阿尔茨海默病生命质量与日常行为能力的关系及其影响因素

The relation and influencing factors regarding quality of life and activity of daily living among patients with Alzheimer's disease

目的利用多元多水平模型对阿尔茨海默病（Alzheimer＇s disease,AD）患者的生命质量与日常行为能力的关系及其影响因素进行研究。方法采用104名AD患者2010年10月-2012年5月每六个月随访一次共4次的随访数据,以AD患者生命质量得分及日常行为能力得分为反应变量,患者的一般情况、认知功能和抑郁状态为解释变量,拟合两元三水平模型后进行分析。结果 AD患者的生命质量与日常行为能力在个体和测量时点水平上具有相关性且为负相关,相关系数分别为-0.41（χ^2=7.857,P〈0.001）和-0.24（χ^2=9.747,P〈0.005）。影响AD患者生命质量的因素有婚姻状况、体育活动、读书看报、饮酒及患者的认知功能和抑郁状态6个因素（回归系数分别为-3.21,1.79,1.69,3.63,0.16,-0.10）,影响AD患者日常行为能力的因素有受教育程度、经常做家务、患者认知功能及抑郁状态4个因素（回归系数分别为-0.98,-4.69,-0.19,0.11）。结论 AD患者的生命质量与日常行为能力呈负相关,且受多种共同因素影响,可据此采取有针对性的措施,提高患者的生命质量与日常行为能力。多元多水平模型对于存在多种反应变量的纵向数据分析有一定的优势。

Objective To introduce the multivariate multilevel models into exploring the relations and the influencing factors between quality of life and activity of daily living among patients with Alzheimer＇s disease （AD）. Methods Data were collected from four follow-up visits to 104 AD patients, which were conducted at an interval of six months from October 2010 to May2012. The multivariate muhilevel model was built to explore influencing factors with quality of life and activity of daily living as the dependent variables, patients＇ basic facts, cognition and depression as explanatory variables. Results AD patients＇ quality of life and activity of daily life were negatively correlated at individual level and observation time level and the correlation coefficients were -0.41 （χ^2=7.857, P〈0.010）and-0.24 （χ^2=9.747, P〈0.005）. Marital status, sports activities, reading books or newspapers, drinking, patients＇ cognition and depression were the significant factors for patients＇ quality of life （regression coefficients were -3.21,1.79,1.69,3.63,0.16,-0.10respectively ） ; Educational level, doing housework, patients＇ cognition and depression were the significant factors for patients＇ activity of daily living （regression coefficients were-0.98,-4.69,-0.19,0.11respectively） Conclusion AD patients＇ activity of daily living is negatively associated with quality of life, and they are influenced by some common factors. Strategies on improving the quality of life and activity of daily living among AD patients can be developed based on the findings of this study. Muhivariate multilevel model is advantageous in studying longitudinal data with two or more dependent variables.