多发性硬化患者生活质量评估及其影响因素探讨

目的评估多发性硬化患者生活质量水平,并探讨其影响因素。方法收集2012年7月~2016年12月就诊于河南省人民医院复发缓解型多发性硬化患者(relapsing-remitting MS,RRMS)36例,继发进展性多发性硬化患者(secondary progressive MS,SPMS)21例作为研究对象。采用多发性硬化生活质量54项评分(Multiple Sclerosis Quality of Life-54 instrument,MSQo L-54)测试MS患者的生活质量;对所有研究对象进行认知功能、抑郁状态、疲劳、睡眠质量及日常生活能力评估。结果 (1)RRMS组及SPMS组患者躯体生活质量(RRMS组58.62±16.32;SPMS组28.77±15.99,P=0.000)、精神生活质量(RRMS组57.33±16.72;SPMS组36.27±23.50,P=0.000)均有下降,SPMS组下降更明显。多元逐步回归法分析,与MS生活质量相关因素中,Hamilton抑郁量表评分处于第一位(β=-0.516,P<0.001),其次为反应躯体化残疾程度的EDSS评分(β=-0.372,P<0.001),第三位为疲劳评分(β=-0.250,P=0.002)。结论 MS患者有不同程度的生活质量下降,SPMS患者更明显。EDSS评分、抑郁、疲劳影响患者生活质量,早期干预抑郁及疲劳,对于改善MS患者生活质量有益。

Quality of life and influential factors in multiple sclerosis

Objective The multiple sclerosis quality of life and their influential factors were studied.Method This was a cross-sectional study with 36 relapsing-remitting MS(RRMS),21 secondary progressive MS(SPMS).Multiple sclerosis quality of life(MSQoL)-54 was conducted.Hamilton depression rating scale,fatigue scale-14 and activity of Daily Living Scale were used in the assessment.Correlation between multiple sclerosis quality of life(MSQoL)-54,Expanded Disability Status Scale(EDSS),depression and fatigue were studied.Result Quality of life(QoL)was significantly impaired in MS patients,especially the SPMS.Depression,EDSS scores,ADL scores,fatigue and sleep quality were related to the QoL of MS.In the stepwise linear regression alalysis,depression made a signiticant contribution to MSQoL and loaded it first(β=-0.516,P<0.001).The second was the EDSS score(β=-0.372,P<0.001),which was used to measure the degree of disability,and the third was fatigue(β=-0.250,P=0.002).Conclusion Quality of life was significantly impaired in MS patients,especially the SPMS.Physical disability,fatigue and depression were independently associated with impaired QoL,suggesting that their recognition and treatment can potentially improve QoL.