葡萄膜炎患者的视觉和健康相关生存质量研究

Vision-and health-related quality of life in patients with uveitis

目的评估并分析葡萄膜炎患者的视觉相关生存质量、健康相关生存质量及其与视力之间的关系。方法横断面研究。对2013年1月1日至2014年4月1日就诊于北京大学第一医院眼科门诊的111例葡萄膜炎患者，进行病史采集和最佳矫正视力（LogMAR）等常规眼科检查，收集入组患者一般信息（性别、葡萄膜炎类型等）。同时进行视觉相关生存质量量表（NEIVFQ．25）和健康相关生存质量量表（SF-36）调查。将入组患者分为前葡萄膜炎组、本研究中其他类型葡萄膜炎（OTU）组（包括中葡萄膜炎、后葡萄膜炎及全葡萄膜炎）。对服从正态分布的变量进行t检验，不服从正态分布的变量进行两独立样本秩和检验，并使用相关性分析、一元线性回归进行双眼视力与NEIVFQ．25量表、SF-36量表之间的相关、回归关系分析。结果人组的111例葡萄膜炎患者中前葡萄膜炎87例（78．4％）、中间葡萄膜炎5例（4．5％）、后葡萄膜炎7例（6．3％）、全葡萄膜炎12例（10．8％）。其中ATU患者平均较好视力0．0，ATU患者平均较差视力0．2；OTU患者平均较好视力0．1，OTU患者平均较差视力0．4。在NEIVFQ．25及SF-36量表中，患者整体健康水平的评分相对量表中其他亚项较低[NEIVFQ-25量表中整体健康水平得分为25．0（25．0～50．0），SF．36量表中整体健康水平得分为46．8（19．8）]；ATU组患者两份量表的总得分高于OTU组患者[SF-36量表中，ATU患者总得分为77．5（10．7），OTU患者总得分68．8（16．9），P〈0．01，t=9．54；NEIVFQ．25量表中，ATU患者总得分为77．3（12．8），OTU患者总得分为59．1（16．5），P〈0．01，t=33．16]；NEIVFQ-25量表平均分与双眼视力均有相关关系[NEIVFQ-25量表平均分为73.4（15．5），平均较好视力为0．0（-0．2～1．0），平均较差视力为0．3（0．5）]，NEIVFQ-25量表平均分与较好视力相关系数为-0．50（t=-5．98，P〈0．01），与较差视力相关系数-0．32（t=-3．48，P〈0．01），进行回归分析，患者视觉相关生存质量与较好视力回归系数-3．9（t=-5．98，P〈0．01），视觉相关生存质量与较差视力回归系数-1．1（t=-3．48，P〈0．01）。结论葡萄膜炎患者对自身整体健康水平的评价相对较低，ATU患者生存质量较本研究中OTU患者高：视觉相关牛存质量与双眼视力均具有相关性。

Objective To evaluate vision-and health-related quality of life in patients with uveitis, and to evaluate the relationship between quality of life and visual acuity. Methods Cross-sectional study. One hundred and eleven patients with uveitis were enrolled in the study from January 1, 2013 to April 1, 2014 in Peking University First Hospital Clinical data collected included medical history, complete ophthalmologic examination and best corrected visual acuity （LogMAR）. Basic clinical data （gender, diagnosis, etc.） was also collected. The National Eye Institute Visual Functioning Questionnaire （NEI VFQ- 25） and the 36-Item Short Form Health Survey （SF-36） were administered. The patients were divided into two groups, anterior uveitis group （ATU）, and other types of uveitis in this study （OTU）. T-test was used for analysis of the data which obey standard normal distribution, otherwise rank sum test was used for data analysis. Correlation and Linear regression were constructed between bilateral visual acuity and the scores of NEI VFQ-25 and SF-36 questionnaires. Results For all the 111 cases included in this study, 87 （78.4%） of them were anterior uveitis （ATU）, 5 of them were intermediate uveitis, 7 of them were posterior uveitis and 12 of them were pan uveitis. Mean visual acuity of better and worse eye were 0.0 and 0.2 in ATU patients, respectively. Mean visual acuity of better and worse eye were 0.1 and 0.4 in OTU patients, respectively. Patients rated the general health subscale score of NEI VFQ-25 and SF-36 lower than other subscales, respectively （score of general health was 25.0 （25.0-50.0） in NEI VFQ-25 and 46.8 （19.8） in SF-36）. ATU group scored higher that OTU group （Mean score of SF-36 was 77.5 （10.7） and 68.8 （16.9） in ATU and OTU group respectively, P value of SF-36〈 0.01, t=9.54. Mean score of NEI VFQ-25 was 77.3 （12.8） and 59.1 （16.5） in ATU and OTU group respectively, P value of NEI VFQ-25〈0.01, t=33.16）. Mean score of NEI VFQ- 25 of all patients was 73.4 （15.5）. Mean visual acuity of better eye and worse eye of all patients were 0.0 （-0.2-1.0） and 0.3 （0.5）, respectively. The correlation coefficient was -0.497 （P〈0.01, t=-5.98） between NEI VFQ -25 score and visual acuity in better eye, and -0.32 （t=-3.48, P〈0.01） between NEI VFQ-25 score and visual acuity in worse eye. The coefficient was -3.9 in linear regression of visual acuity in better eye against NEI VFQ-25 score （t=-5.98, P〈0.01）, and-1.1 of visual acuity in worse eye against NEI VFQ-25 score （t=-3.48,P〈0.01）. Conclusions General health was more affected than other function subscales in uveitis. The quality of life in anterior uveitis was higher than other types of uveitis in this study. Vision-related quality of life correlated with both eyes.