長期血液透析病人在不同問卷工具下健康相關生活品質差異之探討

The Impact of Different Questionnaires on Measuring Health-Related Quality of Life for Maintenance Hemodialysis Patients

李俊億(Chun-I Lee)

指導教授 ： 張睿詒

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2013年)

https://doi.org/10.6342/NTU.2013.10923

摘要

研究背景：生活品質的調查其結果可評估族群中各種疾病之痛苦程度及健康相關生活品質；目前國內外已發展數種不同生活品質發展問卷，一般研究大多以單一量表測量生活品質，鮮少以多種量表測量來探討。
研究目的:調查血液透析病人健康相關生活品質，以瞭解其生活品質之現況，同時探討血液透析病人之基本屬性、疾病特性與血液生化值在不同健康相關生活品質量表之差異，進一步比較不同量表間的差異。
研究方法：本研究採橫斷性研究，利用EQ-5D、SF-12、KDCS、WHOQOL-BREF (TW) 四種量表進行資料收集，以中部及北部共四家區域醫院的血液透析為研究對象。統計方法採單因子變異數分析、多變量線性迴歸及廣義估計方程式評估血液透析病人之基本屬性、疾病特性與血液生化值對健康相關生活品質之差異，進一步探討四種量表的差異。
研究結果：共 398位血液透析病人參與此研究，平均年齡為61.16±13.77歲，男性有184人 (46.2％)，大部份為已婚(70.4%)。結果顯示教育程度、透析時間在1-3年者、有社交活動、生活功能越佳及血清白蛋白正常者在四種健康相關生活品質量表皆呈現正相關。從四種健康相關生活品質量表得知：(1)EQ-5D在性別為女性、年齡50歲以上、未婚、離婚及喪偶、有後遺症、血清白蛋白異常以及疾病嚴重度差者有顯著負相關；學歷為國中以上、持續透析時間為1-3年、有社交活動、KPS皆有顯著正相關。(2)SF-12在生理健康構面，女性、年齡50歲以上、未婚、離婚及喪偶、有後遺症、血清白蛋白異常以及疾病嚴重度差者有顯著負相關；學歷為國中以上、持續透析時間為1-3年、有社交活動、日常體能狀態皆有顯著正相關；在心理健康構面，年齡50歲以上、未婚、離婚及喪偶、血清白蛋白異常以及疾病嚴重度差者有顯著負相關；學歷為國中以上、持續透析時間為1-3年、有社交活動者有顯著正相關。(3)KDCS在生理健康構面，性別為女性、年齡50歲以上、未婚、離婚及喪偶、血清白蛋白異常以及疾病嚴重度差者有顯著負相關；在心理健康構面，學歷為國中以上、持續透析時間為1-3年有顯著正相關。(4) WHOQOL-BREF (TW) 在生理健康構面，年齡50歲以上、未婚、離婚及喪偶、有後遺症、血清白蛋白異常以及疾病嚴重度差者有顯著負相關；學歷為國中以上、持續透析時間為1-3年有顯著正相關；在心理健康構面，未婚、離婚及喪偶、有後遺症、血清白蛋白異常以及疾病嚴重度差者有顯著負相關；學歷為國中以上、持續透析時間1-3年、有社交活動者有顯著正相關；在社會關係構面，女性、學歷為國中以上、持續透析時間1-3年、有社交活動、日常體能狀態正常有顯著正相關；在環境構面，未婚、離婚及喪偶有顯著負相關；學歷為國中以上者有顯著正相關。從廣義估計方程式得知：社交活動在EQ-5D、SF-12、WHOQOL-BREF (TW) 的生理、心理及社會關係構面均有顯著正相關；日常體能狀態在EQ-5D、SF-12的生理構面、WHOQOL-BREF (TW) 的生理及社會關係構面均有顯著正相關。
結論：女性、年齡越高、教育程度為國小者、離婚、喪偶以及未婚、透析時間為1年以下者、有後遺症及併發症者、鮮少參與社交活動、日常體能狀態較差、疾病嚴重度量表分數越差以及血清白蛋白異常者，健康相關生活品質較差。EQ-5D、SF-12和WHOQOL-BREF (TW) 在生理健康範疇具有一致性；SF-12和WHOQOL-BREF (TW) 在心理健康層面具有一致性。

關鍵字

血液透析 ； 健康相關生活品質 ； 健康相關生活品質量表 ； EQ-5D ； SF-12 ； KDCS ； WHOQOL-BREF (TW)

並列摘要

Background: Result from life quality survey can assess degree of painfulness in various diseases and health-related life quality among population; a number of different life quality questionnaires are developed both in Taiwan and aboard. In general, single scale is used to measure life quality assessment and multi scales are rarely used in this situation.

Objective: This research is to investigate hemodialysis patients' health-related life quality, in order to understand the current situation in their life and explore the fundamental properties of hemodialysis patients, disease characteristics and blood biochemical values in differences of various health-related life quality scales, to further compare differences between scales.

Method: Cross-Sectional Study is used in this research, using four types of scales EQ-5D, SF-12, KDCS, WHOQOL-BREF (TW) to collect dates on hemodialysis patients from four regional hospitals in central and northern Taiwan. Statistical methods utilize ANOVA analysis, Simple Linear Regression and Generalized Estimating Equations to evaluate the basic properties of hemodialysis patients, disease characteristics and biochemical data on health-related life quality differences, to further study difference in four scales.

Results: A total of 398 hemodialysis patients participated in this study, the average age was 61.16 ± 13.77 years. There were 184 males (46.2%) and most were married (70.4%). The results showed that patients with higher educational level, duration of 1-3 years dialysis, more active social activities, better living capabilities , and normal serum albumin had a positive correlation in four types of health-related life quality scales. Four health-related quality of life scales show: (1) EQ-5D in female sex, age over 50 years old, unmarried, divorced and widowed, with sequelae, abnormal serum albumin, and with severe diseases had a significant negative correlation; education above junior high school, 1-3 years duration of dialysis, with social activities, KPS all had a significant positive correlation; (2) SF-12 in physiological health dimension, women, ages over 50 years old, unmarried, divorced and widowed, with sequelae, abnormal serum albumin, and with severe diseases had a significant negative correlation; education above junior high school, 1-3 years duration of dialysis, with social activities and daily physical condition had a significant positive correlation; in dimensions of mental health, aged over 50 years, unmarried, divorced and widowed, abnormal serum albumin, and with severe diseases had significant negative correlation; education about junior high school, 1-3 years duration of dialysis, and with social activists had a significant positive correlation; (3) KDCS in physical health dimension, female gender, age over 50 years old, unmarried, divorced and widowed, abnormal serum albumin and with severe diseases had a significant negative correlation; in dimensions of mental health, education about junior high school and 1-3 years duration of dialysis had a significant positive correlation; (4) WHOQOL-BREF (TW) in physiological health dimension, age over 50 years, unmarried, divorced and widowed, with sequelae, abnormal serum albumin, and with severe diseases had a significant negative correlation; education about junior high school and 1-3 years duration of dialysis had a significant positive correlation; in dimensions of mental health, unmarried, divorced and widowed, with sequelae, abnormal serum albumin, and with severe diseases had a significant negative correlation; education about junior high school, 1-3 years duration of dialysis and with social activists had a significant positive correlation.; in dimensions of social relations, women, education above junior high school, 1-3 years duration of dialysis, with social activities and normal daily physical condition had a significant positive correlation; in environmental dimensions, unmarried, divorced and widowed had a significant negative correlation ; education about junior high school had a significant positive correlation. Results from generalized estimating equation: social activities in physiological, mental, and social relation dimensions of EQ-5D、SF-12、and WHOQOL-BREF (TW) all had significant positive correlations; daily physical conditions in physiological dimension of EQ-5D、SF-12 and in physiological and social relation dimensions of WHOQOL-BREF (TW) all had significant positive correlations.

Conclusion: Women, higher age, education level of elementary school, divorced, widowed and unmarried, dialysis for 1 year or less, with sequelae and complications, low participation in social activities, poor daily physical condition, low scores in disease severity, and abnormal serum albumin, health-related quality of life is poor. EQ-5D, SF-12 and WHOQOL-BREF (TW) in physiological health dimension are consistent; SF-12 and WHOQOL-BREF (TW) in mental health dimension are consistent.

並列關鍵字

Hemodialysis ； Health-Related Quality of Life ； EQ-5D ； SF-12 ； KDCS ； WHOQOL-BREF (TW)

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