特发性肺纤维化St．George’s呼吸问卷的横断面和纵向建构效度研究

Cross-sectional and longitudinal construct validity of the Saint George＇s respiratory questionnaire in patients with idiopathic pulmonary fibrosis

目的明确应用St．George’s呼吸问卷测量IPF患者健康相关的生活质量（HRQoL）的横断面和纵向建构效度。方法68例IPF患者进行St．George＇s呼吸问卷评分和肺功能检测，呼吸困难评分，动脉血气检测，6min步行试验（6MWT）和肺高分辨率螺旋CT（HRCT）评分，其中45例患者给予随访。结果基线研究发现，通过St．George’s呼吸问卷评分测定的HRQoL严重受损，特别是症状和活动评分。随访研究发现，活动评分显著下降，TLC及其变化和St．George＇s呼吸问卷各项评分显著负相关（r〈-0．3，P〈0．05）。多元回归分析发现TLC是St．George’s呼吸问卷各项基线评分独立贡献因素。在随访研究中也发现相似结果.HRCT总评分（CT-Tot）和St．George＇s呼吸问卷各项评分显著相关（r〉0．3，P≤0．001）。HRCT磨玻璃影评分（CT—alv）的变化和St．George’s呼吸问卷各项评分相关（r〉0．3，P≤0．001）。多元回归分析显示HRCT纤维化评分（CT—fih）是活动评分变异的贡献因素，随访研究发现，CT—alv的变化是St．George＇s呼吸问卷总评分变化的独立贡献因素。在基线及随访研究中，呼吸困难评分及其变化和St．George’s呼吸问卷除症状评分外的各项评分湿著相关。结论本研究证实了应用St．George’s呼吸问卷评分评估IPF患者健康相关的生活质量具有很好的横断面和纵向建构效度。关于其可信性、反应性及随访研究应作为以后研究的重点。但是为了最后能够应用St．George’s呼吸问卷评分评估IPF患者，需要继续评估其可靠性和反应性。

Objective This study was performed to confirm the cross-sectional and longitudinal construct validity of the Saint George＇s Respiratory Questionnaire （SGRQ） tor the measurement of health-related quality of llfe （HRQoL） in patients with idiopathic puhnonary fibrosis （IPF）. Methods Sixty-eight patients with IPF respondcd to the SGRQ and were subjected to pulmonary function tests （PFTs）, dyspnea testing, arterial hlood gas analysis, the six-minute walk test （6MWT）, as well as the high-resolution computed tomography （HRCT） in a baseline study. A follow-up study was concomitantly performed on 45 of these patients. Results The HRQoL measured by the SGRQ in IPF patients was substantially impaired, especially in symptoms and activity domains, in baseline study. A significant decline in HRQoL was observed in the activity domain during follow-up. The TI,C, and its changes, showed the most significantly inverse correlation with each SGRQ domain （r 〈-0.3, P 〈 0.05）. In a stepwise multiple regression analysis, TLC was the factor made the most significant contribution to each SGRQ component baseline score. Similar results were also found during follow-up. A significant correlation was found between the CT-Tot scores and each component of the SGRQ （r 〉 0.3, P ≤ 0.001）. Changes in CT-alv were also correlated with those in each SGRQ domain （r〉 0.3, P ≤ 0.001）. Stepwise muhiple regression analysis showed that CT-fib contributed to variation in the baseline activity score, and that changes in the CT-alv independently contributed to overall changes in the SGRQ domains in the follow-up study. The dyspnea score, and its changes, significantly correlated with the SGRQ sores, with the exception of the symptoms score, in both the baseline and follow-up studies. Conclusion This study demonstrated that the heahh-related quality of life assessed by the SGRQ has good cross-sectional and longitudinal construct validity in patients with IPF. However, this work needs additional studies to analyze the reliability and the responsiveness in order to definitively be able to use the SGRQ in IPF.