| Objective:To explore the objective characteristics of kidney deficiency and blood stasis syndrome and damp-heat stasis syndrome in patients with Ankylosing Spondylitis(AS),and provide evidence for the standardization of TCM syndromes in AS;To investigate the work disability in patients with Ankylosing Spondylitis and analyze related factors,and provide reference for improving the outcome of work ability in patients with AS in clinical practice.Method:Study 1:This study uses a cross-sectional survey as a method.The research objects are from the Rheumatology and Immunology Department of Guang’anmen Hospital of the China Academy of Chinese Medical Sciences,Xiyuan Hospital of the China Academy of Chinese Medical Sciences,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Bethune International Peace Hospital of the Chinese People’s Liberation Army,Affiliated Hospital of Liaoning University of Traditional Chinese Medicine and Affiliated Hospital of Anhui University of Traditional Chinese Medicine.All case data were screened according to the diagnostic,inclusion,and exclusion criteria of this study,resulting in 2339 clinical cases that met the analysis standard.The clinical data,sociodemographic characteristics and laboratory indicators of patients with AS wara recorded,including gender,age,BMI,education level,and job type;course of disease,family history,infection history,degree of pain,fatigue,degree and time of morning stiffness,BASDAI,BASFI,BASMI,etc;ESR,CRP,PLT,HLA-B27,and imaging findings(grade of sacroiliac arthritis).The Depression Anxiety Stress Scales-21(DASS-21)was used to assess the psychological status of patients,and the chronic disease treatment function fatigue scale(FACIT)was used to assess the degree of fatigue in patients.SPSS25.0 statistical software was used for data analysis.Measurement data that conformed to the normal distribution were represented by the mean±standard deviation(X±S),while those that did not conform to the normal distribution were represented by the median(interquartile range)(M(Q3-Q1)),and counting data were represented by frequency(N)or frequency(%).For the comparison between two independent samples,if the measurement data conforms to the normal distribution and the variance is uniform,the independent sample t-test is used;If the distribution does not conform to normal distribution or the variance is uneven,nonparametric rank sum test shall be used;X2 test was used for counting data.The difference of P<0.05 was statistically significant.Study 2:The demographic,work ability loss,and disease related information of 162 patients with AS who were hospitalized in the Rheumatology Department of***Hospital from October 2021 to October 2022 were recorded.The Chinese version of the Work Efficiency and Activity Disorders Questionnaire(WPAI)was used to investigate the patient’s work hours,work efficiency,absence,daily activity barriers,and total work productivity loss,To analyze the influencing factors related to patients’work ability and efficiency,and to explore the correlation between the outcome of WPAI and factors such as disease activity and psychological status of patients;Spearman correlation analysis was used to evaluate the correlation between variables,and logistic regression analysis was used to explore the influencing factors of work ability disorders in patients with AS.The difference of*P<0.05 was statistically significant.Results:1.Cross-sectional investigation of TCM syndrome types and disease characteristics in patients with ankylosing spondylitis1.1 This study collected medical records of 2339 patients with AS,including 1075 cases(45.95%)of kidney deficiency and blood stasis syndrome,1264 cases(54.04%)of damp heat and blood stasis syndrome,1787 cases(76.41%)of males and 552 cases(23.59%)of females,with a gender ratio of 3.23:1;The average age of the two groups of patients was 37.85± 12.30,33.82± 10.76,and the patients with kidney deficiency and blood stasis syndrome were older(P<0.01);The average course of disease in the two groups was 7.31 ± 6.80 years.5.14±2.6 years,and the course of disease in patients with kidney deficiency and blood stasis syndrome was longer(P<0.05);1.2 In the comparison of disease activity of AS,the mean BASDAI scores of patients with kidney deficiency and blood stasis syndrome and patients with damp heat and blood stasis syndrome were 3.84±1.79 and 4.30±1.99,respectively.The BASDAI scores of patients with damp heat and blood stasis syndrome were higher,with a statistically significant difference(P<0.05);1.31n terms of disease related scale evaluation,patients with kidney deficiency and blood stasis syndrome had higher BASMI and nocturnal pain VAS scores,while patients with damp-heat stasis syndrome had higher BASFI,PGA,and FACIT fatigue index scores,with a statistically significant difference(P<0.05);1.4 In terms of comparison of laboratory indicators,the average CRP values of patients with kidney deficiency and blood stasis syndrome and damp-heat stasis syndrome were 11.34(15.72)and 15.37(17.58),respectively,with a statistically significant difference(P<0.05).However,there was no significant difference in ESR and PLT between the two groups of patients;1.5 In terms of comparison of imaging findings,there was no significant difference in the average value of sacroiliac joint grading between the two groups of patients;In terms of central axis joint involvement,compared with patients with damp-heat and blood stasis syndrome,patients with kidney deficiency and blood stasis syndrome have more central axis joint involvement,and lumbar spine involvement is more significant(P<0.05).1.6 In the evaluation of patients’ psychological status,compared with patients with kidney deficiency and blood stasis syndrome,patients with damp-heat and blood stasis syndrome had higher scores of depression,anxiety,and stress(P<0.05).2.Analysis of work ability disorders and related factors in patients with ankylosing spondylitis2.1 A total of 162 patients with AS were included in this study,including 117 males(72.22%)and 45 females(27.77%),with an average age of 41.55±12.23 years and a mean course of disease of 7.79±8.27 years.There were 40 patients(24.69%)with a family history,39 patients(24.07%)with a previous history of ophthalmitis/intestinal infection/urinary tract infection,and 80 patients(49.38%)with HLA-B27(+);2.2 Of the 162 patients with AS,118(72.83%)were active,41(25.3%)had normal working conditions,77(47.5%)had work ability disorders,and the average absence time of active patients was 6 hours(0-20),with an average decrease in work efficiency of 25.6%(0-60%);135 cases(83.33%)had daily activity disorders;2.3 Comparing the demographic data and disease evaluation indicators between the normal group and the disorder group,there were statistically significant differences in gender,course of disease,BASDAI,BASMI,DASS-depression,DASS-anxiety,fatigue index,and spinal pain between the two groups(P<0.05),while there were no significant differences in other indicators;2.4 Logistic multiple regression analysis showed that BASDFI、BASDAI and DASS anxiety were important factors affecting patients’ work ability among various clinical indicators(OR values respectively were 1.02,1.413 and 1.392);2.5 In multivariate analysis,work productivity losses related to absenteeism due to illness were associated with BASDAI,BASFI,and DASS anxiety(| r |=0.20-0.24);Job productivity loss was associated with BASDAI,BASFI,DASS depression,DASS anxiety,FACIT fatigue,and pain scores(|r|=0.21 to 0.47);Daily activity disorders were associated with BASDAI,DASS stress,and FACIT fatigue(|r|=0.43-0.48);The total work productivity loss of patients was correlated with FACIT fatigue,BASDAI,pain VAS score,DASS depression,DASS anxiety,and DASS stress(|r|=0.24 to 0.46).Conclusion:1.Patients with AS with kidney deficiency and blood stasis syndrome are older,have a longer course of disease,have more obvious nocturnal pain,and the lesion is more likely to involve the central axis joint,especially the lumbar spine;2.Patients with damp-heat stasis syndrome have higher disease activity,fatigue index,and scores of depression,anxiety,and stress;3.The rate of impairment of work ability in patients with AS is high.BASDAI,BASFI,psychological disorders,and fatigue levels are closely related to the loss of work productivity in patients with AS.Attention should be paid to the issue of impairment of work ability in patients with AS. |
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