摘要
目的 评估慢性移植物抗宿主病(cGVHD)患者的生活质量(QoL)现状、差异及其影响因素.方法 通过横断面研究,2021年9月至2023年2月向我中心140例cGVHD患者发放调查问卷,采用Lee症状学量表(LSS)评估症状负荷,医学结局研究36项简短健康调查量表(SF-36)、五水平五维健康量表(EQ-5D-5L)评估生活质量.结果 在140份可评估的调查者问卷中,轻度、中度、重度cGVHD患者分别为32例(22.9％)、87例(62.1％)、21例(15.0％),男性占61.4％,中位移植年龄为34(15～68)岁.原发病类型:急性髓系白血病70例(50.0％),急性淋巴细胞白血病28例(20.0％),骨髓增生异常综合征21例(15.0％),其他21例(15.0％).常见的cGVHD受累器官为皮肤74例(52.9％)、眼睛57例(40.7％)和肝脏50例(35.7％).在整体患者中,LSS量表的眼睛[(20.48±23.75)分]、心理[(16.13±17.00)分]、口 腔[(13.66±20.55)分]评分最高;SF-36 量表的生理职能[(36.07±11.13)分]、社会功能[(36.10±10.68)分]、情感职能[(38.36±11.88)分]方面评分最低;EQ-5D效用指数值为0.764.轻度、中度、重度患者LSS量表总分分别为(6.51±6.15)、(10.07±5.61)、(20.90±10.09)分;SF-36躯体健康总评(PCS)分别为(43.12±6.38)、(40.73±7.14)、(36.97±6.97)分,精神健康总评(MCS)分别为(43.00± 8.47)、(38.90±9.52)、(28.96±9.63)分;EQ-5D 效用指数值分别为 0.810±0.124、0.762±0.179、0.702± 0.198.多因素分析结果显示,总体症状负担(β=-0.517)、口腔相关症状(β=-0.456)、眼睛美国国立卫生研究院(NIH)评分系统分级(β=-0.376)、营养相关症状(β=-0.211)与PCS呈显著负相关;眼睛NIH分级(β=-0.260)与MCS呈显著负相关;口腔相关症状(=-0.400)、关节/筋膜NIH分级(β=-0.332)、累及系统数量(β=-0.253)、整体NIH分级(β=-0.205)、服用免疫抑制剂种类(β=-0.171)与EQ-5D效用指数值呈显著负相关(P＜0.05).EQ-5D效用指数值与SF-36呈中到高相关(|r|=0.384～0.571,P＜0.001).结论cGVHD患者QoL受损,疾病越重QoL越差.总体症状负荷、眼睛严重程度、口腔症状负荷是影响QoL最重要的因素.
Abstract
Objective To evaluate the status of,differences in,and factors influencing quality of life(QoL)in patients with chronic graft-versus-host disease(GVHD).Methods From September 2021 to February 2023,a cross-sectional study of 140 patients with chronic GVHD was conducted at our center.Symptom burden was assessed by the Lee Symptomatology Scale(LSS),and QoL was assessed by the Medical Outcome Study 36-Item Short-Form Health Survey(SF-36)(version 1)and five-level EuroQoL five-dimensional questionnaire(EQ-5D-5L).Results Data from 140 respondents,including 32(22.9％)with mild chronic GVHD,87(62.1％)with moderate chronic GVHD,and 21(15.0％)with severe chronic GVHD,were analyzed.Of the respondents,61.4％were male,and the median transplantation age was 34(15-68)years.The primary diagnoses were acute myeloid leukemia(50.0％),acute lymphoblastic leukemia(20.0％),and myelodysplastic syndrome(15.0％).The common chronic GVHD-affected organs included the skin in 74 patients(52.9％),the eyes in 57 patients(40.7％),and the liver in 50 patients(35.7％).Among the whole cohort,the eye(20.48±23.75),psychological(16.13±17.00),and oral(13.66±20.55)scores were highest in the LSS group.The physiological function(36.07±11.13),social function(36.10± 10.68),and role-emotional functioning(38.36±11.88)scores were lowest in the SF-36 group.The EQ-5D index was 0.764.The total LSS scores for mild,moderate,and severe chronic GVHD were 6.51±6.15,10.07±5.61,and 20.90±10.09,respectively.The SF-36 physical component scores(PCSs)were 43.12±6.38,40.73±7.14,and 36.97±6.97,respectively,and the mental component scores(MCSs)were 43.00±8.47,38.90±9.52,and 28.96±9.63,respectively.The EQ-5D values were 0.810±0.124,0.762±0.179,and 0.702± 0.198,respectively.The multivariate analysis showed that the overall symptom burden(β=-0.517),oral symptom burden(β=-0.456),National Institute of Health(NIH)criteria for the eyes(β=-0.376),and nu-trition-related symptom burden(β=-0.211)were significantly negatively correlated with the PCS.The NIH score(β=-0.260)was negatively correlated with the MCS score.Oral symptom burden(β=-0.400),joint/fascia NIH criteria(β=-0.332),number of involved systems(β=-0.253),overall NIH criteria(β=-0.205),and number of immunosuppressants taken(β=-0.171)were significantly negatively correlat-ed with the EQ-5D score(all P＜0.05).Medium to strong correlations were found between the EQ-5D score and the SF-36 score(|r|=0.384-0.571,P＜0.001).Conclusions The QoL of patients with chronic GVHD is impaired,and the more severe the disease,the poorer the QoL.Overall symptom burden,severity of eyes,and oral symptom burden were the most important factors affecting QoL.
基金项目
国家重点研发计划(2022YFA1103300)
国家重点研发计划(2022YFA1103304)
国家血液系统疾病临床医学研究中心开放课题(2020)(2020ZKZC02)
重庆市自然科学基金创新群体项目(cstc2021jcyjcxttX0001)
维普
万方数据