陕西省大骨节病患者健康相关生命质量调查分析

An investigation and analysis of health-related quality of life in patients with Kashin-Beck disease in Shaanxi Province

目的 了解陕西省成人大骨节病（Kashin-Beck disease，KBD）患者健康相关生命质量（health-related quality of life，HRQOL）现况及其影响因素，为提高KBD患者HRQOL提供参考依据。方法 2016年2月，采取两阶段整群随机抽样方法，在陕西省KBD高发地区（宝鸡、咸阳、铜川市）抽取现存疾病严重程度为Ⅰ度及以上KBD患者901例为调查对象，以入户调查的方式使用中文版SF-36量表测量HRQOL得分。36个条目分别为躯体功能（PF）、躯体角色（RP）、身体疼痛（BP）、总健康状况（GH）、活力（VT）、社会功能（SF）、情感角色（RE）和心理健康（MH）8个维度，以中位数（M）、四分位数（P25、P75）表示。使用多元线性回归对HRQOL影响因素进行分析。结果 共调查901例KBD患者，其中男性患者500人，女性患者401人，年龄为58（22 - 83）岁。Ⅰ度患者占37.18%（335／901），Ⅱ度患者占53.50%（482／901），Ⅲ度患者占9.32%（84／901）。GH、MH的得分男性［GH：35（25，50），MH：56（48，72）］患者高于女性［30（20，45），56（44，68），P均 〈 0.05］；不同年龄组间PF、RP、BP、GH、VT和SF得分比较差异有统计学意义（P均 〈 0.05）；不同教育程度患者间PF、RP、GH、VT、SF、RE和MH得分比较差异有统计学意义（P均 〈 0.05）；PF、SF得分已婚组［PF：55（40，75），SF：62（50，75）］高于其他婚姻状况组［50（35，65），50（38，75），P均 〈 0.05］；不同疾病严重程度者PF、BP、GH和SF得分差异有统计学意义（P均 〈 0.05）。不同地区KBD患者在PF、BP、GH、VT、SF和MH得分比较差异有统计学意义（P均 〈 0.05）。多元线性回归分析发现，与女性比较，男性是GH和MH得分的保护因素；年龄是PF、RP、BP、GH、VT和SF得分的危险因素；与文盲组比较，小学文化是PF和RE得分的保护因素，初中及以上文化是PF、RP、VT、SF、RE和MH得分的保护因素，与Ⅰ度比较，Ⅱ度、Ⅲ度是PF、BP、GH和SF得分的危险因素；与宝鸡市比较，咸阳市是SF的保护因素，铜川市则是PF、GH、VT、SF和MH得分的保护因素。结论 在KBD高发地区制定改善HRQOL措施时，应优先考虑患者年龄、教育程度和疾病严重程度因素。

Objective To investigate health-related quality of life （HRQOL） and influencing factors in adult patients with Kashin-Beck disease （KBD） in Shaanxi Province for improving health-related quality of life of KBD patients. Methods By the two-stage cluster random sampling method, data of 901 cases of KBD patients with the disease severity of grade 1 and higher were collected from higher KBD incidence areas of Baoji, Xianyang and Tongchuan in Shaanxi Province in February 2016. The Chinese version of SF-36 （including 8 dimensions： physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health） was used to measure the HRQOL. Multiple linear regression was used to analyze the influencing factors of HRQOL. Results In 901 cases of KBD patients, male accounted for 55.49% （500/901）, female accounted for 44.51 （401/901）. The median age of patients was 58 （22 - 83） years old. According to the severity of disease criteria, patients with grade Ⅰ were 37.18% （335/901）, patients with grade Ⅱ were 53.50% （482/901） and patients with grade Ⅲ were 9.32% （84/901）. The scores of each dimension of SF-36 scale in patients of male patients had higher scores in GH and MH than women [GH： 35 （25, 50） vs 30 （20, 45）, MH： 56 （48, 72） vs 56 （44, 68）, P 〈 0.05]. There were significant differences in PF, RP, BP, GH, VT and SF scores among different age groups （P 〈 0.05）. Similarly, there were significant differences in PF, RP, GH, VT, SF, RE and MH scores among patients with different educational levels （P 〈 0.05）. Married group was only higher in the PF and SF scores than other marital status groups [PF： 55 （40, 75） vs 50 （35, 65）, SF： 62 （50, 75） vs 50 （38, 75）, P 〈 0.05]. As expected, there were significant differences in the scores of PF, BP, GH and SF between the severity of diseases. There were also significant differences in the scores of PF, BP, GH, VT, SF and MH in KBD patients from different regions （P 〈 0.05）. According to multiple linear regression analysis results, male was the conservation factor of GH and MH scores compared with female; age was a risk factor for PF, RP, BP, GH, VT and SF scores; compared with the illiterate, primary school education was a protective factor for PF and RE scores, junior high school and above were PF, RP, VT, SF, RE and MH scores protective factors; compared with degree Ⅰ KBD, degree Ⅱ and degree Ⅲ were risk factors for PF, BP, GH and SF scores; compared with Baoji area, Xianyang area was a protective factor of SF score, however, Tongchuan area was a protective factor for PF, GH, VT, SF and MH scores. Conclusions KBD has severely damaged the HRQOL of patients. Priority should be given to age, educational attainment and severity of the disease for developing measures to improve KBD patients＇ HRQOL in different regions.