老年肺间质纤维化患者生存现状调查

Survival status of elderly patients with pulmonary interstitial fibrosis

目的 调查老年肺间质纤维化患者生存现状并分析其相关因素。方法 将2020年6月到2022年6月新疆医科大学第一附属医院收治的246例老年肺间质纤维化患者纳为老年组,同期收治的160例非老年肺间质纤维化患者纳为非老年组。采用中文版特发性肺纤维化患者生活质量特异性量表(cATAQ-IPF)调查患者生活质量,中文版死亡态度描绘(DAP-R)量表调查患者死亡态度,对比老年组与非老年组临床特征。采用二元logistic回归模型分析影响老年组患者生活质量的相关因素;采用Pearson相关分析老年组患者生活质量与死亡态度之间的相关性。采用SPSS 22.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ^(2)检验。结果 老年组及非老年组中分别有220例及150例患者完成相关调查,对比发现,老年组年龄,合并高血压、糖尿病、冠心病比例,病程以及肺间质性纤维化-年龄-肺功能(ILD-GAP)指数高于非老年组,文化程度及cATAQ-IPF量表总得分均低于非老年组,差异均有统计学意义(P<0.05)。老年肺间质纤维化患者cATAQ-IPF量表总得分(264.64±36.78)分,其中受损最严重的三个维度分别是呼吸困难、死亡敏感、社交活动,受损相对最轻的维度是人际关系。二元logistic回归分析提示,病程(OR=2.323, 95%CI 1.382~3.906)、ILD-GAP指数(OR=3.725,95%CI 1.285~10.797)、用力肺活量(OR=2.404,95%CI 1.514~3.817)、医学研究委员会呼吸困难量表(OR=2.102,95%CI 1.555~2.843)、焦虑(OR=1.774,95%CI 1.143~2.751)、抑郁(OR=1.610,95%CI 1.124~2.304)是影响老年肺间质纤维化患者生活质量的危险因素,而有配偶(OR=0.619,95%CI 0.474~0.809)及医学应对方式(OR=0.489,95%CI 0.355~0.673)是其生活质量的保护因素(P<0.05)。Pearson相关性分析提示,患者生活质量得分与其死亡恐惧及死亡逃避之间呈正相关(r=0.246、0.233;P=0.036、0.043),与自然接受之间呈负相关(r=-0.278;P=0.021)。结论 与非老年组患者相比,老年肺间质纤维化患者合并基础性疾病更多,肺间质纤维化病程更长,病情更为严重,生活质量更低;除疾病相关因素外,心理因素对其生活质量均有影响,建议临床增加对老年肺间质纤维化患者心理健康的关注与干预。

Objective To investigate the survival status in the elderly patients with pulmonary interstitial fibrosis and analyze its related factors.Methods A total of 246 elderly patients with pulmonary interstitial fibrosis admitted to the First Affiliated Hospital of Xinjiang Medical University from June 2020 to June 2022 were included in the elderly group,and 160 non-elderly patients with pulmonary fibrosis in the non-elderly group.The quality of life of patients was investigated with the Chinese version of the Tool to Assess Quality of Life in Idiopathic Pulmonary Fibrosis(cATAQ-IPF)and the patients′attitude towards death with the Chinese version of the Death Attitude Profile-Revised(DAP-R).The clinical characteristics were compared between the elderly group and the non-elderly group,and binary logistic regression model was employed to analyze the factors affecting the patients′quality of life in the elderly group.Pearson correlation analysis was performed to analyze the correlation between quality of life and patients′attitude towards death in the elderly group.SPSS 22.0 was used for statistical analysis.Depending on data type,data comparison between two groups was performed using t test orχ^(2) test.Results In total,220 patients in the elderly group and 150 in the non-elderly group completed the survey.Age,proportions of hypertension,diabetes mellitus and coronary heart disease,disease course and interstitial lung disease-gender-age-physiology(ILD-GAP)index in the elderly group were higher than those in the non-elderly group,and the education level and total score on cATAQ-IPF scale were lower than those in the non-elderly group,the differences being statistically significant(P<0.05).The total score on cATAQ-IPF in the elderly patients with pulmonary interstitial fibrosis was(264.64±36.78)points,the three dimensions most severely impaired being dyspnea,death sensitivity and social activity and the least impaired being interpersonal relationship.Binary logistic regression analysis suggested that disease course(OR=2.323,95%CI 1.382-3.906),ILD-GAP index(OR=3.725,95%CI 1.285-10.797),forced vital capacity(FVC)(OR=2.404,95%CI 1.514-3.817),modified medical research council scale(mMRC)(OR=2.102,95%CI 1.555-2.843),anxiety(OR=1.774,95%CI 1.143-2.751)and depression(OR=1.610,95%CI 1.124-2.304)were the risk factors of quality of life in the elderly patients with pulmonary interstitial fibrosis,and having a spouse(OR=0.619,95%CI 0.474-0.809)and medical coping style(OR=0.489,95%CI 0.355-0.673)were the protective factors of quality of life(P<0.05).Pearson correlation analysis showed that the patients′quality of life was positively correlated with〖JP〗death fear and death avoidance(r=0.246,0.233;P=0.036,0.043),and was negatively correlated with natural acceptance(r=-0.278,P=0.021).Conclusion Compared with non-elderly patients,the elderly patients with pulmonary interstitial fibrosis have more underlying diseases,longer duration of pulmonary interstitial fibrosis,more serious condition and lower quality of life.In addition to disease-related factors,psychological factors have an impact on their quality of life.It is suggested to increase the attention to and intervention in psychological health in the elderly patients with pulmonary interstitial fibrosis in clinical practice.