SF-36和EQ-5D-5L量表在晚期血吸虫病患者生命质量评价中的比较研究

doi:10.12140/j.issn.1000-7423.2021.05.012

摘要/Abstract

摘要：

目的比较健康状况调查表（SF-36）和五水平欧洲五维度健康量表（EQ-5D-5L）用于晚期血吸虫病患者生命质量评价的效果。方法选择2020年就诊于嘉兴市某两家医院的晚期血吸虫病患者为调查对象,收集患者一般情况相关信息,包括姓名、性别、年龄、晚期血吸虫病临床分型等。分别采用SF-36和EQ-5D-5L量表进行问卷调查,比较两种量表评价晚期血吸虫病患者生命质量的信度、效度以及对于不同健康程度晚期血吸虫病患者的区分程度,并对两种量表评价得分进行相关性分析,对影响晚期血吸虫病患者生命质量的影响因素进行分析。结果 125例晚期血吸虫病患者年龄为47~93岁,平均年龄（75.04 ± 7.53）岁;男性46例（36.80%）,女性79例（63.20%）;巨脾型54例（43.20%）,腹水型71例（56.80%）。SF-36量表内部一致性信度Cronbach’s α系数为0.780,主成分分析法提取2个因子,累计贡献率为70.427%;EQ-5D-5L量表内部一致性信度Cronbach’s α系数为0.850,主成分分析法提取2个因子,累计贡献率为85.884%。SF-36量表各领域中,精神健康平均得分最高（66.82 ± 7.90）,生理职能和情感职能得分最低（均为0分）;生理健康总测量（PCS）平均得分（33.85 ± 8.92）,心理健康总测量（MCS）平均得分（39.76 ± 4.93）;MCS得分较高的患者数为119例,多于PCS的81例。EQ-5D-5L量表中效用指数（UI）得分平均值为（0.801 ± 0.214）;“疼痛或不舒服”维度存在“中度困难、严重困难及极度困难”患者所占比例最高（占24.80%）,“焦虑或抑郁”维度最低（占5.60%）。视觉模拟标尺（EQ-VAS）评分平均值为（66.64 ± 7.85）。年龄对患者PCS、MCS、EQ-VAS评分影响均较大（P < 0.01）,不同性别、临床分型得分之间差异无统计学意义（P > 0.05）。PCS、MCS得分较高者UI得分、EQ-VAS评分均高于PCS、MCS得分较低者（P < 0.01）;在EQ-5D-5L中随着各维度严重程度的增加,患者PCS、MCS得分降低（P < 0.01）。PCS与UI得分、EQ-VAS评分具有相关性（r = 0.716、0.689, P < 0.01）,MCS与UI得分、EQ-VAS评分具有相关性（r = 0.622、0.544,P < 0.01）。结论 SF-36和EQ-5D-5L量表均可用于评价晚期血吸虫病患者的生命质量,其评估效果具有可比性和互补性,但EQ-5D-5L量表因信度、效度更高且结构简单等优势,更适宜用于晚期血吸虫病患者生命质量的评估。

关键词: SF-36量表, EQ-5D-5L量表, 晚期血吸虫病, 生命质量, 信度, 效度

Abstract:

Objective To compare the effects of the 36-item short form health survey (SF-36) and the five-level EuroQol five-dimensional questionnaire(EQ-5D-5L) on the quality of life of patients with advanced schistosomiasis. Methods A total of 125 patients with advanced schistosomiasis were selected from two hospitals in Jiaxing City in 2020, and the general information of the patients was collected, including name, sex, age, and clinical classification of advanced schistosomiasis. The SF-36 and EQ-5D-5L scales were used in questionnaire; investigate the quality of life of patients with advanced schistosomiasis, the reliability and validity of the two scales in evaluating the quality of life of patients with advanced schistosomiasis, and the degree of differentiation in patients with different health levels were compared. The correlation between the scores of the two scales and the factors influencing patient scores were also analyzed. Results The 125 patients with advanced schistosomiasis ranged in age from 47 to 93 years, with an average age of (75.04 ± 7.53) years. There were 46 males (36.80%) and 79 females (63.20%). There were 54 cases (43.20%) of splenomegaly type and 71 cases (56.80%) of ascitic type. The Cronbach’s α coefficient of internal coherence in SF-36 was 0.780 and two factors were extracted by principal component analysis, with a cumulative contribution rate of 70.427%. The Cronbach’s α coefficient of EQ-5D-5L was 0.850 and two factors were extracted by principal component analysis, with a cumulative contribution rate of 85.884%. Among the dimensions of SF-36, the highest average score was on mental health (66.82 ± 7.90), and the lowest scores were on role physical (0) and role emotional (0); the average score of physical component summary (PCS) was(33.85 ± 8.92) and mental health measurement (MCS) was(39.76 ± 4.93), and number of patients with higher MCS score were higher than those with PCS. The average EQ-5D-5L utility index (UI) score was (0.801 ± 0.214). The patients with the dimension of "pain or discomfort" presenting “moderate difficulty, severe difficulty and extreme difficulty” accounted for highest proportion of 24.80%, and the dimension “anxiety or depression” lowest proportion of 5.60%. The average score on visual analogue scale (EQ-VAS) was 66.64 ± 7.85. The age of the patients showed significant influence on the scores of PCS, MCS and EQ-VAS (P < 0.01), but there was no significant difference in the scores of different gender and clinical classification of the patients (P > 0.05). The UI score and EQ-VAS score of those with higher PCS and MCS scores were higher than those with lower PCS and MCS scores (P < 0.01). With the increase of the severity of each dimension of EQ-5D-5L, PCS and MCS scores of patients decreased. PCS was correlated with UI and EQ-VAS scores (r = 0.716, 0.689, P < 0.01), and MCS was correlated with UI and EQ-VAS scores( r = 0.622, 0.544, P < 0.01). Conclusion Both SF-36 and EQ-5D-5L can be used to evaluate quality of life of patients with advanced schistosomiasis, and the assessment outcomes are comparable and complemental. However, as EQ-5D-5L advantages with higher reliability, validity and simpler system structure, thus is more suitable for evaluation of quality of life of patients with advanced schistosomiasis.

Key words: 36-item short form health survey, Five-level EuroQol five-dimensional questionnaire, Advanced schistosomiasis, Quality of life, Reliability, Validity

中图分类号:

R532.21

刘蓉, 张剑锋, 严晓岚, 闻礼永. SF-36和EQ-5D-5L量表在晚期血吸虫病患者生命质量评价中的比较研究[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39(5): 639-645.

LIU Rong, ZHANG Jian-feng, YAN Xiao-lan, WEN Li-yong. Comparative study of SF-36 and EQ-5D-5L in evaluating quality of life for patients with advanced schistosomiasis[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2021, 39(5): 639-645.

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参考文献 15

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	第1水平	第2水平	第3水平	第4水平	第5水平
	Level 1	Level 2	Level 3	Level 4	Level 5
行动能力Mobility	0	0.066	0.158	0.287	0.345
自我照顾 Self-care	0	0.048	0.116	0.210	0.253
日常活动 Usual activity	0	0.045	0.107	0.194	0.233
疼痛或不舒服 Pain/discomfort	0	0.058	0.138	0.252	0.302
焦虑或抑郁 Anxiety/depression	0	0.049	0.118	0.218	0.258

	第1水平Level 1		第2水平Level 2		第3水平Level 3		第4水平Level 4		第5水平Level 5
	例数 No. case	构成比/%Proportion/%	例数 No. case	构成比/%Proportion/%	例数 No. case	构成比/%Proportion/%	例数 No. case	构成比/%Proportion/%	例数 No. case	构成比/%Proportion/%
行动能力Mobility	94	75.20	17	13.60	9	7.20	4	3.20	1	0.80
自我照顾 Self-care	101	80.80	14	11.20	5	4.00	3	2.40	2	1.60
日常活动 Usual activity	51	40.80	56	44.80	13	10.40	2	1.60	3	2.40
疼痛或不舒服 Pain/discomfort	24	19.20	70	56.00	24	19.20	7	5.60	0	0
焦虑或抑郁 Anxiety/depression	47	37.60	71	56.80	7	5.60	0	0	0	0

变量Variable		β值β value	t值t value	P值P value	95%置信区间95%CI
生理健康总测量 Physical component summary	常数Constant		7.860	< 0.01	48.753~81.581
	性别Gender	0.049	0.569	> 0.05	-2.250~4.065
	年龄Age	-0.369	-4.244	< 0.01	-0.641~-0.233
	临床分型Clinical classification	0.001	0.011	> 0.05	-3.011~3.044
心理健康总测量 Mental component summary	常数Constant		11.078	< 0.01	42.823~61.460
	性别Gender	-0.004	-0.050	> 0.05	-1.838~1.747
	年龄Age	-0.270	-3.022	< 0.01	-0.293~-0.061
	临床分型Clinical classification	0.062	0.710	> 0.05	-1.102~2.335
效用指数Utility index	常数Constant		5.297	< 0.01	0.701~1.538
	性别Gender	-0.028	-0.306	> 0.05	-0.093~0.068
	年龄Age	-0.124	-1.344	> 0.05	-0.009~0.002
	临床分型Clinical classification	-0.049	-0.546	> 0.05	-0.098~0.056
视觉模拟标尺EQ-VAS	常数Constant		14.125	< 0.01	85.990~114.025
	性别Gender	0.116	1.385	> 0.05	-0.810~4.583
	年龄Age	-0.429	-5.077	< 0.01	-0.621~-0.273
	临床分型Clinical classification	-0.118	-1.425	> 0.05	-4.446~0.725

	不同分数段Different fractions	例数 No. case	效用指数（均数 ± 标准差） UI ($\bar{x} \pm s$)	t值 t value	P值 P value	视觉模拟标尺（均数 ± 标准差） EQ-VAS ($\bar{x} \pm s$)	t值 t value	P值 P value
生理健康总测量Physical component summary	≤ 34.25	67	0.71 ± 0.25	-6.027	< 0.01	63.28 ± 6.94	-5.762	< 0.01
生理健康总测量Physical component summary	> 34.25	58	0.91 ± 0.10			70.52 ± 7.05
心理健康总测量Mental component summary	≤ 40.13	66	0.72 ± 0.25	-5.085	< 0.01	63.48 ± 7.01	-5.226	< 0.01
心理健康总测量Mental component summary	> 40.13	59	0.89 ± 0.11			70.17 ± 7.25

	水平 Level	例数 No. case	生理健康总测量PCS			心理健康总测量MCS
	水平 Level	例数 No. case	均数 ± 标准差 $\bar{x} \pm s$	F值F value	P值P value	均数 ± 标准差 $\bar{x} \pm s$	F值F value	P值P value
行动能力 Mobility	1	94	36.23 ± 7.63	13.833	< 0.01	40.76 ± 4.39	10.007	< 0.01
	2	17	30.84 ± 7.79			38.54 ± 3.30
	3	9	24.86 ± 5.09			37.19 ± 5.28
	4	4	16.44 ± 7.41			31.59 ± 4.81
	5	1	11.75			22.25
自我照顾 Self-care	1	101	36.05 ± 7.73	12.704	< 0.01	40.65 ± 4.32	7.844	< 0.01
	2	14	27.16 ± 6.41			38.08 ± 3.92
	3	5	24.95 ± 6.69			35.90 ± 6.33
	4	3	16.17 ± 9.25			31.25 ± 5.25
	5	2	18.25 ± 9.19			29.44 ± 10.16
日常活动 Usual activity	1	51	39.06 ± 7.29	21.088	< 0.01	42.23 ± 4.75	14.233	< 0.01
	2	56	32.58 ± 7.16			38.89 ± 3.23
	3	13	25.96 ± 4.55			37.71 ± 4.60
	4	2	21.25 ± 4.95			33.81 ± 3.98
	5	3	11.67 ± 4.88			27.00 ± 3.36
疼痛或不舒服^a Pain/discomfort^a	1	24	40.68 ± 7.53	31.485	< 0.01	42.53 ± 4.70	16.069	< 0.01
	2	70	35.67 ± 6.86			40.63 ± 3.93
	3	24	25.98 ± 5.45			36.65 ± 3.97
	4	7	19.25 ± 7.25			32.32 ± 6.03
焦虑或抑郁^b Anxiety/depression^b	1	47	38.68 ± 7.32	24.423	< 0.01	42.65 ± 4.57	28.537	< 0.01
	2	71	32.11 ± 7.81			38.67 ± 3.47
	3	7	19.14 ± 7.32			31.46 ± 6.38