类风湿关节炎合并失眠的多中心横断面调查

doi:10.3969/j.issn.1004-583X.2024.10.003

临床荟萃 ›› 2024, Vol. 39 ›› Issue (10): 882-888.doi: 10.3969/j.issn.1004-583X.2024.10.003

类风湿关节炎合并失眠的多中心横断面调查

董泓^1a, 李振彬^1a(), 马旭^1b, 罗亚萍², 焦爱军³, 张旭飞⁴, 孙彩霞⁵

1.中国人民解放军白求恩国际和平医院 a.风湿免疫科;b.中医科,河北石家庄 050081
2.河北省中医院风湿免疫科,河北石家庄 050013
3.邢台医学院第二附属医院风湿免疫科,河北邢台 054002
4.石家庄市第三医院风湿免疫科,河北石家庄 050011
5.河北大学附属医院风湿免疫科,河北保定 071000

收稿日期:2024-07-14 出版日期:2024-10-20 发布日期:2024-10-31
通讯作者: 李振彬 E-mail:lizhenbin1962@126.com
基金资助:
国家自然科学基金资助项目——雷公藤择时治疗胶原诱导关节炎及其生物钟机制研究(81873301)

Rheumatoid arthritis combined with insomnia: A multicenter cross-sectional survey

Dong Hong^1a, Li Zhenbin^1a(), Ma Xu^1b, Luo Yaping², Jiao Aijun³, Zhang Xufei⁴, Sun Caixia⁵

1a. Department of Rheumatology and Immunology;b. Department of Traditional Chinese Medicine, Joint Logistics Support Force No. 980 Hospital of the Chinese People’s Liberation Army, Shijiazhuang 050081, China
2. Department of Rheumatology and Immunology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang 050013, China
3. Department of Rheumatology and Immunology, the Second Affiliated Hospital of Xingtai Medical College, Xingtai 054002, China
4. Department of Rheumatology and Immunology, the Third Hospital of Shijiazhuang, Shijiazhuang 050011, China
5. Department of Rheumatology and Immunology, Affiliated Hospital of Hebei University, Baoding 071000, China

Received:2024-07-14 Online:2024-10-20 Published:2024-10-31
Contact: Li Zhenbin E-mail:lizhenbin1962@126.com

摘要/Abstract

摘要：

目的昼夜节律紊乱与自身免疫疾病具有相关性。本研究探讨类风湿关节炎(rheumatoid arthritis,RA)患者合并失眠这一昼夜节律紊乱的相关影响因素。方法采用多中心横断面临床调查方法,由风湿专科副主任医师及以上资质的专家经统一培训后进行问卷采集相关信息。调查问卷从睡眠严重程度指数和RA患者相关临床信息两个维度设计。在河北省的13家研究中心,按纳排标准筛选门诊或住院RA患者的相关信息,对患者失眠的相关因素进行比较和分析。结果共纳入RA患者181例。①一般资料:失眠者60例(33.1%),非失眠者121例,两者男女比均为1∶5;失眠者平均年龄大于非失眠者(P<0.01)。②共病:RA患者合并高血压、呼吸系统疾病、甲状腺疾病、骨质疏松或骨关节炎共病者,其失眠发生率高于无共病患者(P<0.05)。③临床用药:服用中(成)药/中药提取物的RA患者失眠发生率高于未用中药者(P=0.019)。④疾病状态:在疾病活动度和双手X线片的分级中,不同分级RA患者的失眠发生率差异有统计学意义(P<0.05)。⑤RA失眠与非失眠患者其生化和免疫学指标的差异无统计学意义(P>0.05)。结论 RA患者存在较高比例的失眠,这一昼夜节律障碍与年龄、存在相关共病、中高疾病活动度及影像学分级有关。

关键词: 关节炎,类风湿, 入睡和睡眠障碍, 昼夜节律紊乱, 横断面调查

Abstract:

Objective Circadian rhythm disorders links with autoimmune diseases. This study aims to explore the influencing factors for circadian rhythm disorders in patients with rheumatoid arthritis (RA) combined with insomni.Methods This was a multicenter cross-sectional clinical survey. Deputy chief physicians or above experienced in rheumatology were uniformly trained to collect relevant information through questionnaire surveys. The surveying questionnaire was designed from two dimensions of the insomnia severity index (ISI) and clinical information of RA patients. In 13 research centers in Hebei Province, RA outpatients or inpatients were screened according to inclusion and exclusion criteria. Relevant factors for insomnia in RA patients were compared and analyzed. Results A total of 181 RA patients were included in the analysis, including 60 (33.1%) with insomnia, and 121 without it. The male-to-female ratio was 1∶5. The average age of RA patients with insomnia was significantly older than those without insomnia (P<0.01). RA patients with comorbidities like hypertension, respiratory diseases, thyroid diseases, osteoporosis, or osteoarthritis had a significantly higher incidence of insomnia than those without comorbidities (P<0.05). RA patients taking traditional Chinese herbal medicine/ extracts of traditional Chinese medicine (TCM) had a significantly higher incidence of insomnia than those without TCM treatment (P=0.019). There was a significant difference in the incidence of insomnia among RA patients with varied disease activity scores and X-ray grading of hands (P<0.05). There were no significant differences in biochemical and immunological indicators between RA patients with or without insomnia (P>0.05). Conclusion A high proportion of RA patients suffer from insomnia, and the circadian rhythm disorder is associated with age, comorbidities, moderate-to-high disease activity, and radiographic grading.

Key words: arthritis, rheumatoid, sleep initiation and maintenance disorders, circadian rhythm disorder, cross-sectional survey

中图分类号:

R593.22

董泓, 李振彬, 马旭, 罗亚萍, 焦爱军, 张旭飞, 孙彩霞. 类风湿关节炎合并失眠的多中心横断面调查[J]. 临床荟萃, 2024, 39(10): 882-888.

Dong Hong, Li Zhenbin, Ma Xu, Luo Yaping, Jiao Aijun, Zhang Xufei, Sun Caixia. Rheumatoid arthritis combined with insomnia: A multicenter cross-sectional survey[J]. Clinical Focus, 2024, 39(10): 882-888.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.10.003

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I10/882

图/表 7

参考文献 26

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分级	DAS28 (CRP/ESR)	SDAI	CDAI
Ⅰ(缓解状态)	<2.6	≤3.3	≤2.8
Ⅱ(轻微)	≥2.6且≤3.2	>3.3且≤11	>2.8且≤10
Ⅲ(中度)	> 3.2且≤ 5.1	>11且≤22	>10且≤22
Ⅳ(重度)	> 5.1	> 22	>22

分级	DAS28 (CRP/ESR)	SDAI	CDAI
Ⅰ(缓解状态)	<2.6	≤3.3	≤2.8
Ⅱ(轻微)	≥2.6且≤3.2	>3.3且≤11	>2.8且≤10
Ⅲ(中度)	> 3.2且≤ 5.1	>11且≤22	>10且≤22
Ⅳ(重度)	> 5.1	> 22	>22

组别	例数	性别[例(%)]			年龄 (年)		身高 (cm)	体重 (kg)	BMI (kg/m²)	病程 (月)
组别	例数	男	女		年龄 (年)		身高 (cm)	体重 (kg)	BMI (kg/m²)	病程 (月)
失眠组	61	10(16.4)	51(83.6)	59.74±10.08		160.00(158.00, 166.50)		60.57±8.65	23.08±3.21	100(35.5, 210.5)
非失眠组	120	17(14.2)	103(85.8)	54.53±12.24		160.00(158.00, 165.00)		60.79±10.04	23.20±3.52	49(22.5, 143.25)
t/Z/χ²值		0.158		8.191		-0.261		0.020	0.052	-1.701
P值		0.691		0.005		0.789		0.887	0.820	0.088

组别	例数	性别[例(%)]			年龄 (年)		身高 (cm)	体重 (kg)	BMI (kg/m²)	病程 (月)
组别	例数	男	女		年龄 (年)		身高 (cm)	体重 (kg)	BMI (kg/m²)	病程 (月)
失眠组	61	10(16.4)	51(83.6)	59.74±10.08		160.00(158.00, 166.50)		60.57±8.65	23.08±3.21	100(35.5, 210.5)
非失眠组	120	17(14.2)	103(85.8)	54.53±12.24		160.00(158.00, 165.00)		60.79±10.04	23.20±3.52	49(22.5, 143.25)
t/Z/χ²值		0.158		8.191		-0.261		0.020	0.052	-1.701
P值		0.691		0.005		0.789		0.887	0.820	0.088

分类	例数		共病						高血压						糖尿病						高脂血症						脂肪肝
分类	例数		有			无			有			无			有			无			有			无			有		无
失眠	61		53(36.8)			8(21.6)			30(43.5)			31(27.7)			5(25.0)			56(34.8)			11(35.5)			50(33.2)			0(0.0)		61(34.7)
非失眠	120		91(63.2)			29(78.4)			39(56.5)			81(72.3)			15(75.0)			105(65.2)			20(64.5)			100(66.8)			5(100.0)		115(65.3)
χ²值			3.043						4.771						0.758						0.051						2.609
P值			0.056						0.023						0.270						0.485						0.123
分类		肝炎						肝功能异常						肾功能不全						冠心病						慢性胃炎
分类		有			无			有			无			有			无			有			无			有		无
失眠		2(66.7)			59(33.1)			6(42.9)			55(32.9)			5(62.5)			56(32.4)			8(50.0)			53(32.1)			9(45.0)		52(32.2)
非失眠		1(33.3)			119(66.9)			8(57.1)			112(67.1)			3(37.5)			117(67.6)			8(50.0)			112(67.9)			11(55.0)		109(67.7)
χ²值		1.480						0.570						3.107						2.090						1.290
P值		0.263						0.316						0.094						0.117						0.191
分类		呼吸系统病						贫血						白细胞减少						甲状腺疾病						肿瘤
分类		有			无			有			无			有			无			有			无			有		无
失眠		15(57.7)			46(29.7)			15(38.5)			46(32.5)			1(10.0)			60(35.1)			4(80.0)			57(32.4)			3(75.0)		58(32.8)
非失眠		11(42.3)			109(70.3)			24(61.5)			96(67.)			9(90.0)			111(64.9)			1(20.0)			119(67.6)			1(25.0)		119(67.2)
χ²值		7.820						0.500						2.664						4.931						3.122
P值		0.007						0.301						0.906						0.042						0.108
分类	骨质疏松症						骨关节炎						高尿酸血症						痛风						其他风湿免疫疾病				其他疾病
分类	有			无			有			无			有			无			有			无			有		无		其他疾病
失眠	22(50.0)			39(28.5)			27(65.9)			34(4.3)			3(37.5)			58(33.5)			1(33.3)			60(33.7)			3(75.0)		58(32.8)		14(42.4)
非失眠	22(50.0)			98(71.5)			14(34.1)			106(75.7)			5(62.5)			115(66.5)			2(66.7)			118(66.3)			1(25.0)		119(67.2)		19(57.6)
χ²值	6.912						24.520						0.052						0.009						0.134
P值	0.007						0.000						0.543						0.744						0.110

类风湿关节炎合并失眠的多中心横断面调查

Rheumatoid arthritis combined with insomnia: A multicenter cross-sectional survey

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组别		例数		DMARDs
组别		例数		已用此类药			未用此类药			甲氨蝶呤				来氟米特			艾拉莫得			柳氮磺胺吡啶			硫酸羟氯喹
失眠组		61		52(34.2)			9(31.0)			18				22			18			0			9
非失眠组		120		100(65.8)			20(69.0)			55				39			26			1			14
χ²值				0.109
P值				0.461
组别	靶向治疗药物
组别	已用此类药					未用此类药			阿达木单抗			益赛普				依那西普			JAK抑制剂			妥珠单抗
失眠组	20(41.7)					41(30.8)			7			2				1			9			1
非失眠组	28(58.3)					92(69.2)			9			7				1			10			1
χ²值	1.860
P值	0.121
组别			非甾体类抗炎药					糖皮质激素					中药/中药提取物
组别			已用此类药		未用此类药			已用此类药			未用此类药		已用此类药		未用此类药			白芍总苷			雷公藤多苷	其他中成药/中药
失眠组			21(36.8)		36(29.0)			18(30.5)			43(35.2)		44(40.0)		17(23.9)			24			13	12
非失眠组			40(63.2)		85(71.0)			41(69.5)			79(65.8)		66(60.0)		54(76.1)			37			24	29
χ²值			0.371					0.402					4.982
P值			0.328					0.322					0.019

组别	例数		炎症指标		血常规
组别	例数		ESR (mm/h)	CRP (mg/L)	WBC (10⁹/L)	中性粒细胞 (10⁹/L)		淋巴细胞 (10⁹/L)		Hb (g/L)			PLT (10⁹/L)				NLR (%)	PLR (%)
失眠组	61		56.18±36.44	10.28 (4.08, 27.23)	7.21±2.45	4.90 (3.76, 6.09)		1.88±1.23		115.51±18.09			282.00 (230.50, 341.25)				3.10 (1.83, 3.96)	191.83±90.58
非失眠组	120		45.68±36.07	7.60 (1.82, 23.13)	6.76±2.19	4.34 (3.20, 6.15)		2.25±3.88		120.67±22.19			271.00 (219.50, 332.00)				2.62 (1.90, 4.01)	195.89±98.35
t/Z值			-1.843	-1.278	-1.223	-1.419		0.715		1.560			-0.770				-0.229	0.258
P值			0.067	0.201	0.220	0.163		0.483		0.124			0.443				0.819	0.801
组别		肝肾功												肾功能
组别		ALT (U/L)		ALP (U/L)	γ-GT (U/L)		Alb (g/L)		Glb (g/L)		A/G (%)			尿素 (mmol/L)		Cr (μmol/L)		SU (μmol/L)
失眠组		16.9 (11.35, 24.05)		87.00 (74.50, 112.25)	20.35 (14.68, 28.23)		39.2 (34.95, 42.80)		32.15±4.30		1.24±0.27			6.54±8.48		52.5 (45.28, 66.75)		284.46±77.44
非失眠组		14.80 (11.40, 23.80)		84.00 (74.00, 103.10)	22.00 (14.75, 33.60)		40.00 (34.80, 44.50)		32.84±6.75		1.26±0.36			5.52±5.78		53.00 (46.76, 33.60)		290.59±92.77
t/Z值		-0.490		-0.451	-0.692		-0.701		0.642		0.401			-0.932		-0.546		0.441
P值		0.630		0.661	0.488		0.480		0.533		0.689			0.361		0.580		0.664
组别		尿常规[例(%)]							免疫学指标
		正常		异常	RF(IU/mL)				ANA[例(%)]						ACPA(IU/mL)
		正常		异常	RF(IU/mL)				(+)			(-)			ACPA(IU/mL)
失眠组		9(28.1)		36(36.0)	89.00(33.40, 172.50)				17(29.3)			27(42.9)			240.50(103.95, 471.00)
非失眠组		23(71.9)		54(54.0)	87.05(74.00, 103.10)				41(70.7)			36(57.1)			227.50(60.08, 694.50)
Z/χ²值		1.432			<-0.001				2.400						-0.083
P值		0.164			0.999				0.091						0.930

[1]	翟夏音, 兰瑞. 慢性失眠障碍患者血清鸢尾素、锰超氧化物歧化酶水平与认知功能的关系[J]. 临床荟萃, 2022, 37(4): 329-333.
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[3]	王娜;刘华玲. 右佐匹克隆联合枸橼酸坦度螺酮治疗高血压合并焦虑患者的临床观察[J]. 临床荟萃, 2013, 28(9): 1051-1052.
[4]	张哲;蒋国卿;范明月;余洪敏;倪连俊. 米氮平治疗卒中后抑郁伴发失眠的疗效观察[J]. 临床荟萃, 2013, 28(8): 920-922.
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分类		DAS28(ESR)分级								χ²值		P值
分类		Ⅰ		Ⅱ		Ⅲ		Ⅳ		χ²值		P值
失眠非失眠		4(26.7)^▲ 13(73.3)		3(16.7)^▲ 15(83.3)		17(26.6)^▲ 47(73.4)		37(45.1)^*#△ 45(54.9)		9.371		0.025
分类		DAS28(CRP)分级								χ²值		P值
分类		Ⅰ		Ⅱ		Ⅲ		Ⅳ		χ²值		P值
失眠非失眠		5(15.6)^#△ 27(84.4)		3(18.8)^*▲ 13(81.2)		30(34.9)^*▲ 56(65.1)		23(48.9)^#△ 24(51.1)		11.216		0.011
分类		SDAI分级								χ²值		P值
分类		Ⅰ		Ⅱ		Ⅲ		Ⅳ		χ²值		P值
失眠非失眠		3(42.9)^#▲ 4(57.1)		5(14.7)^*△ 29(85.3)		24(31.6)^#▲ 52(68.4)		29(45.3)^*△ 35(55.7)		9.768		0.021
分类		CDAI分级								χ²值		P值
分类		Ⅰ		Ⅱ		Ⅲ		Ⅳ		χ²值		P值
失眠非失眠		1(20.0)^△▲ 4(80.0)		9(23.7)^△▲ 29(76.3)		17(23.9)^*# 54(76.1)		34(50.7)^*# 33(49.3)		13.864		0.003
分类	双手X线片分级										χ²值		P值
分类	Ⅰ		Ⅱ		Ⅲ		Ⅳ		None		χ²值		P值
左手
失眠非失眠	7(25.9)^△▲ 20(74.1)		8(26.7)^△▲ 22(73.3)		19(52.8)^*#☆ 17(47.2)		9(81.8)^*#☆ 2(18.2)		0(0)^△▲ 4(100)		22.660		0.001
右手
失眠非失眠	10(33.3)^▲ 20(66.7)		7(25.9)^▲ 20(74.1)		19(51.4)^▲ 18(48.6)		7(70.0)^*#△☆ 3(30.0)		0(0)^▲ 4(100)		16.153		0.006

分类		DAS28(ESR)分级								χ²值		P值
分类		Ⅰ		Ⅱ		Ⅲ		Ⅳ		χ²值		P值
失眠非失眠		4(26.7)^▲ 13(73.3)		3(16.7)^▲ 15(83.3)		17(26.6)^▲ 47(73.4)		37(45.1)^*#△ 45(54.9)		9.371		0.025
分类		DAS28(CRP)分级								χ²值		P值
分类		Ⅰ		Ⅱ		Ⅲ		Ⅳ		χ²值		P值
失眠非失眠		5(15.6)^#△ 27(84.4)		3(18.8)^*▲ 13(81.2)		30(34.9)^*▲ 56(65.1)		23(48.9)^#△ 24(51.1)		11.216		0.011
分类		SDAI分级								χ²值		P值
分类		Ⅰ		Ⅱ		Ⅲ		Ⅳ		χ²值		P值
失眠非失眠		3(42.9)^#▲ 4(57.1)		5(14.7)^*△ 29(85.3)		24(31.6)^#▲ 52(68.4)		29(45.3)^*△ 35(55.7)		9.768		0.021
分类		CDAI分级								χ²值		P值
分类		Ⅰ		Ⅱ		Ⅲ		Ⅳ		χ²值		P值
失眠非失眠		1(20.0)^△▲ 4(80.0)		9(23.7)^△▲ 29(76.3)		17(23.9)^*# 54(76.1)		34(50.7)^*# 33(49.3)		13.864		0.003
分类	双手X线片分级										χ²值		P值
分类	Ⅰ		Ⅱ		Ⅲ		Ⅳ		None		χ²值		P值
左手
失眠非失眠	7(25.9)^△▲ 20(74.1)		8(26.7)^△▲ 22(73.3)		19(52.8)^*#☆ 17(47.2)		9(81.8)^*#☆ 2(18.2)		0(0)^△▲ 4(100)		22.660		0.001
右手
失眠非失眠	10(33.3)^▲ 20(66.7)		7(25.9)^▲ 20(74.1)		19(51.4)^▲ 18(48.6)		7(70.0)^*#△☆ 3(30.0)		0(0)^▲ 4(100)		16.153		0.006