類風濕性關節炎患者接受生物製劑治療之生活品質及憂鬱程度之探討

Exploring the Quality of Life and Depression Levels for Rheumatoid Arthritis Patients after Receiving the Biological Agents Treatment

羅素惠(Su-Hui Luo)

指導教授 ： 黃國哲

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2008年)

摘要

本研究之目的是探討類風濕性關節炎患者接受傳統抗風濕病藥物治療之外，加上生物製劑治療，其生活品質與憂鬱程度是否有改變。本研究採橫斷式研究，採立意取樣方式，樣本來自於選定台北縣市區域級以上教學醫院，共五家。並選定過敏免疫風濕科的門診患者為研究樣本。自民國97年2月1日至6月10日期間，有效問卷合計回收共322份。本研究以自填式結構性問卷為資料收集工具。問卷包括四個部分：個人基本資料、健康評估（HAQ）、生活品質（台灣簡明版生活品質量表）與心理評估（CES-D量表）。所得資料分析以SPSS（Statistical Package for the Social Science）12.0版電腦軟體進行統計分析，包括描述性分析、獨立樣本t檢定、單因子變異數分析、皮爾森積差相關分析及複迴歸分析等方法。
研究結果顯示，生活品質量表中生理健康範疇、心理範疇、社會關係範疇、環境範疇四個範疇得分，平均值分別是11.05± 2.77, 11.87± 2.90, 13.41 ± 2.09 and 13.17± 2.26。CES-D憂鬱量表平均得分17.23，有49.4%個案得分大於16分。影響目前使用生物製劑之類風濕性關節炎患者而言，有關生活品質中生理健康範疇之重要解釋變項，為研究對象之關節疼痛強度、目前使用鎮靜安眠藥物及身體失能狀況，其解釋力達45.3％。影響目前使用生物製劑之類風濕性關節炎患者生活品質中之心理範疇的重要解釋變項，為研究對象之罹病年數及身體失能狀況，其解釋力為33.9％。而影響目前使用生物製劑之類風濕性關節炎患者的憂鬱程度之重要解釋變項，則包含研究對象罹病年數及身體失能狀況，其解釋力為27.1％。
依據本研究的發現，建議1.臨床醫療人員，提供個別性的照護，藉以改善類風濕性關節炎患者的憂鬱狀態，提升其生活品質。2.臨床醫療人員，對於使用生物製劑治療類風濕性關節炎患者，需隨時評估身心狀況。3.醫療管理者，建置以病人為中心之環境，改善門診患者等候看診時的不適。4.建置使用生物製劑個案管理系統，期望透過個案管理，持續評估患者狀況及治療成效。

關鍵字

生物製劑治療 ； 生活品質 ； 憂鬱程度

並列摘要

The purpose of this study was to elucidate the effect of biologic agent therapy on “Quality of Life” and “Depression Levels” of patients with rheumatoid arthritis (RA) in comparing with conventional disease-modifying antirheumatic drugs (DMARDs) therapy. The research approach is a cross-sectional design. Purposive sampling method was used to collect data from RA patients who were recruited from outpatient clinics of allergy immunology & rheumatology of five teaching hospital in Taipei, Taiwan. Totally 322 questionnaires were collected during February 1, 2008 to June 10, 2008. Data were collected through structured questionnaires including the demographic characteristics, Health to Assessment (Health Assessment Questionnaire, HAQ), Quality of Life (the World Health Organization Quality of Life-BREF,WHOQOL-BREF), and psychology to Assessment (the Center for Epidemiologic Studies-Depression, CES-D). Data were analyzed by descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation analysis, and multiple regression analysis using commercial SPSS/Windows 12.0 statistical software.
This research results show the mean WHOQOL scores of the patients were 11.05±2.77, 11.87±2.90, 13.41±2.09 and 13.17±2.26 in the physical, psychological, social, and environmental domains of the WHOQOL-BREF respectively. The mean CES-D score of the patients was 17.23. There were 49.4% patients had CES-D score more than 16. Our results indicate the significant independent variables influencing the WHOQOL scores physical domain in RA patients using biological therapy include the severity of joint pain, use of sedative / hypnotic agents and functional disability. Total variances explained are 45.3%. The significant independent variables influencing the WHOQOL scores psychological domain in RA patients using biological therapy include the duration of disease and Functional disability. Total variances explained are 33.9%. The significant independent variables influencing the depression level scores in RA patients using biological therapy include the duration of disease and Functional disability. Total variances explained are 27.1%.
Base on the research findings, we suggest (1) Healthcare professionals should provide available healthcare to enhance the quality of life of RA patients. (2) Healthcare professionals must assess the physical and psychological condition of RA patients using biologic agents. (3) Healthcare professional manager should establish patient-centered environment to improve waiting discomfort in outpatient clinics. Finally, we may assess the patient’s status, treatment outcome and possible associated conditions effectively by the administrative system for RA patients using biologic therapy.

並列關鍵字

biologic agent therapy ； Quality of Life ； Depression Levels

參考文獻

王榮德、游正芬、鍾智文、姚開屏(2000)。廿一世紀之健康照護效性評量：生活品質與生活品質調整後之存活分析。台灣醫學雜誌，4(1)，65-74。

王麗惠、劉芹芳(2007)。消化系統癌症惡病質病患的個人基本屬性、營養狀況與日常生活活動能力及生活品質之相關性。護理雜誌，54(3)，33-42。

行政院衛生署全民健康保險爭議審議委員會(2007)。Etanercept(Enbrel®)藥品使用之爭議。醫療爭議審議報導，27，25-29。

李佩珊、李絳桃、黃久美、李奇龍(2006)。更年期婦女之更年期態度、更年期症狀與憂鬱情緒之相關性研究。實證護理，2(2)，156-165。

李麗花、賴惠玲、蕭正光、鍾信心(2005)。音樂對社區老人憂鬱之成效探討。慈濟護理雜誌，4(2)，27-36。