基于EQ-5D-5L量表的甘肃省棘球蚴病患者手术前后生命质量研究

doi:10.12140/j.issn.1000-7423.2024.02.008

中国寄生虫学与寄生虫病杂志 ›› 2024, Vol. 42 ›› Issue (2): 182-190.doi: 10.12140/j.issn.1000-7423.2024.02.008

基于EQ-5D-5L量表的甘肃省棘球蚴病患者手术前后生命质量研究

刘泽航¹(), 张小娟², 杨国兵², 雷家希¹, 刘白雪¹, 王莹¹, 王芝依¹, 王东², 冯宇², 王立英¹^,^*()

1 中国疾病预防控制中心寄生虫病预防控制所（国家热带病研究中心）；传染病溯源预警与智能决策全国重点实验室；国家卫生健康委员会寄生虫病原与媒介生物学重点实验室；世界卫生组织热带病合作中心；科技部国家级热带病国际研究中心，上海 200025
2 甘肃省疾病预防控制中心，兰州 730000

收稿日期:2024-01-02 修回日期:2024-01-24 出版日期:2024-04-30 发布日期:2024-04-22
通讯作者: * 王立英（1979—），女，博士，研究员，从事流行病与卫生统计学研究。E-mail：wangliyingcdc@163.com
作者简介:刘泽航（1998—），男，硕士研究生，主要从事传染病流行病学研究。E-mail：liuzehang1998@163.com
基金资助:
国家自然科学基金(81703281);甘肃省卫生行业科研计划(GSWSKY2017-19);国家卫生健康委包虫病防治研究重点实验室开放课题(2021WZK1006);中国疾病预防控制中心寄生虫病预防控制所科技创新支撑计划(TF2024005)

Assessment of the quality of life of patients with echinococcosis in Gansu Province pre- and post-surgery based on the EQ-5D-5L questionnaire

LIU Zehang¹(), ZHANG Xiaojuan², YANG Guobing², LEI Jiaxi¹, LIU Baixue¹, WANG Ying¹, WANG Zhiyi¹, WANG Dong², FENG Yu², WANG Liying¹^,^*()

1 National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention; Chinese Centre for Tropical Diseases Research; National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases; Key Laboratory of Parasite and Vector Biology, Ministry of Health; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai 200025, China
2 Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730000, China

Received:2024-01-02 Revised:2024-01-24 Online:2024-04-30 Published:2024-04-22
Contact: * E-mail: wangliyingcdc@163.com
Supported by:
National Natural Science Foundation of China(81703281);Gansu Province Health Industry Scientific Research Plan Project(GSWSKY2017-19);NHC Key Laboratory of Echinococcosis Prevention and Control, China(2021WZK1006);Chinese Center for Disease Control and Prevention, Institute of Parasitic Diseases Prevention and Control, Science and Technology Innovation Support Program(TF2024005)

摘要/Abstract

摘要：

目的分析甘肃省棘球蚴病患者手术前后生命质量的变化，评价手术治疗措施对患者生命质量的影响。方法调查甘肃省中央转移支付地方棘球蚴病防治项目县中纳入项目管理并进行手术的棘球蚴病患者，采用调查问卷和EQ-5D-5L量表收集患者基本情况、首诊情况、手术情况和手术前后的生命质量情况。用SPSS 19.0、Origin 2021软件对数据进行统计学分析。结果共收集病例856例，其中男性417例，女性439例。年龄最小为7岁，最大为85岁，平均为53岁。CE患者737例，AE患者14例，未分型患者105例。棘球蚴病患者首次手术术后时间最长的为17.5年，最短的为1个月；调查时间与首次手术时间的平均时间间隔为7.4年（89个月）。棘球蚴病患者手术前后的健康效用值分别为0.910 ± 0.142和0.967 ± 0.067，术后较术前提高了6.3%（Z = -12.081，P < 0.05）；患者手术前后的视觉模拟标尺（VAS）评分分别为（79.10 ± 16.00）和（86.25 ± 11.64）分，术后较术前提高了9.0%（Z = -15.292，P < 0.05）。棘球蚴病患者的健康效用值差值和VAS评分差值的取值范围分别为[-0.308，1.348]和[-55，90]。42.8%（366/856）的棘球蚴病患者手术后健康效用值增加，62.7%（537/856）的患者手术后VAS评分增加。五维度困难程度减轻的占19.1%（818/4 280）；困难程度不变的占76.5%（3 275/4 280），整体健康状况不变组患者的术前健康效用值和VAS评分均高于其他组（Z = -16.580、-8.606，P < 0.05）；困难程度加重的占4.4%（187/4 280），健康效用值下降组患者的首次手术年龄高于其他组（Z = 4.393，P < 0.05）；VAS评分下降组患者的首次手术年龄高于其他组（Z = 3.154，P < 0.05）。趋势性检验结果显示，患者的健康效用值（F = 12.957，P_trend < 0.05）和VAS评分（F = 10.808，P_trend < 0.05）均与术后呈线性正相关趋势。结论手术治疗措施可改善棘球蚴病患者的生命质量。

关键词: 棘球蚴病, EQ-5D-5L量表, 手术患者, 生命质量, 甘肃省

Abstract:

Objective To analyse the changes in quality of life of patients with echinococcosis in Gansu Province pre- and post-surgery, and evaluate the impact of surgical treatments on the patients’ quality of life. Methods The patients with echinococcosis underwent surgery and were managed under the National Project for Echinococcosis Control and Prevention in Gansu Province were surveyed using questionnaire and EQ-5D-5L questionnaire to collect basic information, first visit record, surgical performance, and the quality of life pre- and post-surgery. The data were analyzed by SPSS 19.0 and Origin 2021. Results A total of 856 cases collected, including 417 males and 439 females. The age ranges from 7 to 85 years, with an average of 53 years. There were 737 cases of CE patients, 14 cases of AE patients, and 105 cases of unclassified patients. The longest time from the first surgery to postoperative follow-up for patients with echinococcosis was 17.5 years, and the shortest was 1 month. The average time interval between the investigation and the first surgery was 7.4 years (89 months). The preoperative and postoperative health utility values for patients with echinococcosis were 0.910 ± 0.142 and 0.967 ± 0.067, respectively, showing a 6.3% improvement postsurgery (Z = -12.081, P < 0.05). The preoperative and postoperative visual analog scale (VAS) scores were 79.10 ± 16.00 and 86.25 ± 11.64, respectively, showing a 9.0% improvement postsurgery (Z = -15.292, P < 0.05). The health utility value difference in patients with echinococcosis ranged between -0.308 and 1.348, the VAS score difference ranged between -55 and 90. A total of 42.8% (366/856) patients had an increase in health utility value postsurgery, and 62.7% (537/856) of patients had an increase in VAS score postsurgery. The proportion of patients with reduction of difficulties in the five dimensions was 19.1% (818/4 280), unchanged was 76.5% (3 275/4 280), and those with stable overall health had higher health utility values (Z = -16.580, P < 0.05) and VAS scores (Z = -8.606, P < 0.05). The proportion of patients with increased difficulties was 4.4% (187/4 280), the average age of first operation in the group with decreased health utility value was higher than that in another group (Z = 4.393, P < 0.05). The average age of first operation in the group with decreased VAS score was higher than that in another group (Z = 3.154, P < 0.05). The patients’ health utility value (F = 12.957, P_trend < 0.05) and VAS score (F = 10.808, P_trend < 0.05) showed a trend of positive linear correlation with the extension of postsurgery time. Conclusion Surgical treatment could impact the quality of life for patients with echinococcosis.

Key words: Echinococcosis, EQ-5D-5L questionnaire, Surgical patients, Quality of life, Gansu Province

中图分类号:

R532.32

刘泽航, 张小娟, 杨国兵, 雷家希, 刘白雪, 王莹, 王芝依, 王东, 冯宇, 王立英. 基于EQ-5D-5L量表的甘肃省棘球蚴病患者手术前后生命质量研究[J]. 中国寄生虫学与寄生虫病杂志, 2024, 42(2): 182-190.

LIU Zehang, ZHANG Xiaojuan, YANG Guobing, LEI Jiaxi, LIU Baixue, WANG Ying, WANG Zhiyi, WANG Dong, FENG Yu, WANG Liying. Assessment of the quality of life of patients with echinococcosis in Gansu Province pre- and post-surgery based on the EQ-5D-5L questionnaire[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2024, 42(2): 182-190.

图/表 8

表1

图1

表2

图2

表3

表4

甘肃省856例棘球蚴病患者首次手术治疗前后EQ-5D-5L各维度各水平的分布情况

维度 Dimension	棘球蚴病患者人数（占比/%） No. patients with echinococcosis (Proportion/%)		CE患者人数（占比/%） No. patients with CE (Proportion/%)		AE患者人数（占比/%） No. patients with AE (Proportion/%)		未分型棘球蚴病患者人数（占比/%） No. patients with unclassified echinococcosis(Proportion/%)
维度 Dimension	手术前 Before surgery	手术后 After surgery	手术前 Before surgery	手术后 After surgery	手术前 Before surgery	手术后 After surgery	手术前 Before surgery	手术后 After surgery
行动能力 Mobility
没有困难 No problem	740(86.4)	792(92.5)	632(85.8)	676(91.7)	10(71.4)	13(92.9)	98(93.3)	103(98.1)
有一点困难 Slight problem	105(12.3)	64(7.5)	96(13.0)	61(8.3)	2(14.3)	1(7.1)	7(6.7)	2(1.9)
有中度困难 Moderate problem	7(0.8)	0	6(0.8)	0	1(7.1)	0	0	0
有严重困难 Severe problem	2(0.2)	0	1(0.1)	0	1(7.1)	0	0	0
极度困难 Extreme problem	2(0.2)	0	2(0.3)	0	0	0	0	0
自我照顾 Self-care
没有困难 No problem	752(87.9)	803(93.8)	645(87.5)	687(93.2)	10(71.4)	13(92.9)	97(92.4)	103(98.1)
有一点困难 Slight problem	90(10.5)	50(5.8)	81(11.0)	47(6.4)	2(14.3)	1(7.1)	7(6.7)	2(1.9)
有中度困难 Moderate problem	8(0.9)	3(0.4)	7(0.9)	3(0.4)	1(7.1)	0	0	0
有严重困难 Severe problem	3(0.4)	0	2(0.3)	0	1(7.1)	0	0	0
极度困难 Extreme problem	3(0.4)	0	2(0.3)	0	0	0	1(1.0)	0
日常活动 Usual activity
没有困难 No problem	677(79.1)	748(87.4)	574(77.9)	642(87.1)	10(71.4)	12(85.7)	93(88.6)	94(89.5)
有一点困难 Slight problem	146(17.1)	97(11.3)	137(18.6)	87(11.8)	2(14.3)	2(14.3)	7(6.7)	8(7.6)
有中度困难 Moderate problem	24(2.8)	8(0.9)	20(2.7)	5(0.7)	1(7.1)	0	3(2.9)	3(2.9)
有严重困难 Severe problem	6(0.7)	3(0.4)	4(0.5)	3(0.4)	1(7.1)	0	1(1.0)	0
极度困难 Extreme problem	3(0.4)	0	2(0.3)	0	0	0	1(1.0)	0
疼痛或不舒服 Pain or discomfort
没有疼痛或不舒服 No problem	468(54.7)	693(81.0)	393(53.3)	592(80.3)	9(64.3)	10(71.4)	66(62.9)	91(86.7)
有一点疼痛或不舒服 Slight problem	294(34.3)	157(18.3)	260(35.3)	140(19.0)	2(14.3)	4(28.6)	32(30.5)	13(12.4)
有中度疼痛或不舒服 Moderate problem	61(7.1)	6(0.7)	58(7.9)	5(0.7)	2(14.4)	0	1(1.0)	1(1.0)
有严重疼痛或不舒服 Severe problem	26(3.0)	0	20(2.7)	0	1(7.1)	0	5(4.8)	0
极度疼痛或不舒服 Extreme problem	7(0.8)	0	6(0.8)	0	0	0	1(1.0)	0
焦虑或沮丧 Anxiety/depression
没有焦虑或沮丧 No problem	587(68.6)	749(87.5)	498(67.6)	647(87.8)	8(57.1)	10(71.4)	81(77.1)	92(87.6)
有一点焦虑或沮丧 Slight problem	226(26.4)	100(11.7)	204(27.7)	85(11.5)	4(28.6)	4(28.6)	18(17.1)	11(10.5)
有中度焦虑或沮丧 Moderate problem	33(3.9)	6(0.7)	30(4.1)	5(0.7)	0	0	3(2.9)	1(1.0)
有严重焦虑或沮丧 Severe problem	9(1.1)	0	5(0.7)	0	2(14.3)	0	2(1.9)	0
极度焦虑或沮丧 Extreme problem	1(0.1)	1(0.1)	0	0	0	0	1(1.0)	1(1.0)

表4

表5

图3

参考文献 21

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维度 Dimension	有一点困难 Slight problems	有中度困难 Moderate problems	有严重困难 Severe problems	极度困难 Extreme problems
行动能力 Mobility	0.066	0.158	0.287	0.345
自我照顾 Self-care	0.048	0.016	0.210	0.253
日常活动 Usual activities	0.045	0.107	0.194	0.233
疼痛/不舒服 Pain/discomfort	0.058	0.138	0.252	0.302
焦虑/沮丧 Anxiety/depression	0.049	0.118	0.215	0.258

生命质量指标 Index of quality of life	[0，1）年（n = 40） [0, 1) year (n = 40)	[1，5）年（n = 215） [1, 5 ）years (n = 215)	[5，20] 年（n = 601） [5, 20] years (n = 601)	F₁	P	F₂	P_trend
健康效用值 Health utility value	0.932 ± 0.115	0.961 ± 0.072	0.971 ± 0.060	7.385	< 0.05	12.957	< 0.05
VAS评分/分 Visual analogue scalescore	81.55 ± 14.84	85.07 ± 12.17	86.99 ± 11.11	5.618	< 0.05	10.808	< 0.05

测量内容 Measurement contents	手术前 Before surgery	手术后 After surgery	Z值 Z value	P值 P value
棘球蚴病患者 Patients with echinococcosis
健康效用值 Health utility value	0.910 ± 0.142	0.967 ± 0.067	-12.081	< 0.05
VAS评分/分 Visual analogue scalescore	79.10 ± 16.00	86.25 ± 11.64	-15.292	< 0.05
CE患者 Patients with CE
健康效用值 Health utility value	0.909 ± 0.136	0.966 ± 0.067	-11.432	< 0.05
VAS评分/分 Visual analogue scalescore	79.08 ± 15.91	86.29 ± 11.12	-14.652	< 0.05
AE患者 Patients with AE
健康效用值 Health utility value	0.817 ± 0.320	0.955 ± 0.077	-1.906	> 0.05
VAS评分/分 Visual analogue scalescore	77.14 ± 18.78	79.29 ± 18.28	-0.400	> 0.05
未分型患者 Patients with unclassified echinococcosis
健康效用值 Health utility value	0.928 ± 0.143	0.974 ± 0.064	-3.642	< 0.05
VAS评分/分 Visual analogue scalescore	79.50 ± 16.43	86.91 ± 13.80	-5.092	< 0.05

五维度困难程度变化 Changes of five-dimensional difficulty degree	棘球蚴病患者人数（占比/%）No. patients with echinococcosis (Proportion/%)	CE患者人数（占比/%） No. patients with CE (Proportion/%)	AE患者人数（占比/%） No. patients with AE (Proportion/%)	未分型棘球蚴病患者人数（占比/%） No. patients with unclassified echinococcosis (Proportion/%)
行动能力 Mobility
减轻 Alleviated	91(10.6)	81(11.0)	4(28.6)	6(5.7)
不变 Unchanged	732(85.5)	624(84.7)	10(71.4)	98(93.3)
加重 Aggravated	33(3.9)	32(4.3)	0	1(1.0)
自我照顾 Self-care
减轻 Alleviated	83(9.7)	72(9.8)	4(28.6)	7(6.7)
不变 Unchanged	747(87.3)	640(86.8)	10(71.4)	97(92.4)
加重 Aggravated	26(3.0)	25(3.4)	0	1(1.0)
日常活动 Usual activity
减轻 Alleviated	134(15.7)	121(16.4)	4(28.6)	9(8.6)
不变 Unchanged	670(78.3)	572(77.6)	9(64.3)	89(84.8)
加重 Aggravated	52(6.1)	44(6.0)	1(7.1)	7(6.7)
疼痛/不舒服 Pain/discomfort
减轻 Alleviated	305(35.6)	266(36.1)	5(35.7)	34(32.4)
不变 Unchanged	499(58.3)	426(57.8)	7(50.0)	66(62.9)
加重 Aggravated	52(6.1)	45(6.1)	2(14.3)	5(4.8)
焦虑/沮丧 Anxiety/depression
减轻 Alleviated	205(23.9)	182(24.7)	5(35.7)	18(17.1)
不变 Unchanged	627(73.2)	536(72.7)	8(57.2)	83(79.0)
加重 Aggravated	24(2.8)	19(2.6)	1(7.1)	4(3.8)

基于EQ-5D-5L量表的甘肃省棘球蚴病患者手术前后生命质量研究

Assessment of the quality of life of patients with echinococcosis in Gansu Province pre- and post-surgery based on the EQ-5D-5L questionnaire

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