改变认知因素对功能性消化不良患者生命质量的影响

Effects of changing cognitive factors on the quality of life in patients with functional dyspepsia

目的探讨疾病认知干预对功能性消化不良（FD）患者生命质量的影响。方法采用疾病认知简易问卷（B-IPQ）、尼平消化不良指数（NDI）对2013年5月至2015年2月入选的412例FD患者疾病认知、生命质量分别进行评价，并给予相应的认知干预。随访1年后，患者提供其自觉症状的改善程度及当前治疗情况，分析随访前后疾病认知的变化及其对生命质量的影响。采用t检验、卡方检验、Spearman相关分析及线性回归进行统计学分析。结果随访过程中有53例（12.9%）FD患者失访，24例（5.8%）拒绝随访，最终共335例（81.3%）FD患者完成了平均1年的随访研究。疾病认知改善的患者有185例（55.2%），认知无改善者150例（44.8%）。疾病认知改善与无改善患者选择中药、未服药者比例[分别为6.5%（12/185）比18.7%（28/150），53.5%（99/185）比30.7%（46/150）]差异均有统计学意义（χ2＝10.558、16.695，P均〈0.01）。疾病认知改善与无改善患者自觉消化不良症状改善、无变化和恶化发生率[分别为62.2%（115/185）比40.7%（61/150），12.4%（23/185）比30.0%（45/150），4.3%（8/185）比14.0%（21/150）]差异均有统计学意义（χ2＝14.500、14.735、8.622，P均〈0.01）。疾病认知改善与无改善者的NDI得分分别为（31.6±9.8）分和（45.9±12.8）分，差异有统计学意义（t＝4.862，P〈0.01）。随访前的横向线性回归分析显示，疾病影响、疾病定性、关注、情绪反应是NDI的横向影响因素（β＝0.329、0.183、0.191、0.236，P均〈0.05）。随访后的纵向线性回归分析显示，疾病影响、疾病定性、个人控制、关注、情绪反应、疾病理解是NDI的决定性影响因素（β＝0.248、0.212、－0.125、0.298、0.263、－0.146，P均〈0.05）。结论认识并改变FD患者对疾病的不良认知可能有助于提高其生命质量。

ObjectiveTo explore the effects of cognitive intervention on the quality of life in patients with functional dyspepsia（FD）.MethodsFrom May 2013 to February 2015, a total of 412 patients with FD were enrolled, cognition of the disease and the quality of life were assessed by disease cognitive simple questionnaire （B-IPQ） and Nepean dyspepsia index （NDI）. The patients also received related cognitive intervention. After one-year follow-up, patients reported the degree of improvement in self symptoms and current treatment. The changes of cognition of the disease and its effects on the quality of life before and after follow-up were analyzed. The t test and Chi-square test, Spearman correlation and linear regression were performed for statistical analysis.ResultsDuring follow-up, 53 patients （12.9%） with FD lost to follow-up and 24 patients （5.8%） refused follow-up, and in the end a total of 335 patients （81.3%） with FD completed one year follow-up study. A total of 185 patients （55.2%） had improvement in cognition of the disease and 150 patients （44.8%） without improvement in cognition. The differences in the rates of taking traditional Chinese medicine and not taking any medicine between patients with and without cognition improvement were statistically significant （6.5% （12/185） vs 18.7%（28/150）, 53.5%（99/185） vs 30.7%（46/150）, respectively; χ2=10.558 and 16.695, both P〈0.01）. The differences in the rates of patients with self symptoms improvement, without improvement and self symptoms worsen between patients with and without cognition improvement were statistically significant （62.2% （115/185） vs 40.7%（61/150）, 12.4% （23/185） vs 30.0% （45/150）, 4.3% （8/185） vs 14.0% （21/150）, respectively; χ2=14.500, 14.735 and 8.622, all P〈0.01）. NDI scores of patients with and without cognition improvement were 31.6±9.8 and 45.9±12.8, respectively, and the difference was statistically significant （t=4.862, P〈0.01）. Before follow-up, the results of cross-sectional linear regression analysis indicated disease consequences, disease identity, concern beliefs, emotional response were influence factors of NDI （β=0.329, 0.183, 0.191, 0.236, all P〈0.05）. After follow-up, the results of longitudinal linear regression analysis showed that disease consequences, disease identity, personal control, concern beliefs, emotional response and disease comprehensibility were key influence factors of NDI （β=0.248, 0.212, -0.125, 0.298, 0.263, -0.146, all P〈0.05）.ConclusionRecognizing and improvement of incorrect cognition of the disease in patients with FD may improve their quality of life.