, 45.0-58.0) years in the RA group and 50.0 (IQR, 41.5-56.0) years in the control group. Age and sex were not significantly different between the groups. The median TSK score was 45.0 (IQR, 39.0-49.75) in the RA group, 39.0 (IQR, 37.0-43.0) in the control group (P < 0.001). The median FSS, BDI, and HAQ-DI scores were higher and the median HRQoL domains were lower in the RA group than in the control group (P < 0.05). Multivariate linear regression analysis including age, sex, education level, body mass index (BMI), morning stiffness duration, Disease Activity Score in 28 joints, FSS, BDI, visual analog scale and IPAQ scores variables showed that FSS scores (B = 1.07, P < 0.05), BDI scores (B = 0.24, P < 0.05), and BMI (B = 0.22, P < 0.05) were independent variables for kinesiophobia in patients with RA (R² = 0.32). TSK was a predictive variable for HAQ-DI (B = 0.03, P < 0.001), the physical functioning domain of the HRQoL (B = -1.18, P < 0.001), the bodily pain domain of the HRQoL (B = -0.78, P < 0.05), respectively.ConclusionPhysicians should have awareness of kinesiophobia in patients with RA. Educating patients about kinesiophobia, developing strategies for avoiding kinesiophobia, and specific treatment strategies with a multidisciplinary approach may improve HRQoL and disability.     

等待肺移植患者生存质量及其影响因素研究

目的了解等待肺移植患者的生存质量及其影响因素。方法采用简明健康问卷(SF-36)、焦虑自评量表(SAS)、抑郁自评量表(SDS)和领悟社会支持量表(PSSS)对55例等待肺移植患者进行调查。结果等待肺移植患者SF-36各维度得分23.18~74.57,显著低于常模(均P<0.01);SAS、SDS得分分别为48.09±9.06、52.18±9.98,显著高于常模(均P<0.01);PSSS社会总支持因子得分为5.56±1.04,其中家庭内支持因子得分显著高于家庭外支持因子(P<0.05)。多因素分析结果显示生存质量的影响因素为呼吸困难和抑郁(P<0.05,P<0.01)。结论等待肺移植患者的生存质量较低,其生存质量受呼吸困难和抑郁的影响。医务人员应从患者生理及心理方面进行有效干预,以提高其生存质量。     

宫颈癌放化疗患者生活质量及其影响因素的研究

目的了解宫颈癌患者的生活质量水平,并分析其影响因素。方法采用社会支持评定量表(SSRS),Zung抑郁自评量表(SDS)和癌症患者生活质量量表(QLQ-C30)对148例宫颈癌放化疗患者进行调查。结果患者生活质量得分(64.3±18.2)分;年龄、社会支持、家庭月收入、文化程度和抑郁是宫颈癌患者生活质量的影响因素(P0.05,P0.01)。结论护理人员应了解宫颈癌患者的生活质量水平及其影响因素,并提供有针对性的护理措施,以提高其生活质量。     

残障接受度和应对方式对视力残障青光眼患者视觉相关生活质量的影响

目的了解和评估视力残障青光眼患者的视觉相关生活质量的现状并分析其影响因素。方法采用便利抽样法抽取舟山市某三甲医院的183例青光眼患者,采用一般情况调查表、残障接受度量表(ADS)、医学应对问卷(MCMQ)和视觉相关生活质量量表(NEI-VFQ-25)进行调查,使用单因素分析、Pearson相关和分层多元回归分析视力残障青光眼患者的视觉生活质量的影响因素。结果视力残障青光眼患者的视觉生活质量总分为(69.71±13.85)分,回归分析显示,控制人口学变量之后,残障接受度中的服从维度、转变维度和应对方式中的屈服维度、面对维度共可以解释其视觉生活质量总变异的38.4%。结论视力残障的青光眼患者的视觉相关生活质量处于中等水平,残障接受度和应对方式是青光眼患者视觉生活质量的重要影响因素,医疗工作者应提高对视力残障青光眼患者视觉生活质量的重视力度,制定针对性的干预措施,切实提高其视觉生活质量。