手足口病重症患者健康相关生存质量评估

Health related quality of life on severe hand, foot and mouth disease patients

目的 评估手足口病重症患者的健康相关生存质量。方法 以全国传染病监测信息报告管理系统2012年1月1日至2013年12月31日报告的实验室确诊的6月龄至5岁手足口病重症患者为研究对象，采用代理欧洲五维度健康量表，包括EQ-5D健康描述系统和视觉模拟标尺法（Visual Analogue Scale，EQ-VAS），通过电话调查方式获得患者在患病期间的健康相关生存质量。结果 对685名手足口病重症患者进行调查，男性456例（66.6%），519例（75.8%）研究对象为≤3岁儿童。337例（49.2%）和407例（59.4%）手足口病重症患者在行动能力和日常活动维度报告有问题，569例（83.1%）和616例（89.9%）患者在疼痛/不适和焦虑/抑郁维度报告有问题。重症患者的平均健康效用值为0.58±0.23，EQ-VAS评分为53.6±25.7，随病程延长评分降低。手足口病重症患者患病期间平均质量调整生命年损失为（15.45±13.75）年/1 000人，各并发症患者的质量调整生命年损失（年/1 000人）分别为呼吸道感染11.17 ±8.83；无菌性脑膜炎13.56±11.99；脑干脑炎/急性弛缓性麻痹（acute flaccid paralysis，AFP） 15.31±12.63；心肌炎17.28±18.16；肺出血/肺水肿17.34±14.98；心肺衰竭25.47±20.53。EV71相关患者的质量调整生命年损失为16.51±14.48，高于柯萨奇病毒A组16型（Cox A16）感染患者的13.02±11.45和其他肠道病毒感染患者的14.74±14.22（Z=11.83，P=0.003）。结论 手足口病重症患者的健康相关生存质量受影响较大，且随着并发症的加重和病程的延长而加重。

Objective To evaluate the health related quality of life （HRQoL） for severe hand,foot and mouth disease （HFMD） patients with different complications. Methods A national telephone interview under the EQ-5D proxy2 questionnaire （EQ-SD and EQ-VAS）, was conducted to obtain the HRQoL of lab-confirmed severe HFMD patients, aged between six months and five-year-olds from the national communicable disease surveillance system from January 1, 2012 to December 31, 2013. Results A total of 685 severe HFMD cases were included in the study. A total of 456 （66.6%） of them were males with 75.8% of them younger than three years old. A total of 337 （49.2%） and 407 （59.4%） of the participants reported that they had problems in mobility or daily activities. A total of 569 （83.1%） and 616 （89.9%） of the cases reported having problems in pain/discomfort or anxiety/depression. The average EQ-5D and EQ-VAS scores were 0.58±0.23 and 53.6±25.7, both were positively associated with the duration of illness. Mean quality adjusted life years loss during the HFMD episode for the severe patients was （15.45±13.75） years/1 000 persons. The QALY losses for severe patients with each of below complication were： respiratory diseases （11.17±8.83） years/1 000 persons, aseptic meningitis （13.56±11.99） years/1 000 persons, encephalitis/brainstem encephalitis/acute flaccid paralysis （AFP） （15.31±12.63） years/1 000 persons, Myocarditis （17.28±18.16） years/1 000 persons, pulmonary hemorrhage/pulmonary edema （17.34±14.98） years/1 000 persons, cardiopulmonary failure （25.47±20.53） years/1 000 persons. Among patients with lab confirmed Entero virus A71 （EV71） （16.51±14.48） years/1 000 persons, the QALY loss was seen higher than Coxsackie virus A16 （Cox A16） （13.02±11.45） years/1 000 persons and other Enter virus （14.74±14.22） years/1 000 persons （Z=11.83, P=0.003）. Conclusion The HRQoL loss for severe HFMD patients substantially increased under complications exacerbation and related to the duration of illness.