慢性肝病量表在乙型肝炎肝硬化中的应用评价  

Psychometrics of the chronic liver disease questionnaire for patients with posthepatific B cirrhosis

作　　者：胡鑫才[1] 张华[1] 林彦[1] 周扬[1] 刘平[2] 

机构地区：[1]上海中医药大学附属曙光医院上海市中医药研究院肝病研究所肝肾疾病病证教育部重点实验室上海市中园临床重点实验室国家中医药管理局重点研究室(慢性肝病虚损),201203 [2]上海中医药大学上海高校中医内科学E研究院

出　　处：《中华肝脏病杂志》2012年第8期621-627,共7页Chinese Journal of Hepatology

基　　金：国家重点基础研究发展（973）计划项目（2006CB504801）;上海市重点学科建设项目（Y0302）;上海市教育委员会E研究院建设计划项目（E03008）;上海高校创新团队建设项目（第一期）;上海市医学领军人才项目（2007A卫01）

摘　　要：目的评价慢性肝病量表（CLDQ）在乙型肝炎肝硬化中应用的信度和效度。方法将CLDQ用于297例乙型肝炎肝硬化患者的自评，同时评定患者肝功能Child分级，并以117例健康者为对照。通过条目分析、精密度分析、信度分析、探索性因子分析，以及反应度、区分度分析对量表进行总体评价。计数资料用疋。检验，计量资料两组间比较用两独立样本t检验，多组间比较用单因素方差分析，两两比较用Scheffe法。内部一致性以Cronbach＇s α系数、Gunman分半系数考察，相关性分析用Pearson相关系数，或Spearman相关系数以，方差分析考察区分度，结构效度检验用探索性因子分析的主成分法，并进行最大方差正交旋转。结果量表条目、量表整体及各维度无明显地板效应；条目的天花板效应大部分为30％～60％，腹部症状、活动和焦虑3个维度的天花板效应〈30％。总量表的内部一致性较好（Cronbach’s α=0．905），不同维度的内部一致性（Cronbach＇s α）为0．442～0．848；总量表与各维度相关系数均〉0．6（P值均〈0．01）。健康组量表总得分、各维度得分显著高于患者组垆值均〈0．01），患者组量表总得分和其中的4个维度得分在与不同肝功能分级之间呈现梯度变化，Child分级越重得分越低。探索性因子分析提取的7个公因子与原维度有中等的吻合度。结论CLDQ在乙型肝炎肝硬化中的应用具有较好的信度、内容效度、反应度和区分度，精密度和结构效度中等，可有效用于对乙型肝炎肝硬化患者的生活质量以及疗效的评价。Objective To report on the validity and reliability of the Chronic Liver Disease Questionnaire （CLDQ） for assessing subjects with posthepatitic B cirrhosis. Methods The CLDQ was administered to 117 healthy volunteers and 297 patients with posthepatitic B cirrhosis. All posthepatic B cirrhosis patients were assessed for the Child-Pugh stage. The entire questionnaire and each individual item was analyzed for precision and reliability. Exploratory factor analysis, responsiveness, and discrimination validity were also assessed. Results No significant floor effects were detected, but a moderate ceiling effect （〈 30%） was found for the following subscales： abdominal symptoms （AS）, activity （AC）, and worry （WO）. For most items, the ceiling effect was between 30%- 60%. The internal consistency （Cronbach＇s ct） on total scale level was good （ct=0.905）, and ranged from 0.442 to 0.848 for the different subscales. The correlation coefficients of the total scale with subscales were above 0.6 （P 〈 0.01） for reliability. The CLDQ and subscale scores for healthy controls were higher than those for the patients （P 〈 0.001）, and were gradated from the patients with Child-Pugh A cirrhosis to those with Child-Pugh B or C cirrhosis. Increase in severity of liver disease was accompanied by lower scores by the CLDQ and 4 out 6 subscales. Exploratory factor analysis moderately reproduced the original factor structure. Conclusion The CLDQ has good reliability, satisfactory content, responsiveness and discriminant validity, and moderate precision and construct validity. It is useful for effectively evaluating health-related quality of life and curative effect in patients with posthepatitic B cirrhosis.

关 键 词：肝炎 乙型 慢胜 肝硬化 慢性肝病量表 信度 效度 生活质量 

分 类 号：R575.2[医药卫生—消化系统]