来源：风湿病与关节炎,2024,13（2）:17-22.

强直性脊柱炎睡眠质量与中医证型分析（临床研究）

李雪婷^1,2，邱明山³

　　【摘　要】目的：探讨睡眠质量与强直性脊柱炎（ankylosing spondylitis,AS）患者中医证型的关系，为伴睡眠质量问题AS患者的辨证论治提供参考。方法：选取AS患者110例，进行中医证型辨证，记录患者的一般资料、Bath强直性脊柱炎疾病活动指数（BASDAI）、Bath强直性脊柱炎功能指数（BASFI）、C反应蛋白（CRP）、红细胞沉降率（ESR）。运用睡眠状况自评量表（SRSS）评估睡眠质量。采用SPSS 20.0软件进行统计分析。结果：不同证型伴睡眠质量问题程度的分布差异有统计学意义（P < 0.05），AS患者肾虚督寒证较肾虚湿热证更易发生睡眠质量问题（P < 0.05）。AS患者肾虚督寒证伴睡眠质量问题多表现为轻度睡眠质量问题，在早醒、恶梦夜惊、失眠后反应方面分值均高于肾虚湿热证（P < 0.05），其失眠后反应主要为乏力、疲倦、做事效率低下；AS患者肾虚督寒证伴睡眠质量问题较无睡眠质量问题者ESR及CRP水平高、BASDAI及BASFI分值高（P < 0.05）。AS患者肾虚湿热证伴睡眠质量问题多表现为中度睡眠质量问题，在入睡困难方面分值明显高于肾虚督寒证（P < 0.05）；且CRP、ESR、BASDAI、BASFI均高于肾虚督寒证（P < 0.05）；AS患者肾虚湿热证伴睡眠质量问题较无睡眠质量问题者病程长、年龄大、ESR及CRP水平高、BASDAI及BASFI分值高（P < 0.05）。结论：①AS患者不同证型的睡眠质量问题分布存在差异，肾虚督寒证伴睡眠质量问题发生率较高，但程度较轻，在早醒、恶梦夜惊、失眠后反应等方面困扰较大；肾虚湿热证伴睡眠质量问题时程度较重，以入睡困难为主要表现。②AS患者2种证型伴睡眠质量问题时ESR、CRP、BASDAI、BASFI均较高，肾虚湿热证上述指标均高于肾虚督寒证。

　　【关键词】　强直性脊柱炎；睡眠质量；中医证型；睡眠状况自评量表；临床分析

Analysis of Sleep Quality and TCM Syndrome Types in Ankylosing Spondylitis

LI Xue-ting,QIU Ming-shan

　　【ABSTRACT】Objective:To explore the relationship between sleep quality and traditional Chinese medicine（TCM）syndrome types in patients with ankylosing spondylitis（AS）,and provide reference for the diagnosis and treatment of AS patients with sleep quality problems.Methods:One hundred and ten patients with AS were selected for TCM syndrome differentiation,and their general information,Bath Ankylosing Spondylitis Disease Activity Index（BASDAI）,Bath Ankylosing Spondylitis Functional Index（BASFI）,C-reactive Protein（CRP）,and Erythrocyte Sedimentation Rate（ESR）were recorded.Self Rating Sleep Scale（SRSS）was used to evaluate sleep quality.Statistical analysis was conducted using software SPSS 20.0.Results:There was a statistically significant differ-ence in the distribution of sleep quality problems among different syndrome types（P < 0.05）,and AS patients with kidney deficiency and Du cold syndrome were more prone to sleep quality problems than those with kidney deficiency and damp heat syndrome（P < 0.05）.AS patients with kidney deficiency and Du cold syndrome often exhibited mild sleep quality problems,with scores higher than those with kidney deficiency and damp heat syndrome（P < 0.05）in early awakening,nightmares and night terrors,and post insomnia reactions.The main post insomnia reactions were fatigue and low work efficiency.The ESR and CRP levels,as well as the BASDAI and BASFI scores,were higher in AS patients with kidney deficiency and Du cold syndrome accompanied by sleep quality problems compared to those without sleep quality problems（P < 0.05）.AS patients with kidney deficiency and damp heat syndrome accompanied by sleep quality problems often exhibited moderate sleep quality problems,and their scores in difficulty falling asleep were significantly higher than those of kidney deficiency and Du cold syndrome（P < 0.05）;and CRP,ESR,BASDAI,and BASFI were all higher than those of Kidney Deficiency and Du Cold Syndrome（P < 0.05）.AS patients with kidney deficiency and damp heat syndrome accompanied by sleep quality problems had a longer course of disease,older age,higher ESR and CRP levels,and higher BASDAI and BASFI scores（P < 0.05）compared to those without sleep quality problems.Conclusion:①There are differences in the distribution of sleep quality problems among different syndrome types of AS patients.The incidence of sleep quality problems in kidney deficiency and Du cold syndrome is relatively high,but the degree is relatively mild.They are more troubled by early awakening,nightmares and night terrors,and post insomnia reactions.Kidney deficiency damp heat syndrome with sleep quality problems is more severe,with difficulty falling asleep as the main manifestation.②ESR,CRP,BASDAI,and BASFI are all higher in AS patients with two types of syndrome accompanied by sleep quality problems.The above indicators are higher in kidney deficiency and damp heat syndrome than in kidney deficiency and Du cold syndrome.

　　【Keywords】  ankylosing spondylitis;sleep quality;TCM syndrome types;Self Rating Sleep Scale;clinical analysis