艾滋病患者生活质量影响因素的多元线性回归分析

Multiple linear regression analysis on influencing factors of quality of life in AIDS patients

目的:筛选出在中国文化背景下影响艾滋病患者生活质量的主要因素。方法:于2005-03采用多阶段抽样的方法,利用WHOQOL-120HIV回译量表对河南省上蔡县艾滋病患者(艾滋病病毒抗体阳性)进行问卷调查,内容包括一般情况和生活质量评价指标。①一般情况有性别、年龄、最高文化程度、婚姻状况、家庭年收入、目前出现的艾滋病相关症状等。②生活质量评价:采用已进行适当文化调适的WHOQOL-120HIV量表,包括生理、心理、独立性、社会关系、环境、精神支柱/宗教/个人信仰等6个领域、29个方面的120个条目,每个指标分为5个等级,按照健康状况最好到最坏依次记为1,2,3,4,5,此外还包括4个关于总体健康状况和生活质量的问题。计算并记录6大领域的各个领域得分和总体生活质量得分。具有高中以上文化程度者自行填写,其他文化程度者进行面对面访谈式调查。结果:发放问卷66份,收回合格问卷64份,有效率97%。①男性生活质量心理领域得分高于女性[(12.36±1.82),(11.26±2.21)分,t=2.14,P=0.036]。②按年龄分布的25,75百分位数将调查对象分为3组,即<35岁组、35～59岁组、≥60岁组,进行各年龄组间的方差分析显示各年龄组在生理领域和环境领域差异有显著性意义(F=4.13,P=0.021;F=5.14,P=0.009)。③已婚者社会关系领域得分高于丧偶者[(13.47±1.85),(11.66±2.95)分,t=2.37,P=0.021];④年收入小于1000元、1000～2999元和大于3000元3组患者社会关系领域的得分分别为(12.10±2.27),(13.13±1.91),(14.13±1.92)分,年收入越高者在社会关系领域的得分越高(F=4.98,P=0.010)。⑤按患者出现的艾滋病症状多少的25,50,75百分位数考虑将其分为3组,方差分析显示,出现症状的多少影响生活质量中心理、生理、独立性、社会关系、环境、精神支柱和个人信仰6个领域的得分,出现艾滋病相关症状越少,生活质量越高。⑥Spearman等级相关分析显示,艾滋病相关症状数目与生活质量得分呈负相关(rs=-0.54,P=0.001)。⑦以性别、是否服抗病毒药物、婚姻状况、是否规律服药、文化程度高低、年龄、年收入、症状出现的多少等变量作为自变量,将生活质量各领域得分和总体生活质量得分作为因变量分别进行多元逐步回归分析,结果显示较大年龄、女性、丧偶、艾滋病相关症状的数目与生活质量得分呈负相关。结论:性别、年龄、收入的高低、婚姻状况等分别影响艾滋病患者生活质量的不同领域,而艾滋病相关症状则是艾滋病患者生活质量的主要影响因素。

AIM： To screen the important influencing factors of quality of life of AIDS patients under Chinese culture background. METHODS： With multi-stage sampling method, AIDS patients （positive HIV antibody） from Shangcai County of Henan Province were assigned to fill in the WHOQOL-120 HIV questionnaire in March 2005 including general condition and evaluated index of quality of life. ①The general condition was composed of sex, age, highest education degree, marital status, annum income, current AIDS related symptoms and so on. ②Evaluation of quality of life： The modified WHOQOL-120 HIV scale was adopted including 6 domains, 29 aspects and 120 items： physiological, psychological, independence, social relationship, environment, mental support/religion/ individual beIief, every index was divided into 5 grades, which was scored 1, 2, 3, 4, 5 according to the health condition. Additionally, there were 4 questions about general health condition and quality of life. The scores of each field and total scores of quality of life were calculated and recorded. The people with high school education or above were allowed to fill in the questionnaires by themselves, and the other ones were given face to face investigation. RESULTS： Totally 66 copies of WHOQOL-120 HIV questionnaires were sent out and 64 of them were qualified with efficient rate of 96%. ①The scores ＇in Psychological Domain of males were higher than those of females [（12.36±1.82）, （11.26±2.21） scores, t=2.14, P=0.036]. ②The examinees were divided into 3 groups according to 25 and 75 percentile of age distribution： 〈 35 years group, 35-59 years group and ≥60 years group. The analysis of variance in different age group showed that there were significant differences in physical and environmental fields among different age groups [F=4.13, P=0.021; F=5.14, P=0.009]. ③Married persons had higher scores of Social Relationship Domain compared with persons lost spouse [（13.47±1.85）, （11.66±2.95） scores, t=2.37, P=0.021].④The scores in Social Relationship Domain of patients with annual income 〈 1 000 yuan, 1 000-2 999 yuan and 〉 3 000 yuan were （12.10±2.27）, （13.13±1.91）, and （14.13±1.92）, respectively; the higher the income, the higher the scores in social relationship domain （F=4.98, P=0.010）. ⑤Patients were divided into 3 groups according to 25, 50 and 75 percentile of the AIDS symptoms, and the analysis of variance showed that the numbers of symptoms could influence the scores of physiological, psychological, independence, social relationship, environment, mental support and individual belief; the fewer the symptoms, the higher the quality of life.⑥Spearman correlation analysis showed that there was a negative correlation between total score of quality of life and numbers of symptoms in AIDS patients （r,=-0.54, P=0.001）. ⑦With sex, taken antiviral drug or not, marital status, taken drug regularly or not, education degree, age, annual income and numbers of symptoms as independent variables and the scores of each domain of quality of life and general quality of life as dependent variables, the multiple stepwise regression analysis showed that the patients of older, female, lost spouse and numbers of symptoms were negatively associated with the scores of quality of life. CONCLUSION： Sex, age, annual income, marital status and so on can affect different domains of quality of life in AIDS patients, in which the number of AIDS related symptoms is the most important influencing factor.