代謝症候群患者生活品質與診斷指標探討

Study on Health Related Quality of Life among Patients with Metabolic Syndrome and Its Diagnostic Indicators

粘沛琳(Pei-Lin Nien)

指導教授 ： 廖宏恩

亞洲大學/健康學院/健康管理研究所/碩士(2009年)

摘要

摘要
背景與目的：「代謝症候群」是近幾年來逐漸受到關注的健康議題，根據2002年臺灣三高盛行率的調查顯示，男女罹患「代謝症候群」比率分別為16.9％與13.8％（陳建仁等，2003），且隨著年齡的增加，盛行率也逐漸增加（Ford & Li, 2008）。然而，代謝症候群對民眾生活造成不便性仍無定論，故本研究欲比較代謝症候群患者與非代謝症候群(高危險群、健康者)患者之健康生活品質情形及迴歸分析代謝症候群診斷指標與代謝症候群之相關性。
方法：本研究於某醫院門診及體檢進行系統性抽樣，以滿20歲以上民眾為受訪者(n=1205)，填寫健康生活品質量表(SF-36)及以2005年國民健康調查部份基本資料之研究問卷，並病歷回顧以區分代謝症候群、高危險群及健康者，結果以SPSS12.0電腦套裝軟體進行統計推論。
結果：在調整人口學及健康指標變項後，發現代謝症候群患者比非代謝症候群患者(高危險群、健康者)在「生理」及「心理」健康層面之生活品質佳，且有統計上之顯著性(p＜0.05)。另生理健康生活品質之平均分數以代謝症候群患者顯著低於其他非代謝症後症候群患者(高危險群、健康者) (p<0.05)；而心理健康生活品質之平均分數則以代謝症候群患者顯著高於非代謝症後症候群患者(高危險群、健康者)(p＜0.05)；進一步發現心理健康生活品質之平均分數，以「知悉」自己是代謝症候群患者顯著低於非代謝症候群患者(高危險群、健康者)(p＜0.05)。
代謝症候群五種診斷指標項目中以腰圍(OR=22.15，95% CI 10.84-45.28，B值3.10)及HDL值(OR=25.43，95% CI 9.38-68.95，B值3.24)與代謝症候群最為顯著相關(p＜0.05)。
結論：代謝症候群患者在「生理」、「心理」健康生活品質顯著比非代謝症候群患者(高危險群、健康者)佳；缺乏與健康的一般人相比，「代謝症候群」患者的生活品質仍需進一步探討。研究另發現持續有運動習慣可以改善生理及心理健康生活品質。
「腰圍」越大發生「代謝症候群」機會愈大，而「腰圍值」取得簡易、成本低，且不會有疼痛情形，為最具效益之診斷指標，但臨床上大都未被制定為常規項目。期研究結果可做為醫護人員日後照護患者健康生活品質變化、預防保健教育推廣及制定臨床作業標準之參考依據。

關鍵字

代謝症候群 ； 健康生活品質 ； 腰圍 ； 肥胖

並列摘要

Abstract
Background and purpose: The metabolic syndrome, a constellation of abnormalities, has been drawing people’s attention recently. According to Dr. Chen’s survey in Year 2002, the prevalence rates of the metabolic syndrome among males and females were 16.9% and 13.8%, respectively (Chen et al., 2003). In addition, its prevalence is sharply increasing along the aged (Ford & Li, 2008). However, the magnitude of public health burden of the metabolic syndrome is still not understood. This study intended to compare the health-related quality of life among metabolic syndrome group, high risk group, and risk free patients. Additionally, a regression analysis was carried out to exam the relationship between regular clinical tools and diagnosis of the metabolic syndrome.
Methods: By using systematic sampling method, we enrolled 1205 respondents with over the age of 20 from 5 different out-patients clinics in a regional hospital. Those respondents were categorized into metabolic syndrome group, high risk group, and risk free patients by reviewing their medical records. All subjects were face-to-face interviewed with a structured questionnaire composed of the Taiwan version of the short-form 36-item health survey (SF-36) and parts of National Health Interview Survey (NHIS), Year 2005. The SPSS12.0 software was employed for statistical inference.
Results: After adjusting confounding factors, we found that metabolism syndrome group has significantly both better physical and mental health-related quality of life than that of high risk group as well as risk free group (p<0.05). We found that the average scores of physical health-related quality of life among the metabolic syndrome group is significantly lower than that of the other two control groups (p<0.05). On the Contrary, the average scores of mental health-related quality of life among the metabolic syndrome group is significantly higher than that of the other two control groups (p<0.05).
Among 5 clinical tools to diagnose the metabolic syndrome, the circumference of waist (OR = 22.15, 95% CI 10.84-45.28, B = 3.10) and high-density lipoprotein (HDL) values (OR = 25.43, 95% CI 9.38-68.95, B = 3.24) possess the most significant relationships with the diagnosis of the metabolic syndrome (p<0.05).
Conclusion: Although our study showed metabolism syndrome group has significantly both better physical and mental health-related quality of life than that of high risk group as well as risk free patients, lack of healthy general population comparison in this study suggests the quality of life of the metabolic syndrome population still remains unsolved. On the other side, our study has shown keeping an exercise habit can improve both the physical and psychological health-related quality of life.
The close relationship between the measurement of the waist circumference and the diagnosis of the metabolic syndrome implies a more cost-effective way to diagnose the metabolic syndrome and strongly suggests that the circumference of waist should be include into the routine check up list for better monitoring the metabolic syndrome.

並列關鍵字

Metabolic Syndrome ； Health-related quality of life (SF-36) ； waist circumference ； Obesity

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