經濟、社會及心理因素與北台灣血液透析病患之健康相關生活品質的關係探討:多中心研究

Abstract

研究背景及目的 健康相關生活品質影響末期腎病病患的結果及存活。本研究目的為探討經濟、社會及心理因素與北台灣血液透析病患之健康相關生活品質的關係。 研究對象及方法 研究對象為在北台灣14家透析中心接受長期血液透析兩個月或以上的病患，研究方法為透過問卷調查方式收集病患的人口學、經濟、社會及心理資料，並以貝克憂鬱量表及Medical Outcomes Study Short-Form 36 (SF-36)來測量病患的憂鬱狀況和健康相關生活品質。SF-36包含八個量表，分別為身體生理功能(PF)、因身體生理問題角色受限(RP)、身體疼痛(BP)、一般健康狀況(GH)、活力(VT)、社會功能(SF)、因情緒問題角色受限(RE)和心理健康(MH)。此八個量表可再進一步分為兩大量表：Physical Component Summary (PCS)及Mental Component Summary (MCS)。分析方法為使用單變項線性迴歸來評估PCS、MCS、八個量表與經濟、社會及心理變項的關係，再以多變項線性迴歸來尋找與健康相關生活品質有顯著關係的各種變項。 結果 有861位血液透析病患參與此研究，平均年齡為59.42 ± 13.18歲 (14.77至89.33歲)，男性有373人(43.32%)。大部分病患為已婚(71.93%)，60.5%有不同程度的憂鬱症。血液透析病患在SF-36八個量表的得分均比台灣一般民眾的得分低。年齡與身體功能相關的生活品質量表有負相關(P<0.01)。離婚病患在PF(P<0.05)、BP(P<0.01)和PCS(P<0.05)的得分較高，而單身病患在RP(P<0.05)和PCS(P<0.05)的得分數低。較高的月收入與RE、MH和MCS有正面關係(P<0.01)。較常參與社交活動與SF也有正面關係(P<0.05)。憂慮的事情越多，則SF(P<0.05)、MH(P<0.01)和MCS(P<0.01)的得分越低。貝克憂鬱量表的分數越高，SF-36八個量表、PCS及MCS的分數則越低(P<0.01)。 結論 較高的月收入及較常參與社交活動兩者均與血液透析病患較好的健康相關生活品質有關，而憂慮的事情越多及較高的貝克憂鬱量表得分則與較差的健康相關生活品質有關。

Background and Purpose of Study Health-related quality of life (HRQOL) affects outcome and survival of end-stage renal disease patients. This study aimed to evaluate the associations between economic, social, psychological factors and HRQOL of hemodialysis (HD) patients in northern Taiwan. Patients and Study Methods Patients who had received maintenance HD for at least 2 months at 14 dialysis centers in northern Taiwan were invited to join the study. Demographic, economic, social and psychological data of the patients were collected by questionnaires. Depression status was assessed by the Beck Depression Inventory (BDI). HRQOL was measured by the Medical Outcomes Study Short-Form 36 (SF-36) which consists of eight dimensions, namely physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE) and mental health (MH). These dimensions are further compressed into two scales: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Simple linear regression analyses were used to evaluate the associations between scores of PCS, MCS, the eight dimensions of the SF-36 and economic, social and psychological variables. Multiple linear regression analyses were used to search for significant associations between HRQOL and variables of interest after adjusting for demographic and clinical factors. Results Eight hundred and sixty one HD patients completed the study. There were 373 male (43.32%). The mean age was 59.42 ± 13.18 years (14.77 to 89.33 years). Most of them were married (71.93%). 60.5% of all patients had various degrees of depression. HD patients had lower scores in all eight dimensions of the SF-36 compared with the general population sample in Taiwan. Age was inversely associated with physical function-related QOL dimensions (P<0.01). Divorced patients scored better in PF (P<0.05), BP (P<0.01) and PCS (P<0.05) whereas single patients scored worse in RP (P<0.05) and PCS (P<0.05). Higher monthly income was positively associated with RE, MH and MCS (P<0.01). Increased frequency of joining social activities was positively associated with SF (P<0.05). More things worried was inversely associated with SF (P<0.05), MH (P<0.01) and MCS (P<0.01). Higher BDI scores were strongly inversely associated with lower scores of PCS, MCS and all eight dimensions of the SF-36 (P<0.01). Conclusion Higher monthly income and increased frequency of joining social activities are associated with better HRQOL, whereas more things worried and higher BDI scores are associated with worse HRQOL of HD patients.