Chan P T, Mok C C, Chan K L, Ho L Y
Division of Rheumatology, Department of Medicine, Tuen Mun Hospital, Tsing Chung Koon Road, New Territories, Hong Kong, SAR, China.
Clin Rheumatol. 2014 May;33(5):659-66. doi: 10.1007/s10067-014-2525-2. Epub 2014 Feb 16.
The objective of the study was to study the functioning and health-related quality of life (HRQoL) in patients with systemic sclerosis (SSc) and its associated factors. Consecutive SSc patients and an equal number of age- and gender-matched healthy controls were recruited for the assessment of functioning and HRQoL by the Health assessment questionnaire disability index (HAQ-DI) and Medical Outcomes Study Short Form 36 (SF-36), respectively. The extent of skin involvement of SSc was assessed by the modified Rodnan skin score (mRSS), and disease severity was assessed by the Medsger severity index. Factors associated with functioning and HRQoL in SSc patients were studied by linear regression. Seventy-eight Chinese SSc patients were studied (87 % women; age 50.2 ± 12.1 years; disease duration 7.8 ± 6.5 years; 81 % limited cutaneous subtype). The median mRSS of the patients was 8 (IQR 0-10). Patients with SSc had significantly higher HAQ-DI (0.69 ± 0.69 vs 0.04 ± 0.18; p < 0.001) but lower SF36 scores (p < 0.05 in all domains) than matched controls. Linear regression revealed that the mRSS was inversely associated with the physical component (beta = -0.39; p = 0.001) and mental component scores (beta = -0.27; p = 0.031) of the SF36 but positively correlated with the HAQ-DI score (beta = 0.51; p < 0.001) adjusted for age, sex, and disease duration. The SF36 and HAQ-DI scores also correlated significantly with the Medsger SSc severity index in the general, peripheral vascular, skin, tendon/joint, and heart domains. SSc patients had impaired physical and social functioning and poorer HRQoL than healthy individuals. The extent of skin involvement, tendon/joint contracture, damage in the heart, and peripheral vascular system were associated with poorer functioning and HRQoL.
本研究的目的是探讨系统性硬化症（SSc）患者的功能状况及与健康相关的生活质量（HRQoL）及其相关因素。连续纳入SSc患者以及数量相等、年龄和性别匹配的健康对照，分别采用健康评估问卷残疾指数（HAQ-DI）和医学结局研究简明健康调查问卷36项版本（SF-36）评估功能状况和HRQoL。采用改良Rodnan皮肤评分（mRSS）评估SSc的皮肤受累程度，采用Medsger疾病严重程度指数评估疾病严重程度。通过线性回归研究与SSc患者功能状况和HRQoL相关的因素。共研究了78例中国SSc患者（87%为女性；年龄50.2±12.1岁；病程7.8±6.5年；81%为局限性皮肤亚型）。患者的mRSS中位数为8（四分位间距0-10）。与匹配的对照相比，SSc患者的HAQ-DI显著更高（0.69±0.69对0.04±0.18；p<0.001），但SF-36评分更低（所有领域p<0.05）。线性回归显示，校正年龄、性别和病程后，mRSS与SF-36躯体健康评分（β=-0.39；p=0.001）和精神健康评分（β=-0.27；p=0.031）呈负相关，但与HAQ-DI评分呈正相关（β=0.51；p<0.001）。SF-36和HAQ-DI评分在总体、外周血管、皮肤、肌腱/关节和心脏领域也与Medsger SSc严重程度指数显著相关。与健康个体相比，SSc患者的躯体和社会功能受损，HRQoL较差。皮肤受累程度、肌腱/关节挛缩、心脏和外周血管系统损伤与功能状况较差和HRQoL较差相关。
