免疫性血小板减少性紫癜的研究与进展

免疫性血小板减少性紫癜(ITP)是血液系统一种常见的获得性免疫性疾病,目前对ITP发病机制的研究多集中在机体内细胞免疫紊乱、体液免疫紊乱和氧化应激作用等方面,在多种因素共同影响下,机体免疫系统平衡状态的改变是疾病发生的前提。该文就近年来ITP发病机制研究中和进展作一综述。     

Measurement of utility values in the UK for health states related to immune thrombocytopenic purpura

Abstract

Objective:

To measure utility values associated with immune (idiopathic) thrombocytopenic purpura (ITP), as perceived by the United Kingdom (UK) general public.     

儿童急性特发性血小板减少性紫癜不同治疗方案疗效及预后因素研究

目的分析儿童急性特发性血小板减少性紫癜（ITP）不同治疗方案的疗效,并探讨影响其远期预后的主要因素。方法分析2006年1月至2008年12月就诊于我院的72例儿童急性ITP患儿的不同治疗方案的近期疗效,并分析相关因素与患儿远期预后的关系。结果①泼尼松组显效率66.6%,有效率78.6%;无效9例（21.4%）;而丙种球蛋白组（丙球组）显效率90.0%,有效率96.7%,无效1例（3.3%）;丙球组的近期疗效明显优于丙球组（P〈0.05）;②丙球组的血小板开始上升时间、达峰值时间和恢复正常时间明显短于泼尼松组,而治疗第7天的血小板值则明显高于泼尼松组,显示丙球在早期提高血小板值方面的优势;③全组患儿中位随访56（12～70）个月,共有60例患儿治愈,12例患儿转为慢性ITP,不同治疗方式的预后转归无明显差异（P〉0.05）;④Logistic回归分析显示：患儿起病至开始治疗的时间、治疗后血小板开始上升的时间和血小板恢复正常的时间是影响预后的相关因素。结论对于儿童急性ITP患者应该早发现、早诊断、早治疗,特别是早期应用丙种球蛋白,可明显促进血小板的早期恢复,减少转为慢性ITP的可能性,应该作为一线治疗药物。     

Health-related quality of life in type 1 diabetes mellitus pediatric patients and their caregivers in Spain: an observational cross-sectional study

Objectives: This study assessed the health-related quality of life (HRQOL) of pediatric patients with type 1 diabetes mellitus (T1DM) and their caregivers.

Methods: CHRYSTAL was an observational cross-sectional study conducted in Spain in 2014 on 275 patients under 18?years old diagnosed with T1DM. Patient/caregiver pairs were stratified by patients’ HbA1c level (≥7.5% versus <7.5%) and by presence or absence of T1DM complications and/or comorbidities. EQ-5D and PedsQL questionnaires were administered to patients and caregivers.

Results: On the EQ-5D, according to caregivers’ perception, 17.7% of children experienced moderate pain or discomfort, 9.7% suffered problems performing usual activities, and 13.2% demonstrated moderate anxiety or depression. Mean EQ-5D index score was 0.95 and mean visual analog scale (VAS) score was 86.1. By HbA1c level (≥7.5% versus <7.5%), mean index scores were 0.94 and 0.95, and mean VAS scores were 82.8 and 89.2, respectively. Mean index scores were 0.91 for children with complications and/or comorbidities and 0.96 for children without. Mean VAS scores were 83.7 and 87.2, respectively. HRQOL per the PedsQL tool ranged from 68.1 (ages 2–4) to 73.1 (ages 13–18). EQ-5D index and VAS scores were significantly correlated (rho = 0.29–0.43) with several age groups of the PedsQL. EQ-5D scales showed significant moderate correlation between EQ-5D-Y and EQ-5D-3L proxy VAS score (rho = 0.45; p?<?.001).

Conclusions: Patients with few complications and controlled HbA1c reported a relatively high HRQOL. The results suggest that parent-proxy EQ-5D ratings are valid for use as part of an overall health outcomes assessment in clinical studies of T1DM in pediatric patients.     

Health-related quality of life burden of women with endometriosis: a literature review

ABSTRACT

Purpose: The purpose of this study was to conduct a comprehensive and systematic literature review of the health-related quality of life (HRQL) burden of endometriosis in adults and adolescents.

Methods: We conducted a systematic search and review of studies published between January 1999 and January 2006 using MEDLINE and relevant online resources. Search terms used included endometriosis, quality of life, burden of illness, psychology, and adolescent. We assessed: (1) the HRQL impact of endometriosis and related key symptoms; (2) the impact of specific pharmacologic and surgical treatments of endometriosis on HRQL; and (3) the presence and impact of endometriosis in adolescents.

Results: Twenty relevant studies were identified and reviewed. Generic instruments most commonly used to assess HRQL in patients with endometriosis included the SF‐36 and the SF‐12. The EQ‐5D was used to measure utilities. The Endometriosis Health Profile-30 (EHP‐30) and its subset, the EHP‐5, have been recently developed for use in endometriosis studies. Endometriosis was associated with significant impairments in pain, psychological functioning, and social functioning. Pharmacological and surgical treatments for endometriosis improved patients physical functioning, psychological functioning, vitality, pain level, and general health. Few studies used disease specific instruments to characterize the HRQL burden of endometriosis, addressed the HRQL impact of endometriosis-related infertility, and examined endometriosis in adolescents. Instruments specifically validated to measure HRQL in adolescents were not identified.

Conclusions: Endometriosis impairs HRQL, especially in the domains of pain, psychological and social functioning. Therapies have been shown to alleviate symptoms and improve HRQL. Further research is warranted to evaluate the impact of endometriosis on HRQL in adolescents and the impact of infertility due to endometriosis on HRQL.     

血栓性血小板减少性紫癜2例

目的 分析2例血栓性血小板减少性紫癜(TTP)患者治疗方法,为该类患者成功抢救提供借鉴。方法 通过运用改良血浆置换联合山莨菪碱、激素及阿司匹林治疗方法,观察TTP患者的治疗效果。结果 2例患者治疗后精神神经症状、肝肾功能和血液学指标[患者一:RBC:(2.17 vs 3.17)×10¹²·L-1 ,HB:65.00 vs 110.00 g·L-1,PLT:(10.00 vs 257.00)×10⁹· L-1;患者二:RBC(1.98 vs 3.52)×10¹²·L-1 ,HB:51.00 vs 105.00 g·L-1,PLT:(15.00 vs 128.00)×10⁹· L-1]有明显改善。结论 该治疗方法对于TTP患者有积极作用。     

人工髋关节置换后患者生活质量及其影响因素

目的分析人工髋关节置换患者生活质量的主要影响因素,为增进人工髋关节置换患者生活质量提供参考。方法用SF-36量表评价90例人工髋关节置换患者的生活质量,同时调查可能影响生活质量的社会经济、文化因素,以及被调查对象的个人特征和患病情况。用t检验、方差分析和逐步回归对每一影响因素进行分析,找出主要影响因素。结果①与一般人群比较,治疗前患者的生活质量在各个领域均明显低于正常人,治疗后均得到改善;②生活质量与各单因素在部分领域有关,相关分析提示,各影响因素大多对部分维度呈中、低度相关,多元回归分析发现,临床病情对患者健康相关生活质量的影响作用比常见的一些人口学指标更为重要,所有因素对各维度变异的解释作用为29.7%～66.2%。结论①人工髋关节置换患者的相关生活质量较一般人群已出现明显下降;②常见的人口学资料及临床病情共同用于解释患者相关生活质量下降的意义有限,导致患者相关生活质量下降最为主要的因素尚需进一步研究。     

Economic burden and quality of life of vulvodynia in the United States

Abstract

Objective:

To explore the economic burden and quality of life of vulvodynia in the United States.     

冠心病患者生命质量分析

目的:对冠心病(CHD)患者入院初和出院前的生命质量进行评价,并对其影响因素进行研究,从而方便医生有针对性地采取治疗和康复措施,改善患者临床症状和提高患者生存质量。方法:以统一印制的调查表对241例CHD患者运用生活质量调查健康状况调查问卷(SF-36量表)进行问卷调查,调查表内容包括基本情况、生活行为习惯、医疗保障情况、入院原因、生命质量调查等五项内容。应用SPSS统计软件进行数据录入和分析,对比采用独立样本的t检验和方差分析。结果:运用SPSS对SF-36量表各维度分值进行计算,入院初与出院前各维度无统计学意义。从性别、文化程度、职业、病种角度分别对入院初和出院前进行分析,入院初的部分领域差异有显著性,而出院前均无统计学意义。结论:CHD患者生活质量应成为我们关心的内容,对CHD患者生命质量的评价应成为继续研究的主题。本研究表明SF-36量表未能精确地测量CHD患者短期治疗的生存质量的变化。     

欧洲五维健康量表效用值积分体系构建方法及结果的国际比较

文中系统地介绍了英国、美国、日本等7个国家在发展本国欧洲五维健康量表(EQ-5D)效用值积分体系时所采用的方法,并比较各研究结果间的差异及其原因,旨在为建立适合我国人群的EQ-5D效用值积分体系提供参考。不同人群对于健康相关生命质量的偏好具有一些共同点,但表现出来的差异也很大,我国应及早进行研究,这有助于推动国内成本效用分析方法在药物经济学领域中的应用与发展。     

Quality of life in raloxifene-treated Japanese women with postmenopausal osteoporosis: a prospective,postmarketing observational study

Abstract

Objective:

To assess changes in quality of life (QOL) and pain in raloxifene-treated Japanese women with postmenopausal osteoporosis.     

军事训练伤患者生命质量影响因素分析

目的探讨军事训练伤患者生命质量的主要影响因素,从而为增进军事训练伤患者生命质量提供参考。方法用SF-36量表评价105例军事训练伤患者的生命质量,同时调查可能影响生命质量的训练情况、文化因素,以及被调查对象的个人特征和患病情况,进行相关统计学分析,找出其主要影响因素。结果生命质量与各单因素在部分领域有关,相关分析提示,各影响因素大多对部分维度呈中、低度相关,多元回归分析发现,临床病情对患者健康相关生活质量的影响作用比常见的一些人口学指标更为重要,所有因素对各维度变异的解释作用为25.2%～72.3%。结论常见的人口学资料及临床病情共同用于解释军事训练伤患者相关生活质量下降的意义有限,导致军事训练伤患者相关生活质量下降最为主要的因素尚需进一步研究。     

SF-36量表在测定慢性病患者生命质量中的应用考评

目的 通过测定6种慢性病患者的生命质量，对SF-36英国发展版量表的信度、效度和反应度进行考评。方法 用 SF-36英国发展版对住院的6种慢性病患者进行生命质量的测定，分析包括内部一致性信度和重测信度；结构效度、效标效度和区分效度；反应度。结果 SF-36具有较好的信度，除SF外，各领域的内部一致性系数和重测信度系数均在0．7以上，SF的信度系数也在0．6以上。反应度分析显示。SF-36的反应度较好，但测量时间对反应度有一定的影响。SF-36的效度一般，特别是在VT、MH方面效度不佳。结论 SF-36用于慢性病患者的生命质量评估还有待进一步研究，应用于治疗效果评价时注意评价时间对结果的影响。     

伴与不伴鼻息肉的慢性鼻-鼻窦炎患者生存质量比较

目的 探讨伴鼻息肉的慢性鼻-鼻窦炎（CRSwNP）和不伴鼻息肉的慢性鼻-鼻窦炎（CRSsNP）患者生存质量的差异。方法 选取2017年1月至2017年6月安徽省立医院的慢性鼻-鼻窦炎患者100例,依据欧洲鼻-鼻窦炎鼻息肉诊疗指南,分为CRSwNP组50例,CRSsNP组50例,运用Lund-Mackay CT评分及Lund-Kennedy鼻内镜评分对客观病情进行评估,采用汉化版生存质量评定量表（SF-36）及视觉模拟评分量表（VAS）对主观生存质量进行评估,分析两组患者生存质量差异。结果 ①CRSwNP组的Lund-Mackay CT评分（13.71±6.60）分及Lund-Kennedy鼻内镜评分（8.38±2.81）分均高于CRSsNP组的Lund-Mackay CT评分（8.11±6.45）分及Lund-Kennedy鼻内镜评分（4.78±2.08）分,差异均有统计学意义（P<0.05）;②CRSwNP组的VAS总体评分（19.55±8.02）分与CRSsNP组（19.21±9.65）分相比,差异无统计学意义（P>0.05）,但CRSsNP组的头痛、面部胀痛症状[（3.70±3.10）分、（3.72±3.01）分]高于CRSwNP组[（0.98±1.83）分、（0.55±1.18）分],鼻塞、嗅障碍症状评分[（4.19±3.28）分、（2.72±3.51）分]低于CRSwNP组[（6.65±3.24）分、（7.23±3.36）分],差异均有统计学意义（P<0.05）;③CRSwNP组SF-36量表躯体健康总分（PCS）（319.21±54.34）分与CRSsNP组（295.22±70.52）分相比,差异无统计学意义（P>0.05）,但CRSsNP组的生理职能（RF）（64.27±39.04）分低于CRSwNP组（79.42±28.54）分,差异有统计学意义（P<0.05）;④CRSwNP组SF-36量表精神健康总分（MCS）（306.79±67.52）分与CRSsNP组（286.24±86.02）分相比,差异无统计学意义（P>0.05）,但CRSsNP组活力（VI）、精神健康（MH）[（66.39±23.32）分、（66.98±21.14）分]低于CRSwNP组[（76.51±16.49）分、（76.65±17.48）分],差异均有统计学意义（P<0.05）。结论 客观病情方面,CRSwNP患者较CRSsNP患者更为严重,但生理职能、活力及精神健康方面,CRSsNP患者较CRSwNP患者下降更为显著,应注意提高客观病情轻但主观生活质量差的患者生活质量。     

阿达木单抗治疗对类风湿关节炎患者生存质量的影响

目的:观察阿达木单抗治疗对类风湿关节炎患者生存质量的影响。方法:前12周为随机、双盲、安慰剂对照的临床研究,后12周为开放研究。65例活动性类风湿关节炎(RA)患者接受12周的阿达木单抗40 mg、80 mg或安慰剂/隔周的治疗,所有受试者在12~24周接受40 mg/隔周的阿达木单抗治疗,在干预前和干预后采用SF-36生存质量量表对患者的生存质量进行评定和比较。结果:干预后所有患者SF-36生存质量量表得分在生理功能、生理职能、躯体疼痛、总体健康、精力、社会功能、情感职能、精神健康8个维度较干预前有明显的提高。结论:阿达木单抗有利于改善类风湿关节炎患者的生存质量。     

Health-related quality of life (HRQOL) among patients with Generalised Anxiety Disorder: evaluation conducted alongside an escitalopram relapse prevention trial

ABSTRACT

Background: Improving health-related quality of life (HRQoL) should be a treatment goal for patients with Generalised Anxiety Disorder (GAD).

Objectives: To assess the impact of treatment with escitalopram on HRQoL as well as the effect of relapse on HRQoL and work productivity.

Methods: This study was conducted alongside a double-blind, placebo-controlled, relapse prevention multinational clinical trial. Relapse was defined as a Hamilton Anxiety Scale (HAMA) ≥ 15. Treatment responders (HAMA ≤ 10) after 12 weeks of open-label treatment (10?mg/day escitalopram for Week 1 followed by 20?mg/day thereafter) were included. The study dataset comprised patients (n = 329) from French, Canadian, German and Swedish centres. HRQoL was assessed using the SF-36 scale, and data on sick leave and on-the-job productivity as measured by the Work Limitation Questionnaire and the work efficacy and work satisfaction visual analogue scales (VAS) scales were collected at baseline, randomization (Week 12), Weeks 36, 60 and at last assessment. For future health economic analysis, quality adjusted life years were calculated from the SF-36 results.

Results: At baseline, GAD patients reported significantly impaired quality of life compared with the general population. During the 12-week open-label treatment period, treatment responders reported significant improvements in HRQoL on all dimensions of the SF-36 (?p < 0.001) and on-the-job productivity (?p < 0.001), whereas sick leave decreased but did not reach statistical significance. After randomization, relapsed patients reported significantly lower QoL than non-relapsed patients on all 4 SF-36 mental health dimensions (?p < 0.001). Relapsed patients reported slightly lower on-the-job productivity than non-relapsed patients and scored lower on the work efficacy and work satisfaction VAS scales.

Conclusion: GAD adversely affects patient functioning and daily life. Short-term treatment with escitalopram reverses this impairment to population norms. GAD relapse is associated with a deterioration of HRQoL and work productivity.     

Health-related quality of life during bosutinib (SKI-606) therapy in patients with advanced chronic myeloid leukemia after imatinib failure

Objectives: The tyrosine kinase inhibitor (TKI) bosutinib has demonstrated activity in patients with advanced phase chronic myeloid leukemia (CML), but effects on health-related quality of life (HRQoL) remain unexplored. This study evaluated HRQoL in advanced CML patients receiving bosutinib in an ongoing phase 2 study following resistance or intolerance to prior imatinib therapy.

Methods: This analysis included data from 76 accelerated-phase (AP) and 64 blast-phase (BP) patients resistant/intolerant to prior imatinib with or without prior exposure to other TKIs. Patient-reported HRQoL assessments completed at baseline; weeks 4, 8, and 12; every 12 weeks thereafter; and at treatment completion included the Functional Assessment of Cancer Therapy–Leukemia (FACT-Leu); general health status was assessed using the 5-item EuroQol (EQ-5D) instrument and a visual analog scale (VAS).

Results: HRQoL at baseline was somewhat worse in BP versus AP CML patients. There was a significant improvement in the mean FACT-Leu Total scale at weeks 24, 36, and 48 in AP CML patients and at weeks 4, 8, 12, 24, 36, 48, and 96 in BP CML patients compared with baseline. EQ-5D Utility scores were stable throughout treatment in AP CML patients but significantly improved versus baseline in BP CML patients at weeks 4, 8, 12, and 36. Mean VAS scores were significantly improved at weeks 8, 36, and 48 in AP CML patients and at weeks 4, 8, 12, 24, 36, and 96 in BP CML patients. The lack of a comparison group limits attribution of improvements in HRQoL specifically to bosutinib treatment; potential bias due to non-ignorable dropout may limit the ability to generalize these findings to situations where durations of therapy exceed the 96-week follow-up duration of the present study.

Conclusion: These findings suggest that bosutinib therapy is associated with improved HRQoL in advanced phase CML patients.

Clinical trial registration: NCT00261846.     

山西省煤矿接尘工人工作相关因素与生存质量关系研究

目的评价山西省煤矿接尘工人的生存质量,并探讨其与工作相关因素的关系。方法选取山西省7家煤矿的2 300名接尘工人为调查对象,采用自编的工作相关因素问卷以及健康状况量表(SF-36)生存质量量表进行调查,采用SPSS 13.0统计软件进行分析。结果煤矿接尘工人生存质量7个维度的得分偏低。总的工作年限、井下工作年限、接尘工龄等16种因素与生存质量的生理领域和心理领域有关系(P<0.05)。结论影响煤矿接尘工人生存质量的工作相关因素是多方面的,需采取综合措施提高其生存质量。