老年前列腺增生患者生活质量调查及其与下尿路症状和情绪障碍的相关性

Investigation of quality of life in elderly patients with benign prostatic hyperplasia and its correlation with lower urinary tract symptoms and emotional disorders

目的探讨老年前列腺增生(BPH)患者生活质量、下尿路症状(LUTS)及情绪障碍三者的相关性。方法选择澄迈县人民医院2021年1月至2023年1月收治的155例老年BPH患者为研究对象。采用修订版良性前列腺增生症患者生活质量量表(BPHQLS)、国际前列腺症状问卷调查表(IPSS)、膀胱过度活动评分量表(OABSS)及焦虑自评量表(SAS)调查患者生活质量、LUTS及焦虑情绪。采用SPSS 19.0统计软件进行数据处理。根据数据类型采用t检验或χ^(2)检验进行组间比较。采用Pearson相关分析患者LUTS、情绪障碍及生活质量三者的相关性。采用AMO 25.0构建结构方程模型分析焦虑情绪在老年BPH患者LUTS与生活质量间的中介效应(标准化)。结果6份问卷无效,问卷回收有效率为96.13%(149/155)。老年BPH患者BPHQLS平均得分(97.45±12.16)分,IPSS平均得分(12.21±2.79)分,OABSS平均得分(8.96±2.03)分,SAS平均得分(48.56±8.89)分,焦虑发生率为71.14%(106/149)。老年BPH患者SAS评分高于国人常模水平[(48.56±8.79)和(37.22±9.72)分],差异有统计学意义(P<0.05)。IPSS轻中度组患者BPHQLS评分高于重度组[(107.12±13.45)和(86.25±12.05)分];SAS评分低于重度组[(44.14±7.96)和(56.59±8.87)分],差异有统计学意义(P<0.05)。合并焦虑的老年BPH患者BPHQLS得分低于无焦虑者,IPSS及OABSS得分均高于无焦虑者[(92.34±12.58)和(110.06±14.16)分,(13.29±2.69)和(9.56±2.94)分,(9.50±2.17)和(7.65±2.26)分],差异均有统计学意义(P<0.05)。Pearson相关性分析提示,老年BPH患者生活质量BPHQLS得分与下尿路症状IPSS及OABSS量表得分、SAS量表得分均呈负相关(r=-0.411,-0.395,-0.406;P<0.05);IPSS、OABSS量表得分与焦虑症状SAS量表得分均呈正相关(r=0.443,0.451;P<0.05)。LUTS对生活质量有直接负向预测作用(β=-0.321;P<0.05),并可通过焦虑情绪间接(负向)影响生活质量(β=-0.196;P<0.05),总效应为-0.517。焦虑情绪对生活质量有直接(负向)效应(β=-0.269;P<0.05)。采用Bootstrap法对数据重复取样后进行中介效应,各模型的路径95%CI均不包括0,提示中介效应均有统计学意义(P<0.05)。结论有效疏导老年BPH患者情绪障碍,尽快采取有效措施改善其LUTS,对于提高患者生活质量具有重要意义。

Objective To explore the correlation between quality of life and lower urinary tract symptoms(LUTS)and emotional disorders in the elderly patients with benign prostatic hyperplasia(BPH).Methods We enrolled 155 elderly BPH patients admitted to Chengmai County People′s Hospital from January 2021 to January 2023.Their quality of life,LUTS and anxiety were investigated using revised version of quality-of-life scale for benign prostatic hyperplasia(BPHQLS),international prostate symptom score(IPSS),overactive bladder symptom scale(OABSS)and self-rating anxiety scale(SAS).SPSS statistics 19.0 was used for data processing,and t test or Chi-square test was performed for inter-group comparisons according to the data type.Pearson correlation was performed to analyze the correlation between LUTS,emotional disorders and quality of life.A structural equation model was constructed using AMO 25.0 for the mediating effect of anxiety on LUTS and quality of life in the elderly BPH patients(standardized).Results The valid questionnaire recovery rate was 96.13%(149/155)with six invalid questionnaires.The elderly BPH patients averaged(97.45±12.16)points on QLS-BPH,(12.21±2.79)points on IPSS,(8.96±2.03)points on OABSS and(48.56±8.89)points on SAS,and the incidence of anxiety was 71.14%(106/149).SAS score in the elderly BPH patients was higher than that of Chinese norm[(48.56±8.79)vs(37.22±9.72)points],and the difference was statistically significant(P<0.05).The QLS-BPH score in the mild-to-moderate IPSS group was higher than that in the severe group[(107.12±13.45)vs(86.25±12.05)points],the SAS score was lower than that in severe group[(44.14±7.96)vs(56.59±8.87)points],and the differences were statistically significant(P<0.05).Compared with the BPH patients without anxiety,those with anxiety had lower QLS-BPH score[(92.34±12.58)vs(110.06±14.16)points],but higher scores on IPSS[(13.29±2.69)vs(9.56±2.94)points]and OABSS[(9.50±2.17)vs(7.65±2.26)points],and the differences were statistically significant(P<0.05).Pearson correlation analysis indicated that the QLS-BPH score in the elderly BPH patients was negatively correlated with IPSS score for LUTS,OABSS score and SAS score(r=-0.411,-0.395,-0.406;P<0.05).IPSS and OABSS score were positively correlated with SAS score(r=0.443,0.451;P<0.05).LUTS had a direct negative predictive effect on the quality of life(β=-0.321;P<0.05)and an indirect(negative)effect on the quality of life through anxiety(β=-0.196;P<0.05),with a total effect of-0.517.Anxiety had a direct(negative)effect on the quality of life(β=-0.269;P<0.05).After repeated sampling of data,Bootstrap method was used for mediating effect,and the 95%CI of each model did not include 0,suggesting that the mediating effect was statistically significant(P<0.05).Conclusion Effectively easing emotional disorders and taking effective measures to improve LUTS as soon as possible are of great significance in improving the quality of life in the elderly BPH patients.