健康生命量表应用于自动化腹膜透析和持续非卧床腹膜透析患者生命质量评价的信效度研究

Reliability and validity of Chinese version of SF-36 scale for quality of life evaluation in automated peritoneal dialysis and continuous ambulatory peritoneal dialysis patients

目的基于陆军军医大学第二附属医院肾内科管理的腹膜透析患者数据,应用健康生命量表(the MOS item short form health survey, SF-36)对自动化腹膜透析(automated peritoneal dialysis,APD)患者及持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者进行多维度分析。方法采用目的抽样方法对2018年1月~2019年6月期间在陆军军医大学第二附属医院肾内科置管并行腹膜透析治疗的患者使用SF-36量表进行问卷填写,共收回有效问卷241份,其中APD组135份,CAPD组106份,通过信度以及集合效度、区分效度和结构效度等维度进行综合分析,从而得出2组患者在社会回归方面的结果。结果 APD组和CAPD组总体Cronbach’s α系数分别为0.93和0.92,2组量表均有良好的内部一致性信度。APD组(n=135)和CAPD组(n=106)样本的集合效度成功率分别为83%和93%,区分效度试验成功率分别为96%和98%,APD和CAPD具有良好的集合效度及区分效度(APD组Cronbach’s α=0.93,CAPD组Cronbach’s α=0.92,P值分别为0.034和0.025);标准效度方面,APD组样本的标准与量表得分计算的秩相关系数0.593大于CAPD组0.403,P值分别为0.320和0.300,SF-36量表用于APD组样本具有更加良好的标准关联效度;结构效度,2组数据非标准化因子载荷系数的t检验均显现出所有载荷系数在0.1水平上,并具有统计学意义(APD组t>0.1,CAPD组t>0.1,P值分别为0.017和0.030),这说明量表条目设定在2组中均是合理的。结论 SF-36量表用于腹膜透析患者生命质量统计分析具有良好的信度和效度,APD组内部信度以及标准关联效度等方面要优于CAPD组,提示APD患者在社会回归和情感功能等的优势。

Objective Based on the data from new peritoneal dialysis patient treated in the Department of Nephrology, Xinqiao Hospital of Army Medical University, multidimensional analyses on patients with automated peritoneal dialysis(APD) or continuous ambulatory peritoneal dialysis(CAPD) were performed by using the SF-36 quality of life questionnaire. Methods Purpose sampling method was used to investigate the peritoneal dialysis patients treated in the Department of Nephrology, the Second Hospital of PLA Military Medical University in the period from January 2018 to June 2019 by using the questionnaire of SF-36 scale. A total of 241 valid questionnaires were received, including 135 questionnaires from APD group and 106 from CAPD group. Their reliability and the dimensions of collective validity, discriminant validity and structural validity were comprehensively analyzed to obtain the results of social regression in the two groups of patients.Results The overall Cronbach’s α coefficients were 0.93 and 0.92 in APD group and CAPD group respectively, with better internal consistency reliability in both groups. The success rates of collective validity of the samples were 83% and 93%, and the success rates of discrimination validity tests were 96% and 98% in APD group(n=135) and CAPD group(n=106) respectively. Both groups had better collective validity and discrimination validity(Cronbach’s α=0.93 and 0.92, P=0.034 and 0.025 in APD group and CAPD group respectively). For standard validity, the rank correlation coefficient calculated by the standard and scale scores of the samples in APD group was 0.593, greater than 0.403 in CAPD group(P=0.320 and 0.300 respectively), suggesting that SF-36 scale has better standard correlation validity used in APD group. For structural validity, the t-test of the unstandardized factor load coefficients demonstrated that the load coefficients were statistically significant at >0.1 level in both groups(P=0.017 and 0.030 for APD group and CAPD group respectively), indicating that the designed entries in the scale are informative for both groups. Conclusion The SF-36 scale has good reliability and validity for statistical analysis of quality of life in peritoneal dialysis patients, and the internal reliability and standard correlation validity are better for APD group than for CAPD group, suggesting that social function and emotional state are better in APD patients than in CAPD patients.