中老年骨质疏松症人群Charlson共病指数及健康相关生命质量研究

A study on the Charlson comorbidity index and health-related quality of life in the middle-aged and elderly osteoporosis population

目的:探讨骨质疏松症(osteoporosis,OP)患者共病特征及该类人群健康相关生命质量的影响因素,为OP共病患者的共防、共治并提高全生命周期生活质量提供决策参考。方法:2017年11月至2018年7月,在北京市朝阳区、丰台区10个社区收集居民临床信息、生物样本并进行骨密度检测。借助Charlson共病指数(Charlson comorbidity index,CCI)对该人群共病情况进行量化,按性别、年龄等因素分组,探讨CCI组间差异。结合患者临床信息,对比分析共病(CCI≠0)与非共病(CCI=0)人群的差异特征。采用Pearson/Spearman相关性分析和二元Logistic回归分析,探索OP患者健康相关生命质量的影响因素。结果:521例OP患者中,121例患者无合并症,合并1、2、3、4种合并症的患者分别有153、106、65、30例,5种及以上合并症患者46例。高血压病为OP患者最常见共病,占比21.60%;其次为高脂血症,占比13.51%。最常见的两病组合为高血压病加高脂血症(64例,12.28%)。通过CCI不同年龄段组间差异分析发现,患者年龄越大CCI越高,组间差异有统计学意义(Z=1.93,P=0.05)。共病(CCI≠0)与非共病(CCI=0)患者欧洲五维健康量表(EuroQol five-dimensional questionnaire,EQ-5D)效用值总分以及焦虑沮丧维度差异均有统计学意义(Z=-2.67,P=0.01;Z=-2.44,P=0.02)。相关性分析发现,CCI、骨折史、跌倒史、双髋骨密度T值和甲状旁腺激素均与OP患者健康相关生命质量相关(P<0.05)。二元Logistic回归分析提示,右髋骨密度T值(P=0.02)、CCI(P=0.01)、骨折史(P=0.03)和跌倒史(P=0.01)是影响OP患者健康相关生命质量的影响因素。结论:北京市中老年OP人群共病负担较重,应进一步加大该类人群的健康管理,特别是合并多种共病情况应予以高度重视。在制定OP临床诊疗方案时,建议充分考虑共病因素,以进一步提高该类人群的生活质量。

Objective To explore the characteristics of comorbidities in patients with osteoporosis(OP)and factors associated health-related quality of life,so as to provide decision-making reference for improving the ability of disease co-prevention and co-treatment and the patient’s life-cycle quality of life.Methods From November 2017 to July 2018,clinical information and biological samples from residents in 10 communities in Chaoyang District and Fengtai Distric of Beijing were collected,and bone density testing was conducted.Based on the Charlson comorbidity index(CCI),the comorbidity of the population was quantified,and grouped according to factors such as gender,age,and the differences between the groups were explored.Combined with the clinical information of patients,the difference characteristics of comorbidity and non-comorbidity population were analyzed.Pearson/Spearman correlation analysis and binary Logistic regression analysis were used to explore the factors affecting the health-related quality of life in patients with OP.Results Among the 521 OP patients,121 patients had no comorbidities,and there were 153,106,65,and 30 patients with one,two,three,and four comorbidities,respectively,46 patients with 5 or more kinds of comorbidites.Hypertension was the most common comorbidity in OP patients,accounting for 21.60%;followed by hyperlipidemia,accounting for 13.51%.The most common combination of the two diseases was hypertension plus hyperlipidemia(64 cases,12.28%).Through the analysis of differences between age groups,it was found that the older patients,showed higher the CCI,and the difference between groups was statistically significant(Z=1.93,P=0.05).There were significant differences in the total EQ-5D score and the dimensions of anxiety and depression between patients with comorbidities(CCI≠0)and non-comorbidities(CCI=0)(Z=-2.67,P=0.01;Z=-2.44,P=0.02).Correlation analysis found that CCI,history of fracture,history of falls,hip bone mineral density T value and parathyroid hormone were all related to the health-related quality of life in OP patients(P<0.05).Binary Logistic regression analysis suggested that the right hip bone mineral density T value(P=0.02),CCI(P=0.01),fracture history(P=0.03)and fall history(P=0.01)were the risk factors that affect the health-related quality of life in OP patients.Conclusion The burden of comorbidities among middle-aged and elderly OP populations in Beijing is relatively heavy,and the health management of such populations should be further strengthened,specifically the combination of multiple comorbidities should be given high priority.Comorbid factors are of great importance for the diagnosis and treatment strategy of OP patients,which could further improve the quality of life.