基于聚类分析对常见风湿病患者心境状态影响因素的探索  

Study and analysis on the mood state of patients with common rheumatism:a cluster analysis

作　　者：李鑫雅 赵雅琪 徐伟[2] 张瑾 张瑛 麻贞贞 杨清锐 Li Xinya;Zhao Yaqi;Xu Wei;Zhang Jin;Zhang Ying;Ma Zhenzhen;Yang Qingrui(Department of Rheumatology and Immunology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Ji′nan 250021,China;Department of Rheumatology and Immunology,Shandong Provincial Hospital Affiliated to Shandong University,Ji′nan 250021,China)

机构地区：[1]山东第一医科大学附属省立医院风湿免疫科,济南250021 [2]山东大学附属省立医院风湿免疫科,济南250021

出　　处：《中华风湿病学杂志》2025年第2期110-117,共8页Chinese Journal of Rheumatology

基　　金：国家自然科学基金青年基金(82201994);山东省自然科学基金(ZR2022MH016,ZR2021QH043)。

摘　　要：目的分析常见风湿病[类风湿关节炎(RA)、系统性红斑狼疮(SLE)、强直性脊柱炎(AS)]患者心境状态的影响因素,找到消极情绪患者的共性特征,以期在临床实践中早期识别及干预治疗具有焦虑抑郁倾向的风湿病患者。方法纳入2023年4-5月就诊于山东第一医科大学附属省立医院的风湿病患者205例(RA 83例、SLE 74例、AS 48例)。收集患者的一般情况及情绪纷乱总分(TMD)。将研究对象分为TMD低、中、高3组(TMD≤90分;90分<TMD≤105分;TMD>105分)。分类变量采取χ^(2)检验,连续变量经过正态分布检验,如服从正态分布,2组间比较采用独立样本t检验(方差齐)或Welch′s t检验(方差不齐),多组间比较采用单因素方差分析;如不服从正态分布,组间比较采用Kruskal-Wallis H检验。将TMD>90分的患者定义为情绪消极组,纳入性别、年龄、学历、经济收入状况、TMD进行两步聚类分析得到3个聚类小组并分析组间差异,采用logistic回归分析危险因素。结果研究发现,低血清白蛋白水平(F=6.26,P=0.003)、低受教育水平(χ^(2)=8.36,P=0.015)、低经济水平(χ^(2)=15.59,P<0.001)、短病程(H=28.01,P<0.001)、高疾病活动度(χ^(2)=56.93,P<0.001)的风湿病患者有更高的TMD得分,且与疾病类型无关(χ^(2)=9.04,P=0.090)。与情绪积极组比较,情绪消极组具有"女性占比高(57.6%与73.4%,χ^(2)=5.16,P=0.023)、短病程[24(12,48)个月与48(24,93)个月,Z=13.58,P<0.001]、低血清白蛋白[(42.2±4.0)g/L与(44.0±3.4)g/L,t=-14.09,P=0.002]、低受教育水平(χ^(2)=10.29,P=0.029)、低收入水平(χ^(2)=10.29,P=0.036)、高疾病活动度(χ^(2)=61.91,P<0.001)"的特征。聚类分析结果提示,除病程外,3个聚类组中上述因素差异有统计学意义;值得注意的是,聚类2组年龄(F=19.25,P<0.001)和血清白蛋白(F=5.64,P=0.004)数值最小,TMD得分最高(F=18.13,P<0.001)。回归分析表明:性别、病程和疾病活动度为消极情绪发生的相关因素,其中高�ObjectiveTo analyze the influencing factors of mood state of common rheumatic(rheumatoid arthritis;systemic lupus erythematosus;ankylosing spondylitis)patients and find out the common characteristics of patients with negative emotions,so as to identify and treat rheumatic patients with anxiety and depression in clinical practice.MethodsA total of 205 patients with rheumatism(83 with rheumatoid arthritis,74 with systemic lupus erythematosus,48 with ankylosing spondylitis)admitted to the Shandong Provincial Hospital Affiliated to Shandong University from April to May 2023 were included.The general condition and POMS of patients were collected.All patients were divided into 3 groups of low-TMD/middle-TMD/high-TMD(TMD≤90 scores;90 scores<TMD≤105 scores;TMD>105 scores).Theχ^(2)test was used for categorical variables,and the continuous variables were tested for normal distribution.If they followed a normal distribution,the independent sample t test(for homogeneous variance)or the Welch′s t test(for unequal variance)was used for comparison between the two groups,and one-way analysis of variance was used for comparison between multiple groups;if they did not follow a normal distribution,the Kruskal-Wallis H test was used for comparison between groups.Patients with TMD>90 scores were defined as the negative emotion group.Gender,age,education level,economic income status,and TMD were included in the two-step cluster analysis(TCA)to obtain three cluster groups and analyze the differences between the groups.Logistic regression was used to analyze the risk factors.ResultsThe study found that patients with rheumatic diseases with low serum albumin levels(F=6.26,P=0.003),low education level(χ^(2)=8.36,P=0.015),low economic level(χ^(2)=15.59,P<0.001),short disease course(H=28.01,P<0.001),and high disease activity(χ^(2)=56.93,P<0.001)had higher TMD scores,which was not related to the type of disease(χ^(2)=4.81,P=0.090).The negative mood group had a higher proportion of females(57.6%vs.73.4%,χ^(2)=5.16,P=0.023),a short

关 键 词：风湿病 心境紊乱 焦虑 抑郁 聚类分析 

分 类 号：R593.2[医药卫生—内科学]