纵向多分类项目反应理论评估阿尔茨海默病生命质量的反应转移  

Response shifts in quality of life in patients with Alzheimer’s disease based on longitudinal polytomous item response theory

作　　者：王旭霞 贺润莲[2] 吴燕萍[3] 韩红娟[1] 葛晓燕[1] 刘龙[1] 许晓萌[1] 张岩波[1] 余红梅[1] WANG Xu-xia;HE Run-lian;WU Yan-ping;HAN Hong-juan;GE Xiao-yan;LIU Long;XU Xiao-meng;ZHANG Yan-bo;YU Hong-mei(Department of Epidemiology and Health Statistics,Shanxi Medical University,Taiyuan,Shanxi 030001,China)

机构地区：[1]山西医科大学卫生统计学教研室,山西太原030001 [2]山西医科大学附属太原中心医院,山西太原030001 [3]山西医科大学计算机中心,山西太原030001

出　　处：《现代预防医学》2019年第5期844-848,共5页Modern Preventive Medicine

基　　金：国家自然科学基金资助项目(81673277;81872714)

摘　　要：目的探讨阿尔茨海默病(Alzheimer's disease,AD)患者在入院治疗后的生命质量测评中是否发生反应转移(response shift,RS),分析反应转移的类型并评估生命质量的真实改变。方法采用SF-12量表分别在住院前和出院后一个月对238名60岁以上的AD患者进行生命质量的评价,从量表条目水平,运用纵向多分类项目反应理论(Longitudinal Polytomous Item Response Theory,LPIRT)探讨患者生命质量测评中的反应转移现象。结果条目2(2)发生了内在评价标准的改变(G=9.90,P<0.05),考虑到该改变后,维度生理功能(physical functioning,PF)在两次测量间没有发生改变(-0.039,■=0.03,P>0.05)。条目6(1)的内在评价标准(G=26.58,P<0.05)和价值观(G=20.67,P<0.05)均发生了反应转移;条目6(3)的内在评价标准发生了变化(G=8.58,P<0.05)。考虑条目6(1)(3)中的改变后,维度心理健康(mental health,MH)的真实改变为发生恶化(-8.824,■=5236.83,P<0.001)。结论 AD患者在入院治疗后可能发生两种类型的反应转移,评价患者生命质量变化时应考虑反应转移。Objective To detect response shifts(RS)and true changes in quality of life(QOL)in patients with Alzheimer’s Disease(AD)after discharge.Methods The life quality of 238 patients with AD aged 60 years or older prior to hospitalization and one month after discharge was measured by using 12-item Short Form(SF-12).RS was detected by Longitudinal Polytomous Item Response Theory(LPIRT)in item level.Results The results showed recalibration(G=9.90,P<0.05)of item 2(2).With RS taken into account,the true change estimated in the domain of physical functioning was not statistically significant(-0.039,χ^2=0.03,P>0.05).Reprioritization(G=20.67,P<0.05)and recalibration(G=26.58,P<0.05)on item 6(1)of the domain of MH were detected.Recalibration(G=8.58,P<0.05)was detected in item 6(3).With RS taken into account,the true changes of the domain of mental health deteriorated(-8.824,χ^2=5236.83,P<0.001).Conclusion Two types of reaction metastases may occur in AD patients after admission,and response shifts should be considered when evaluating changes in patient quality of life.

关 键 词：反应转移 纵向多分类项目反应理论 阿尔茨海默病 生命质量 

分 类 号：R196[医药卫生—卫生事业管理]