基于广义估计方程的阿尔茨海默病健康相关生命质量影响因素研究

Influencing Factors for Health-related Quality of Life of Alzheimer's Disease Based on Generalized Estimating Equations

目的研究阿尔茨海默病(Alzheimer’s disease,AD)进程中不同认知转归结局健康相关生命质量(healthrelated quality of life,HRQOL)的主要影响因素。方法将阿尔茨海默病进程中的疾病状态和生命质量相结合,以认知正常老化为状态1、轻度认知障碍为状态2、中重度认知障碍为状态3、阿尔茨海默病为状态4,针对3次随访的纵向资料,引入广义估计方程,研究AD进程中HRQOL随疾病状态转移的影响因素。结果状态1至状态2 HRQOL有统计学意义的影响因素是婚姻、离休前职业、参加娱乐公益活动、吸烟、GDS;状态2至状态3 HRQOL影响因素是婚姻、夫妻关系、出生胎次、参加体育锻炼、一级亲属痴呆、ADL、GDS;状态3至状态4 HRQOL影响因素是教育水平、退休后第二职业、做家务情况、参加体育锻炼、喝茶、一级亲属痴呆、高血脂、GDS;状态3至状态2 HRQOL影响因素是教育水平、离休前职业、业余爱好、喝茶、吸烟、铝制炊具使用、控制食量、脑部疾患、ADL、GDS。结论 AD进程中HRQOL随状态转移的影响因素各有不同,应该根据不同认知转归结局生命质量各自的影响因素,制定疾病分阶段卫生政策,提高老年人生命质量。

Objective To explore the main influencing factors of health-related quality of life （HRQOL） in the different cognitive outcome of AD progression. Methods Combining disease status and quality of life in the AD progression, three waves data were collected and generalized estimating equations was used. Cognitive normally aging, MCI, moderate or severe cognitive impairment,and AD were defined as state 1,2,3 ,and 4,respectively. Results Marital,occupation before retire,recrea- tional and public service activities, smoking and GDS were statistically significant for HRQOL from state 1 to state 2. Marriage, conjugal relation, number of birth, physical exercise, first-degree relatives with dementia, ADL and GDS were statistically signifi- cant for state 2 to state 3. Education, second career after retirement, doing housework,physical exercise, tea, first-degree relatives with dementia,hyperlipidemia and GDS were statistically significant for state 3 to state 4. Education, occupation before retire, hobbies, tea, smoking, aluminum cookware, control appetite, brain disorders, ADL and GDS were statistically significant for state 3 to state 2. Conclusion The influencing factors of HRQOL with the state transitions in AD process were different. Health poli- cy can be developed based on influencing factors of different cognitive outcomes to improve HRQOL among the elderly.