堪萨斯城生存质量表对慢性心力衰竭患者生存质量评估的可行性评价

Evaluation of Kansas City questionnaire of cardiomyopathy in clinical practice in patients with chronic heart failure

目的 采用美国堪萨斯城心肌病患者生存质量表(KCCQ)对慢性心力衰竭(心衰)患者生存质量评估进行可行性评价。方法 2002年9月-2003年1月入住我院的心衰患者共96例,人院第二天填写KCCQ和明尼苏达生活质量表(MLWHF),治疗3个月后再次填写这两份量表。结果除了自我认识方面得分外,KCCQ的可信度系数(cronbach α)大于0.8;KCCQ与MLWHF有良好的相关性(r=0.566-0.894,P<0.01)。在病情稳定的24例患者中,两次KCCQ各个部分的得分,差值在-1.8～6.5之间(P>0.05)。在好转的44例患者中,两次KCCQ的各个方面得分差值在15.9-27.5之间(P<0.01)。恶化的14例患者3个月后KCCQ各项得分的变化除了自我认识外,其余方面的差值在-12.97～-22.70之间(P<0.01)。KCCQ得分(除了自我评价和自我认识)随着心衰严重而降低,与心衰的严重程度呈负相关。单因素的logistic回归分析中,除了KCCQ自我认识得分外,KCCQ躯体受限得分、KCCQ自我评价得分、KCCQ症状得分、KCCQ社会功能得分、KCCQ总得分、KCCQ临床得分、KCCQ心理方面得分都是短期预后因子。结论 KCCQ有很好的可信度和效度,可以用于心衰患者生存质量的评价、患者的管理和预后判断。

Objective To investigate the reliability,validity and responsiveness of KCCQ. Methods A consecutive series of 96 patients admitted to the first affiliated hospital of Sun Yatsen University Cardiologic Department with CHF between September 2002 and January 2003 were studied. Upon entry into the study, patients were asked to fill out the disease-specific quality of life questionnaires KCCQ and Minnesota living with heart failure questionnaire ( MLWHF) , which were repeated three months later. Results Almost all of the intra-cronbach α of KCCQ is larger than 0. 8 except the self efficacy domain. KCCQ was highly correlated with MLWHF (r = 0. 566 to 0. 894, P < 0. 01 for all). Among 24 stable CHF patients, minimal changes in KCCQ domains were detected after three months of observation ( mean change = -1. 8 to 6. 5 points, P > 0. 05 for all). In contrast, significant changes in scores of KCCQ were observed among patients whose status were improved ( mean change = 15. 9 to 27. 5 points, P < 0. 01 for all) and among patients, deteriorated (mean change = - 12.97 to -22.70 points, P <0. 01) except self efficacy domain. KCCQ scores decreased proportional with the severity of CHF. In univariate regression, except self-efficacy, physical limitation of KCCQ, self-evaluation of KCCQ, symptoms of KCCQ, social limitation of KCCQ, the emotional domain of KCCQ, clinical summary of KCCQ and total score of KCCQ were the short-time prognostic factors of CHF. Conclusion KCCQ is a valid, reliable, responsive measurement of healthy status for patients with CHF, and can be used to assess the quality of life, manage treatment and evaluate prognosis of patients with CHF.