肺动脉高压患者健康相关生活质量的调查研究  

Study on Health-related Quality of Life of Patients With Pulmonary Hypertension in the Era of Modern Targeted Therapy

作　　者：吴艳[1] 严欣欣[1] 谭江山 彭富华[1] 王晓建[1] 郭婷婷[1] 胡崧 贾镭[1] 高鑫[1] 华潞[1] WU Yan;YAN Xinxin;TAN Jiangshan;PENG Fuhua;WANG Xiaojian;GUO Tingting;HU Song;JIA Lei;GAO Xin;HUA Lu(Thrombotic Diseases Center,National Clinical Research Center of Cardiovascular Diseases,Key Laboratory of Pulmonary Vascular Medicine,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院,国家心血管疾病临床医学研究中心,肺血管医学重点,实验室,血栓性疾病诊治中心,北京市100037

出　　处：《中国循环杂志》2021年第5期481-487,共7页Chinese Circulation Journal

基　　金：中国医学科学院医学与健康科技创新工程(2016-CXGC11-5,2017-I2M-3-003);中国医学科学院阜外医院国家心血管疾病临床医学研究中心自主课题(NCRC2020007);国家科技重大专项(2018ZX09711001-003-012)。

摘　　要：目的:评估在靶向药物治疗时代肺动脉高压(PAH)患者生活质量现状,探讨影响患者生活质量的危险因素。方法:选择2017年1月至2018年12月连续在中国医学科学院阜外医院经右心导管检查确诊为PAH的患者,利用简明生活质量量表第二版进行生活质量评分,并通过多因素Logistic回归分析影响患者生理健康和心理健康的危险因素。结果:共回收416例PAH患者的有效量表。患者生理健康总分(PCS)和心理健康总分(MCS)基于常模的维度中位得分为38.6(29.6,47.7)分和39.1(26.0,53.4)分,均显著低于中国普通人群常模。女性与男性患者相比,在八个维度中任一维度的得分以及PCS[37.7(28.5,46.2)分vs.42.2(32.6,48.9)分,P=0.007]和MCS[36.0(24.6,52.3)分vs.46.8(33.5,55.3)分,P=0.02]均显著较低。随着受教育程度的升高,患者的MCS显著升高,PCS亦呈现出上升趋势;农村地区患者生理职能、情感职能、精神健康和PCS较居住于中小城市和大城市的患者显著降低(P均<0.01)。无工作者与兼职或全职工作者相比,在八个维度中任一维度得分以及PCS和MCS中得分显著降低(P均<0.01)。多因素Logistic回归分析显示,女性(OR=2.35,95%CI:1.17~4.71,P=0.016)、年龄(OR=1.06,95%CI:1.03~1.09,P=0.016)、无工作(OR=4.08,95%CI:1.58~10.56,P=0.001)是影响PCS的独立危险因素;而女性(OR=2.51,95%CI:1.24~5.08,P=0.01)、居住地农村(OR=3.41,95%CI:1.24~9.39,P=0.018)是影响MCS的独立危险因素。结论:PAH患者生活质量与中国普通人群常模相比显著下降。无工作及居住在农村的女性患者是生理健康和心理健康受损最为严重的人群,需要得到更多的医疗救助和社会家庭支持。Objectives:To examine health-related quality of life(HR-QOL)of patients with pulmonary hypertension in the modern targeted therapy era,and determine the risk factors.Methods:Patients,who were diagnosed as pulmonary hypertension in Fuwai Hospital from January 2017 to December 2018,were enrolled in the study.Medical Outcomes Study Form-36 version 2(SF-36 v2)was used to examine patients’HRQOL,and then socio-economic factors were analyzed to determine the risk factors for physical component summary scores(PCS)and mental component summary scores(MCS).Results:A total of 416 SF-36 v2 QOL forms were collected with the response rate of 83.0%.Generally,the scores of PCS and MCS were 38.6(29.6,47.7)and 39.1(26.0,53.4),which were significantly impaired in comparison with the Chinese norms.Compared to male patients,QOL was dramatically reduced in the female patients on all the 8 subscales(all P<0.05),as well as PCS(37.7[28.5,46.2]vs.42.2[32.6,48.9],P=0.007)and MCS(36.0[24.6,52.3]vs.46.8[33.5,55.3],P=0.02).Significantly better MCS and a trend of better PCS were observed in proportion with the increase of education level.Patients who lived in rural areas had much worse physical role functioning,emotional role functioning,mental health and MCS compared to those who lived in urban areas(all P<0.01).QOL was significantly worse in unemployed patients on all 8 subscales,PCS and MCS than in patients with full-time or part-time jobs(all P<0.01).Female(OR=2.35,95%CI:1.17-4.71,P=0.016),age(OR=1.06,95%CI:1.03-1.09,P=0.016),unemployment(OR=4.08,95%CI:1.58-10.56,P=0.001)were the independent risk factors for the worst PCS,while female(OR=2.51,95%CI:1.24-5.08,P=0.01),living in rural area(OR=3.41,95%CI:1.24-9.39,P=0.018)were the independent risk factors for the worst MCS.Conclusions:QOL for PAH patients is dramatically impaired compared to the Chinese norms.Unemployed female and female living in the countryside were the worst affected population for PCS and MCS,who deserved more medical care,family and social supports.

关 键 词：肺动脉高压 健康相关生活质量 简明生活质量量表 社会经济因素 

分 类 号：R541[医药卫生—心血管疾病]