肌無力症患者生活品質與焦慮憂鬱之相關因素

Abstract

肌無力症是神經肌肉的自體免疫疾病，患者會有上眼臉下垂、複視、口齒不清、吞嚥困難、全身無力等症狀，嚴重時甚至呼吸困難導致生命危險。隨著醫療科技發展，肌無力症不論在診斷及治療都有進步，平均餘命延長及人口老化等因素，其盛行率有增加之趨勢。參考全民健康保險重大傷病領證人數，推估台灣肌無力症盛行率每百萬人口約187人。由於疾病的特性會使患者身體上出現的障礙，影響生活上的自理能力，也會影響其社交、工作、求學的機會及心理層面，進而影響其生活品質。本研究利用病人自行報告之結果，透過患者自填問卷的方式獲得其健康相關的生活品質報告，以作為協助醫師提供更好更多的以病人為中心的照護服務。 本研究採橫斷式調查研究，以單一醫院的門診肌無力症患者為研究樣本，個人為分析單位。資料來自兩方面，健康生活品質及社會及人口學方面，以結構式問卷進行調查；臨床資料方面，以樣本醫院提供之肌無力患者資料庫登錄資料為準。本研究自103年7月1日至8月31日進行調查，共回收問卷132份，其中116份為有效問卷（有效樣本率為88%），收案病患平均年齡46.4歲，其中女性有78位。利用統計軟體SPSS 17.0，以雙變項分析及線性迴歸分析，檢定各變項與生活品質之關係。研究結果顯示，不同焦慮程度是影響生活品質主要因子，焦慮分數越高，生活品質越差；在分層分析中顯示，最年長的一組其憂鬱程度會影響生活品質，但有擔任肌無力俱樂部幹部對生活品質有正向效果。 情緒障礙是肌無力症患者最常見的併發症，在治療肌無力症的同時，心理的健康也是醫療團隊應積極維護的。肌無力俱樂部具有提升生活品質的功能，在年長的樣本中得到驗證，建議可以多鼓勵所有病友參加幹部的培訓課程，讓病友轉換生病者的角色，成為主動關懷的人，對於其生活品質會有所助益。臨床上，建議對肌無力患者進行全面的生活品質量表及焦慮憂鬱量表調查，以瞭解患者生活品質及心理狀況，對於焦慮憂鬱患者能及早介入治療，以維護其生活品質。

Myasthenia Gravis（MG）is a neuromuscular autoimmune disease. Patients will have symptoms like ptosis, diplopia, dysarthria, dysphagia, generalized muscle weakness, and, in the most severe situation, respiratory insufficiently, even leading to life-threatening. As medical technology developing, there has been great progress in the diagnosis and treatment of myasthenia gravis. Due to longer life expectancy and aging population, there is a clear trend towards an increase in the prevalence of the disease. According to the number of valid catastrophic illness cards issued by Taiwan’s National Health Insurance, the prevalence of myasthenia gravis in Taiwan is estimated to be 187 cases per million people. Due to the nature of the disease, patients are affected in self-care ability, social, work, pursuing education opportunities and psychological aspect, thereby affecting their quality of life. In this study, using patient-reported outcome, obtained the quality-of-life through asking patients to fill out a self-administered questionnaire directly. The results will be provided to the clinicians to deliver better patient-centered service. This study was a cross-sectional research. Patients were recruited from the outpatient neurology clinic of a single hospital, individuals as ananlysis unit. Data were obtained from two parts. Health-related quality-of-life and socio-demographic features were collected from the structured questionnaires, and clinical data were acquired from the database registered in the sample hospital. The study was conducted between 1st July 2010 and 31st August 2014. There were 132 questionnaires collected, of which there were 116 valid questionnaires (effective sample rate of 88%). The recruited patients’ average age was 46.4 years, 78 were female.Using the statistical software SPSS 17.0, with bivariate analysis and linear regression analysis to test the relationship between various variables and quality of life. The results reveal that the different degrees of anxiety were the main factor affecting the quality of life, the higher anxiety’s score was, the worse quality of life became. Stratified analyses showed that the different degrees of depression affected the quality of life in the oldest group. But the samples served as volunteer’s cadres in MG club had positive effect on quality of life. Mood disorder is the most common co-morbidity in MG patients. In the treatment of myasthenia gravis, mental health should be actively maintained. MG club had a function to enhance the quality of life of patients; it had been verified in the oldest group of patients. It is recommended that more patients be encouraged to attend the training courses of volunteer cadres. It will help the patients convert the sick role to become an active person of delivering care for other patients. Therefore the quality-of-life of patients will be improved. Clinically, in order to understand the quality of life and psychological status of patients with MG, it is recommended to conduct a comprehensive investigation of quality-of-life scale and Hospital Anxiety Depression Scale. Early intervention will be provided to patients with anxiety or depression so as to maintain their quality-of-life.