克罗恩病患者健康相关生存质量研究及其影响因素

Healthy-related quality of life in patients with Crohn disease and its affecting factors

为探讨克罗恩病(Crohn disease,CD)患者心理症状及影响生存质量(quality of life,QOL)的因素,调查CD组及健康对照组人群各50例,分别采用ZUNG焦虑自评量表(self-rating anxiety scale,SAS)、ZUNG抑郁自评量表(self-rating depression scale,SDS)、炎症性肠病专用量表(inflammatory bowel disease questionnaire,IBDQ)、健康调查简表(short from-36 health survey,SF-36)进行测评。结果显示,焦虑、抑郁发生率CD组SAS[(40.3±8.5)分]、SDS[(47.1±11.1)分]与健康对照组[SAS(37.6±7.0)分,SDS(41.8±9.6)分]比较,差异均有统计学意义(t=5.4,P<0.05;t=10.6,P<0.05)。IBDQ各维度得分,CD活动期患者为肠道症状(49.50±7.62)分,全身症状(23.92±5.07)分,情感功能(57.13±15.62)分,社会功能(22.15±9.08)分;CD缓解期患者为肠道症状(60.12±4.01)分,全身症状(26.24±3.97)分,情感功能(67.34±15.17)分,社会功能(25.44±2.03)分,2组各维度得分比较差异均有统计学意义(P均<0.05)。SF-36量表各维度如躯体功能、躯体疼痛、一般健康状况、情感角色、总的心理健康和总的躯体健康等方面得分,CD组均明显低于健康对照组,2组差异均有统计学意义(P均<0.05);CD缓解期患者在躯体功能、一般健康状况和总的心理健康维度的得分均高于CD活动期患者(P<0.05);出现营养不良的患者在总的躯体健康和活力维度的得分显著低于无营养不良组,差异有统计学意义(P<0.05)。对患者生存质量进行多因素分析显示,疾病分期、营养风险对IBDQ总分有明显影响(P<0.05),其他因素如性别、年龄、婚姻状况、受教育背景、医疗费用、生物制剂治疗、手术治疗对IBDQ评分无明显影响(P>0.05)。综上,对CD患者进行心理疏导,活动期积极治疗,有望改善CD患者生存质量。

To evaluate the psychological symptoms of patients with Crohn disease(CD),and to explore the risk factors affecting quality of life(QOL)in CD patients,50 adult patients with CD,and 50 healthy controls were enrolled.Psychological questionnaires including self-rating anxiety scale(SAS),self-rating depression scale(SDS),the inflammatory bowel disease questionnaire(IBDQ)and the short form-36 health survey(SF-36)were completed.The results showed both the SAS(40.3±8.5 VS 37.6±7.0)and the SDS(47.1±11.1 VS 41.8±9.6)in CD patients were significantly higher than those in the healthy controls(t=5.4,P<0.05;t=10.6,P<0.05).The IBDQ scores revealed the physical symptoms scores were 49.50±7.62,systemic symptoms scores 23.92±5.07,emotional functions scores 57.13±15.62,and social function scores 22.15±9.08 in CD active phase.However,the above scores were 60.12±4.01,26.24±3.97,67.34±15.17,and 25.44±2.03 respectively in the remission phase.Four subscale items of IBDQ in CD active phase were significant lower than those in the remission phase(all P<0.05).The subscale items of SF-36 scores(PF,RP,BP,GH,VT,SF,RE,MH)in CD patients were significant lower than those in healthy controls(all P<0.05).The SF-36 items scores of PF,RP and MH in the remission phase were significant higher than those in the active phase(all P<0.05).The SF-36 items scores of GH and VT in patients with malnutrition were significant lower than those with nutrition(both P<0.05).Multivariate regression analysis showed that disease status and nutritional risk(P<0.05)significantly affected the patients'IBDQ scores.Factors including sex,age,marital status,education background,medical insurance,use of biologicals,surgery treatment had little influence on the total score of IBDQ(P>0.05).Psychological conseling and treatment in the active phase may improve QOL of CD patients.