基于EQ-5D量表的温州地区原发性开角型青光眼患者的生活质量研究

Quality of life of patients with primary open-angle glaucoma based on EQ-5D in Wenzhou

目的观察温州地区原发性开角型青光眼(POAG)患者的生活质量及其关联特征。方法横断面研究。纳入2014年3月至2019年10月在温州医科大学附属眼视光医院开展的温州青光眼进展研究中确诊的POAG患者339例,采用欧洲五维度生活质量(EQ-5D)量表[含视觉模拟尺度(VAS)]评估POAG患者生活质量,并分析不同性别、年龄、视力及视野缺损程度、青光眼家族史、高血压、糖尿病、偏头痛以及日常睡眠、业余锻炼与生活质量的关系。健康效用值与VAS评分以M(P25,P75)表示,两组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis H检验。结果339例POAG患者中男性164例(48.4%),女性175例(51.6%),年龄(63±10)岁。34例(10.0%)患者接受过药物治疗(含1例手术治疗),305例(90.0%)患者入组前均未接受过抗青光眼治疗。POAG患者视野较好眼中未出现视野缺损者占10.5%(32/305),早期、中期、晚期视野缺损者分别占68.9%(210/305)、17.0%(52/305)、3.6%(11/305)。EQ-5D量表测得的POAG患者的健康效用值为1.000(1.000,1.000),平均值为0.964;VAS评分为80(75,90)分,平均值为81.58分。共94例POAG患者EQ-5D量表测得健康效用值下降,其中焦虑或抑郁和疼痛或不适比例分别为45.7%(43例)和34.1%(32例),行动能力存在困难13.8%(13例),日常活动受限6.4%(6例)。POAG患者视野较好眼中未出现视野缺损者及早期、中期视野缺损者的健康效用值均为1.000(1.000,1.000),晚期视野缺损者的健康效用值为1.000(0.862,1.000),不同视野缺损程度多组间健康效用值及VAS评分比较差异均无统计学意义(均P>0.05)。不同睡眠质量间健康效用值差异有统计学意义(H=17.465,P<0.01),睡眠质量很好患者健康效用值为1.000(1.000,1.000),睡眠质量一般患者健康效用值为1.000(0.866,1.000),差异有统计学意义(z=3.613;P<0.05)。合并偏头痛、合并高血压、合并糖尿病患者的健康效用值均为1.000(0.875,1.000),无偏头痛、无高血压、无糖尿病患者的健康效用值均为1.000(1.000,1.000),是否合并偏头痛、高血压、糖尿病之间健康效用值差异均有统计学意义(Z=-2.189,-3.864,-2.417;均P<0.05)。EQ-5D量表健康效用值与年龄、性别、青光眼家族史、业余锻炼程度、烟酒史以及抗青光眼药物治疗史之间未发现明显关联(均P>0.05)。结论温州地区POAG患者EQ-5D量表结果显示,早期视野缺损的患者生活质量较好,晚期视野缺损的患者生活质量降低;睡眠质量、合并症及心理生理不适也与POAG患者生活质量降低有关。(中华眼科杂志,2021,57:207-214)

Objective To evaluate the quality of life of patients with primary open-angle glaucoma(POAG)and its related factors in Wenzhou.Methods Cross-sectional analysis.A total of 339 POAG patients diagnosed in the Wenzhou glaucoma progression study conducted in the Eye Hospital,School of Ophthalmology and Optometry,Wenzhou Medical University from March 2014 to October 2019 were included.Quality of life of POAG patients was assessed by EQ-5D including the visual analogue scale(VAS).The effects of gender,age,visual field loss(VFL),family history of glaucoma,hypertension,diabetes,migraine,sleep quality,and amateur exercise on the quality of life were analyzed.The utility value(UV)and VAS score were expressed as the median(P25,P75),and Mann-Whitney U was used for the comparison between two groups.Kruskal-Wallis H was performed to compare the differences among multiple groups.Results A total of 339 POAG patients were included in the study;164 were males(48.4%),and 175 were females(51.6%).The mean age was(63±10)years.Thirty-four patients(10.0%)had received medication(including one with combined surgical treatment),while the remaining 305 patients(90.0%)had received no anti-glaucoma treatment.Among the patients,10.5%(32/305)had no VFL,68.9%(210/305)had mild VFL,17.0%(52/305)had moderate VFL,and 3.6%(11/305)had severe VFL.In all patients,the median of UV was 1.000(1.000,1.000),the mean of UV was 0.964,and the median of VAS score was 80(75,90),the mean of VAS score was 81.58.Anxiety or depression and pain or discomfort occurred in 45.7%(43/94)and 34.1%(32/94),respectively,of POAG patients with decreased UVs,as well as mobility constraints in 13.8%(13/94)and usual activity constraints in 6.4%(6/94).The median of UV of the eye with a better visual field in the group without VFL or with mild or moderate VFL was 1.000(1.000,1.000),and in the group with severe VFL was 1.000(0.862,1.000),but there was no significant difference in the UV and the VAS score of the eye with a better visual field among groups with different degrees of VFL(both P>0.05).There was statistically significant difference in the UV among groups with different sleep qualities(H=17.465;P<0.01).Using pairwise comparison,the median of UV of the very good sleep group was 1.000(1.000,1.000),significantly different to the slightly poor sleep group 1.000(0.866,1.000)(z=3.613;P<0.05).The median of UV in patients with migraine was 1.000(0.875,1.000),without migraine 1.000(1.000,1.000),and in patients with hypertension was 1.000(0.875,1.000),without hypertension 1.000(1.000,1.000),and in patients with diabetes was 1.000(0.875,1.000),without diabetes was 1.000(1.000,1.000),the difference was statistically significant(Z=-2.189,-3.864,-2.417;all P<0.05).The UV was not related to age,gender,family history of glaucoma,amateur exercise,alcohol and tobacco,and history of anti-glaucoma medication(all P>0.05).Conclusions VFL is related to the UV of POAG patients in Wenzhou.Quality of life in mild POAG patients is good but decrease in advanced POAG patients.Sleep quality,systemic complications and physical or psychological discomfort impact on quality of life in POAG patients.(Chin J Ophthalmol,2021,57:207-214)