| PurposeTo understand the population baseline characteristics and disease profile of female patients with SLE,including general demographic characteristics,clinical and laboratory indicators,and disease activity scores,and compare the differences of different population baseline characteristics and disease profile and quality of life;To understand the incidence of negative emotions,such as anxiety and depression,and the medication adherence of female patients with SLE,to compare the differences of different degrees of negative emotions and quality of life,and to explore the differences of different degrees of medication adherence and quality of life;To explore the correlation between disease activity,negative mood and medication adherence with quality of life;To explore the mediating effect of negative mood and medication adherence on disease activity and quality of life.MethodsThe outpatient and inpatient from the First Affiliated Hospital of Anhui Medical University and the First Affiliated Hospital of University of Science and Technology of China were selected from two tertiary class A hospitals in Hefei,Anhui Province from December 2018 to December 2020 by accidental sampling.The population baseline characteristics and disease profile,Hospital anxiety and depression scale,Morisky medication adherence scale-8,Systemic lupus erythematosus index 2000(SLEDAI-2000)and SF-36 were used to investigated.Pearson correlation analysis and Spearson correlation analysis were used to examine the correlation between negative emotion,medication adherence,disease activity and quality of life.T-test,ANOVA and multiple linear regression were used to find the factors influencing the quality of life of female patients with SLE,including population baseline characteristics,disease profile,medication adherence and negative emotion.A mediating effect model was established to analyze the mediating effect of medication adherence and negative emotion on disease activity and quality of life.ResultsA total of 501 female patients with SLE were enrolled,with a mean age of(34.20±9.79)years.The median and quartile of disease duration were 8(3,12)years;The median and quartile of BMI were 21.09(19.53,22.89);The median and quartilel of disease activity was 14(6,22),with 77.6% of patients with mild or more disease activity.The mean score of anxiety was(6.09±6.00),32.8% patients with suspected or certain anxiety.The mean score of depression was(5.61±3.84),29.6% patients with suspected or certain depression.The mean score of medication adherence was(5.72±1.62),and 44.9% patients with moderate or good medication adherence.The scores of physical functiong(PF),role physical(RP),body pain(BP),general health(GH),vitality(VT),social function(SF),role emotional(RE)and mental health(MH)of SLE were respectively(79.3±22.7),(50.1±43.2),(77.1±19.9),(53.8±22.3),(62.0±20.6),(68.0±25.0),(62.9±42.6),(60.9±20.4),which were lower than the quality of life of Chinese healthy residents,the difference was statistically significant.Pearson correlation analysis and Spearman correlation analysisResults showed that anxiety,depression,disease activity and quality of life dimensions were negatively correlated,which was statistically significant(P<0.001).medication adherence was positively correlated with all dimensions of quality of life,with statistical significance(P<0.001).Single factor analysisResuls showed that patients with different age,culture level,income level,BMI,if there are nervous system abnormalities,vision loss,vasculitis,arthritis,myositis,lupus headache,lupus nephritis,hypertension,elevated blood sedimentation rate,elevated C reactive protein,elevated Ig A,elevated Ig G,elevated Ig M and patients with different negative emotions and different disease activity,its difference in PF dimensions have statistical significance(all P<0.05).Different age,culture level,income level,medical treatment charge payment forms,BMI,if there are butterfly erythema,nervous system abnormalities,vision loss,vasculitis,arthritis,myositis,lupus headache,lupus nephritis,elevated blood sedimentation rate,elevated C reactive protein,elevated Ig A,Ig G,and Ig M,positive anti-ds DNA antibodies,decreased white blood cells and patients with different negative emotions,different medication adherence and different disease activity its difference in RP dimensions have statistical significance(all P<0.05).Different patients age,cultural level,income level,if there are nervous system abnormalities,vision loss,vasculitis,arthritis,myositis,skin rash,upus headache,ulcer,fever,elevated blood sedimentation rate,elevated C reactive protein,elevated Ig A and Ig M,decreased C3,positive anti-ds DNA antibodies,decreased platelets,decreased white blood cells and patients with different negative emotions,different medication adherence and different disease activity,its difference in BP dimensions have statistical significance(all P<0.05).Different age,culture level,income level,if there are nervous system abnormalities,vision loss,vasculitis,arthritis,myositis,skin rash,alopecia,lupus headache,ulcer,fever,hypertention,lupus nephritis,elevated blood sedimentation rate,elevated C reactive protein,elevated Ig M,positive anti-ds DNA antibodies,decreased white blood cells,proteinuria and patients with different negative emotions,different medication adherence and different disease activity,its difference in GH dimensions have statistical significance(all P<0.05).Different culture degree,income level,payment method of medical treatment,if there are discoid lupus,nervous system abnormalities,vision loss,vasculitis,arthritis,myositis,skin rash,alopecia,fever,lupus headache,ulcer,lupus nephritis,elevated blood sedimentation rate,decreased platelets,decreased white blood cells,and patients with different negative emotions,different medication adherence and different disease activity,its difference in VT dimensions has statistical significance(all P<0.05).Different age,culture level,income level,course of the disease,payment method of medical treatment,,BMI,whether there are nervous system abnormalities,vision loss,vasculitis,arthritis,myositis,skin rash,fever,lupus headache,ulcer,hypertention,elevated blood sedimentation rate,elevated Ig M,decreased C3,decreased platelets,proteinuria and patients with different negative emotions,different medication adherence and different disease activity,its difference in SF dimensions has statistical significance(all P<0.05).Different payment method of medical treatment,,whether there are nervous system abnormalities,vision loss,vasculitis,arthritis,myositis,skin rash,alopecia,lupus headache,ulcers,fever,lupus nephritis,elevated blood sedimentation rate,elevated Ig A and Ig M,decreased C3,decreased white blood cells,proteinuria and patients with different negative emotions,different medication adherence and different disease activity,its difference in RE dimensions has statistical significance(all P<0.05).Patients with different educational levels,income levels,whether there are discoid erythema,nervous system abnormalities,vision loss,arthritis,myositis,alopecia,lupus headache,ulcer,fever,decreased white blood cells and patients with different negative emotions,different medication adherence and different disease activity,its difference in MH dimensions has statistical significance(all P<0.05).Different age,educational level,income level,payment method of medical treatment,whether there are butterfly erythema,nervous system abnormalities,vision loss,vasculitis,arthritis,myositis,lupus headache,fever,hypertention,ulcer,lupus nephritis,elevated blood sedimentation rate,elevated C reactive protein,elevated Ig A,Ig G and Ig M,decreased C3,positive anti-ds DNA antibodies,decreased white blood cells,proteinuria and patients with different negative emotions,different medication adherence and different disease activity,its difference in PCS dimensions has statistical significance(all P<0.05).Different educational level,income level,payment method of medical treatment,whether there are discoid erythema,nervous system abnormality,vision loss,vasculitis,arthritis,myositis,skin rash,alopecia,lupus headache,ulcer,fever,lupus nephritis,elevated erythrocyte sedimentation rate,elevated Ig M,decreased white blood cells and patients with different negative emotions,different medication adherence and different disease activity,its difference in MCS dimensions has statistical significance(all P<0.05).Multiple linear regression analysisResults showed that the influencing factors of PF dimension were age,income,whose BMI greater than 30,nervous system abnormalities and depression.The influencing factors of RP dimension were income,whose BMI greater than 25 and less than 29.9 as well as greater than 30,butterfly erythema,elevated blood sedimentation rate,depression,and medication adherence.The influencing factors of BP dimension were arthritis,elevated blood sedimentation rate,decreased C3,anxiety,depression,and medication adherence.The influencing factors of GH dimension were income,arthritis,hypertension,anxiety,depression,and medication adherence.The influencing factors of VT dimension income,medical payment method of new rural cooperative medical susutem(NCMS),vasculitis,anxiety and depression.The influencing factors of SF dimension were income,course of disease,whose BMI greater than 25 and less than 29.9 as well as greater than 30,nervous system abnormalities,hypertension,decreased C3,anxiety and depression.The influencing factors of RE dimension were lupus headache,elevated Ig M,anxiety and depression.The influencing factors of MH dimension were anxiety and depression.The influencing factors of PCS dimension were the educational level,income,butterfly erythema,vision loss,arthritis,decreased C3,anxiety,depression,and medication adherence.The influencing factors of MCS dimension were income,nervous system abnormalities,anxiety and depression.Mediating effect analysisResults showed that the mediating effect of medication adherence on PCS accounted for 10.19%,and the mediating effect of medication adherence on MCS accounted for 11.49%.The mediating effect of medication adherence had a greater impact on MCS than PCS.The mediating effect of anxiety on PCS accounted for33.38%,and the mediating effect of anxiety on MCS accounted for 46.41%.The mediating effect of anxiety on MCS was greater than PCS.The mediating effect of depression on MCS accounted for 34.01%,and the mediating effect of depression on MCS accounted for 49.61%.The mediating effect of depression on MCS was greater than that of PCS.ConclusionsPopulation baseline characteristics and disease profile are closely correlated with quality of life of female patients with SLE.Low medication adherence and the occurrence of negative emotions are all risk factors for female patients with SLE with low quality of life.At the same time,the medication adherence and negative emotions are intermediary factors of low quality of life.Medical personnel need comprehensively considerate the actual situation of patients,improving health outcomes by improving medication adherence and focusing on negative emotions. |
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