扩张型心肌病心力衰竭阶段患者健康相关生命质量评价及影响因素分析

Predictors of health-related quality of life in patients with dilated cardiomyopathy in the heart failure stage

目的了解扩张型心肌病心力衰竭阶段患者生命质量并探索其影响因素。方法2013年9月至2014年12月，采用目的抽样的方法抽取温州市某三甲医院住院扩张型心肌病心力衰竭阶段患者80例，对其展开一般情况问卷及SF．36v2量表问卷调查，并查阅相应病历。调查对象的一般资料采用描述性统计分析；计量资料采用均数±标准差；计数资料采用百分比；两组或多组定量资料间比较采用秩和检验；以生命质量SF-36v2量表两大主成分即生理健康、心理健康评分为因变量，以单因素分析结果显示的有统计学意义的变量为自变量，采用多元线性回归分析，分析出生理健康、心理健康的影响因素。结果该群体SF-36v2量表8个维度（生理功能；生理职能；身体疼痛；一般健康状况；精力；社会功能；情感职能；精神健康）及两大主成分（PCS：生理健康；MCS：心理健康）评分低，分别为20．18±14．66、31．91±10．00、45．07±11．49、30．76±7．01、37．56±11．59、24．87±11．67、36．01±13．97、36．47±11．29、26．96±12．09、40．75±12．28；经单因素分析发现，PCS评分的影响因子为：调查对象的性别（z=-2．05，P=0．04）、教育程度（H=8．37，P=0．02）、信仰状况（Z=-2．19，P=0．03）、医疗支付类型（H=8．49，P=0．01）、家庭年收入（H=6．52，P=0．04）、纽约心脏病学会（NYHA）心功能分级（H=5．55，P=0．04）、合并疾病（z=-2．27，P=0．02）；MCS评分的影响因子为：调查对象的婚姻状况（Z=-2．37，P=0．02）、年龄（H=10．51，P=0．01）、居住情况（H=19．76，P=0.00）；进一步经多元线性回归分析发现，调查对象PCS评分的影响因子主要有性别（t=3．50，P=0．00）、教育程度（t=2．70，P=0．01）、NYHA心功能分级（t=-2．84，P=0．01）及合并慢性病种类（t=-3．52，P=0．00），另外婚姻状况（t=2．88，P=0．01）是MCS评分的主要影响因子。结论扩张型心肌病心力衰竭阶段患者健康相关生命质量低；注意合并疾病的管控、心力衰竭的管理及加强配偶的支持是提高其生命质量的关键。

Objective To survey the quality of life and its influencing factors among patients with dilated cardiomyopathy in the heart failure stage. Methods During September of 2013 to December of 2014, 80 patients diagnosed of dilated cardiomyopathy in the heart failure stage were recruited as participants in major hospital in Wenzhou city. All of them finished questionnaires including general condition questionnaire and Chinese version of SF-36 v2, and corresponding pathography were read by investigators to complete the general condition questionnaire. The descriptive statistics analysis was used to describe general data of participants; mean ± standard deviation was used to analyze measurement data; percentage was used to analyze count data; rank-sum test was used to compare two or multiple groups; multiple factor logistic regression analysis （Pin = 0.05, Pout = 0.1） was used to analyze influencing factors of physical component summary and mental component summary based on the norm of the SF-36v2 with the independent variables showing a statistical significance in one-way ANOVA. Results The scores of eight dimensions （physical function; role-physical; bodily pain; general health; vitality; social function; role-emotional; mental health）; reported health transition two component summary （PCS： physical component summary; MCS mental component summary） of the SF-36 v2 were all significantly lower in patients with dilated cardiomyopathy in the heart failure stage, and they were 20.18± 14.66, 31.91 ± 10.00, 45.07± 11.49, 30.76±7.01, 37.56± 11.59, 24.87± 11.67, 36.01 ± 13.97, 36.47± 11.29, 26.96± 12.09, 40.75± 12.28 respectively. One-way ANOVA showed that gender （Z=-2.05, P=0.04）, education （H=8.37, P=0.02）, belief（z=-2.19, P=0.03）, insurance （H=8.49, P=0.01）, actual annual income （H=6.52, P=0.04）, NYHA classes （H=5.55, P=0.04）, comorbidity （Z=-2.27, P=0.02）significantly influenced physical component summary, while marital status （Z=-2.37, P=0.02）, age （H=10.51,P=0.01）, living condition （H=19.76, P= 0.00） significantly influenced mental component summary. Multiple factor Logistic regression analysis showed gender （t=3.50,P=0.00）, education（t=2.70,P=0.01）, NYHA classes （t=-2.84,P=0.01） and comorbidity （t=-3.52,P=0.00） were the main factors influencing the patients＇ physical component summary, while marital status （t=2.88, P=0.01） was the only one factor influencing the patients＇ mental component summary. Conclusions The quality of life among patients with dilated cardiomyopathy in the heart failure stage was low. Better managing and controlling eomorbidity and heart failure, and strengthening partner＇ support were the key measures to improve the quality of life among patients with dilated cardiomyopathy in the heart failure stage.