家族性高膽固醇血症患者治療遵從性及其生活品質之探討

背景：血脂異常會提高罹患冠狀動脈疾病的風險，然而臨床上發現許多病人因治療遵從性不足，降低了醫療照護的有效性。家族性高膽固醇血症患者因基因遺傳導致先天性膽固醇代謝異常而高於一般民眾，有更高的早發性心血管疾病之風險，故更加需要配合治療控制疾病，避免因膽固醇升高導致提早罹患心血管疾病。研究目的：（一）探討高膽固醇血症患者目前的健康狀況與其治療遵從性；（二）調查高膽固醇血症患者之人口學特性與其健康相關生活品質；（三）分析高膽固醇血症患者人口學特性與心血管疾病盛行率與治療遵從性之相關性；（四）分析高膽固醇血症患者治療遵從性與生活品質之間的相關性。研究方法：研究設計採用橫斷式相關性研究，以家庭為基礎之連續取樣法，使用結構式問卷於北部某醫學中心之高血脂特別門診個案。研究工具包括：健康相關生活品質量表及世界衛生組織之－台灣簡版生活品質量表、治療遵從行為評估量表。研究結果以統計套裝軟體SPSS 22.0版本進行資料分析，包括描述性統計、皮爾森相關係數、獨立樣本t-檢定及變異數分析進行各變項之間比較，並以多元迴歸法分析生活品質的相關因素。研究結果：本研究共收集340位家族性高膽固醇血症患者，其平均年齡為58.38歲(±13.08)，女性居多，共212人（62.4%），其教育程度偏低（高中及以下）佔51.7%、已婚者居多佔77.5%，男性女性總膽固醇平均值分別為334.70mg/dl(±96.09)、313.58mg/dl(±60.64)；低密度脂蛋白平均值分別為216.28mg/dl(±72.09)、178.72mg/dl(±47.47)。罹患心血管疾病達性別顯著差異，女性罹病率較男性低（p<0.05）。治療遵從性方面（身體活動及藥物治療）無性別顯著差異，但在飲食作息部分女性較男性能遵從治療。年紀愈大者的服藥遵從性愈好（42.31 v.s. 40.40）及教育程度偏低者（43.13 v.s. 41.08）服藥遵從性較高，而治療遵從性與生活品質呈正相關（r=0.175）。生活品質測量結果中，身體範疇及心理範疇有顯著的性別不同差異（p<0.05），男性比女性擁有較好的身體及心理生活品質；年齡層差異方面，年紀大的患者身體範疇生活品質較差（44.43 v.s. 49.87），但心理範疇生活品質較年紀輕者好（47.38 v.s. 43.98）；教育程度高的比教育程度低者擁有較好的身體及心理生活品質（13.40 v.s. 12.62）；無工作者對於身體及心理範疇的生活品質較不滿意。以逐步回歸分析發現以職業狀態、心血管疾病病史、性別、肥胖、糖尿病病史及睡眠品質可以解釋身體範疇生活品質25.5%之變異量；睡眠品質、年齡及服藥遵從性可以解釋心理範疇生活品質10.9%之變異量；睡眠品質可以解釋社會範疇生活品質2.7%之變異量；睡眠品質可以解釋環境範疇生活品質5.4%之變異量。結論：透過本研究之初探了解家族性高膽固醇患者之治療遵從性、生活品質，以及治療遵從性和生活品質的相關因素。家族性高膽固醇血症患者面對早發性心血管疾病的威脅，心理生活品質較差。服藥遵從性愈好者，其心理範疇生活品質愈好。服藥遵從性愈好，亦可以進而預防早發性心血管疾病。建議在臨床護理衛教時，對家族性高膽固醇血症患者加強服藥遵從之相關衛教主題。

關鍵字

家族性高膽固醇血症；治療遵從性；生活品質；服藥遵從性

並列摘要

Background: Dyslipidemia is the one risk factor for cardiovascular disease. However, poor adherence to treatment diminishes the effectiveness in medical treatment. Familial Hypercholesterolemia (FH) is a genetic disorder disease that causes high low density lipoprotein cholesterol from birth and runs in a family. Individuals with FH are more likely to develop coronary artery disease than people without FH. They have to pay more attention to their treatment in order to control their disease and reduce the risk of premature cardiovascular disease. Objective: (1) To describe health status and adherence to treatment of FH populations. (2) To investigate demographic characteristic of FH and their quality of life. (3) To analyze the correlations between the prevalence of cardiovascular events of FH and their adherence to treatment. (4) To analyze the correlations between adherence to treatment and quality of life among FH. Design Method: A cross-sectional design was used, home-based recruited. The research subjects who were receiving medical treatment from a hyperlipidemia specialist at a medical center in Taipei, were requested to join this study after consent. The participants were asked to fill in a formally structured questionnaire which included patient demographic information, treatment adherence questionnaire from Australia, Taiwanese medication adherence scale and Health related Quality of life was measured according to the Short-Form 12 and Taiwanese version of the WHOQOL-BREF. Data were analyzed by using SPSS 22.0 statistical software. Results: A total of 340 subjects were recruited, their mean age 58.38(±13.08) years old. The majority of subjects were female, a total of 212(62.4%), 51.7% of the female had lower educational status. 77% of the women were married. Mean total cholesterol and low density lipoprotein cholesterol (LDL-c) of male and female were 334.70mg/dl(±96.09), 216.28mg/dl(±72.09) and 313.58mg/dl(±60.64), 178.72mg/dl(±47.47) respectively. The prevalence of cardiovascular events among FH individuals had a significant gender difference (p<0.05), male had higher prevalence of CVD history than female. The measurements of treatment adherence, physical activity and medication did not show any significance, only Food section was significant between genders. Female had a higher food adherence than male. Older subjects (aged ≥50) and those with lower education level showed higher medication adherence. There were positive correlations between medication adherence and quality of life among FH subjects. In the measurement of quality of life, physical and psychological domain had a significant gender difference. Male had better quality of life in these two domains above. Older subjects had poorer physical quality of life than younger subjects (44.43 v.s. 49.87) but older subjects had better psychological quality of life (47.38 v.s. 43.98). Subjects with high educational status had better physical and psychological quality of life (13.40 v.s. 12.62). Non-job workers had lower quality of life among physical and psychological domain. By stepwise regression analysis, we found that job status, CVD history, sex, obesity, diabetes mellitus history, sleep quality may explain the 25.5% variance in the physical domain of quality of life. Sleep quality, age, medication adherence may explain the 10.9% variance in the mental domain of quality of life. Only sleep quality may explain the 2.7%variance in the social domain and may explain 5.4% variance in the environment domain of quality of life. Conclusion: Patients suffering from FH are constantly worried about getting premature cardiovascular disease. In our study, good adherence to treatment was associated with better psychological quality of life. Clinical health provider should give detailed patient education about medication in order to promote their adherence and reduce the prevalence of premature cardiovascular disease.