温义权 蒋雨彤 陈启云 张曦 廖泽涛 古洁若

【摘要】目的 探討吸烟与强直性脊柱炎（AS）患者疾病活动度、功能和健康状况的关系。方法 对687例AS患者进行横断面调查研究，收集患者的年龄、性别、吸烟等情况，其中吸烟状况分为从不吸烟、已戒烟或当前吸烟、烟龄和家庭成员吸烟情况，以及患者的病程、晨僵持续时间、CRP、ESR，并记录晨僵程度、全身疼痛、夜间背痛、全日背痛的视觉模拟评分（VAS）。采用巴氏AS疾病活动度评分（BASDAI）、巴氏AS功能指数（BASFI）、健康评估问卷（HAQ-S）对患者进行疾病、功能及健康状况评估，并对烟龄与临床参数之间的关系进行相关性分析。结果 687例AS患者中，从未吸烟411例（59.8%）、已戒烟108例（15.7%）、当前吸烟168例（24.5%）;吸烟者的烟龄为4.0（8.5）包年;有家人吸烟186例（27.1%），无家人吸烟501例（72.9%）。与从未吸烟者相比，当前吸烟者的年龄较大、病程较长、晨僵程度较重，且全身疼痛、夜间背痛、全日背痛的VAS和BASDAI、HAQ-S评分及CRP水平均较高（P均< 0.05）。非吸烟者与已戒烟者各项指标比较差异均无统计学意义（P均> 0.05）。吸烟者的年龄（rs = 0.255）、病程（rs = 0.168）、晨僵持续时间（rs = 0.145）、晨僵程度（rs = 0.170）、全身疼痛（rs = 0.089）、夜间背痛（rs = 0.133）、全日背痛（rs = 0.116）、CRP（rs = 0.106）、BASDAI（rs = 0.114）、BASFI（rs = 0.075）、HAQ-S（rs = 0.092）均与烟龄相关（P均< 0.05）。结论 吸烟与AS患者的疾病活动、功能限制和健康状况恶化有关。

【关键词】强直性脊柱炎;吸烟;疼痛

【Abstract】Objective To investigate the relationship between cigarette smoking， disease activity， functional limitation， and health status in Chinese patients with ankylosing spondylitis （AS）.  Methods A total of 687 AS patients were recruited in this cross-sectional survey. Age， gender and smoking status were collected. Smoking status was obtained by a standard questionnaire involving smoking status （non-smoker， ex-smoker or current smoker）， the age when starting smoking and smoking status of family members. The course of disease， duration of morning stiffness， C-reactive protein （CRP） and erythrocyte sedimentation rate （ESR） were observed. The severity of morning stiffness， visual analogue scale （VAS） scores of systemic pain， nocturnal back pain and during whole day were recorded. The disease， functional limitation and health status were evaluated by using the Bath AS Disease Activity Index （BASDAI）， the Bath AS Functional Index （BASFI） and Health Assessment Questionnaire for Spondyloarthropathy （HAQ-S）. Correlation analysis was performed between duration of cigarette smoking and clinical parameters.  Results Of all the 687 patients， 168 （24.5%） are current smokers， 108 were ex-smokers （15.7%） and 411 patients never smoked （59.8%）， respectively. The smokers had 4.0 （8.5） packs of cigarette per year. The family members of 186 patients （27.1%） smoked and family members of 501 cases （72.9%） did not smoke. Compared with non-smokers， current smokes had older age， longer duration of disease， more severe morning stiffness higher VAS of the systemic pain， nocturnal back pain and back pain， during whole day， HAQ-S， BASDAI scores， and level of CRP （all P < 0.05）. Compared with the ex-smokers， current smokers had older age and more severe morning stiffness （both P < 0.05）. The parameters did not significantly differ between non-smokers and ex-smokers （all P > 0.05）. Age （rs = 0.255）， course of disease （rs = 0.168）， duration of morning stiffness （rs = 0.145）， degree of morning stiffness （rs = 0.170）， systemic pain （rs = 0.089）， nocturnal back pain （rs = 0.133）， back pain during whole day （rs = 0.116）， CRP （rs=0.106）， BASDAI （rs=0.114）， BASFI （rs = 0.075） and HAQ-S （rs = 0.092） were significantly correlated with duration of smoking （all P < 0.05）.  Conclusion Cigarette smoking is correlated with disease activity， functional limitation and health status in AS patients.

【Key words】Ankylosing spondylitis;Smoking;Pain

强直性脊柱炎（AS）是一种慢性炎症性疾病，主要通过引起骶髂关节和脊柱的炎症而影响中轴骨骼，也可以出现前葡萄膜炎等关节外表现。AS可导致疼痛、功能限制和预期寿命缩短。其发病机制尚不明确，环境因素如吸烟对疾病的发生、发展有一定的作用。目前很多研究都集中在吸烟和类风湿性关节炎之间的关系。吸烟是类风湿性关节炎发展的危险因素之一[1]。然而，关于吸烟对AS影响的研究仍然有限。……