Smith Graeme D, Watson Roger, Roger Derek, McRorie Euan, Hurst Nigel, Luman Widjaja, Palmer Kelvin R
Gastrointestinal Unit, Western General Hospital, Edinburgh, UK.
J Adv Nurs. 2002 Apr;38(2):152-60. doi: 10.1046/j.1365-2648.2002.02159.x.
Health related quality of life is impaired in patients suffering from inflammatory bowel disease. Although counselling directed towards physical and psychological morbidity is assumed to improve health related quality of life, this has never been demonstrated.
Physical and psychological well-being were assessed using questionnaires administered to 100 out-patients in the United Kingdom suffering from inflammatory bowel disease, 50 subjects not suffering from inflammatory bowel disease and a disease control group comprising 28 patients with psoriatic arthritis. A specific nurse led counselling package was given to half the inflammatory bowel disease group and health related quality of life was assessed at baseline, 6 and 12 months.
Inflammatory bowel disease and psoriatic arthritic patients had a range of physical disease activity, although none were severely ill during the course of the study. Medical therapy was similar in both groups throughout the duration of the trial. The mean Short Form 36 (SF-36) scores for mental health were low in inflammatory bowel disease patients; 62.9 +/- 9.1 (SD) in ulcerative colitis, 60 +/- 9.8 (SD) in Crohn's disease, compared with 72.4 +/- 7.2 (SD) in healthy controls (P < 0.05). Mean SF-36 scores for social function were also reduced in Crohn's disease patients; 68.4 +/- 10.1 (SD) in Crohn's disease, compared with 87 +/- 10.1 (SD) in healthy controls (P < 0.05). As expected, the mean SF-36 scores in psoriatic arthritic patients were significantly low 61.9 +/- 1.5 (SD) compared with 82.4 +/- 14 (SD) in healthy controls (P < 0.05). Crohn's disease patients were significantly more anxious than the other groups, mean HAD score was 10 +/- 3.7 (SD) in Crohn's disease patients and 6.86 +/- 3.5 (SD) in healthy volunteers (P < 0.05), although mean HAD scores for depression were similar in all groups. Maladaptive coping mechanisms were present in a significant proportion of Crohn's disease patients. At follow-up all aspects of psychological morbidity returned to the normal range in the Crohn's disease patients without significant change in the mean physical disease index.
Health related quality of life can be improved over 6 months by provision of a nurse led counselling service but the effects are not sustained for 12 months.
炎症性肠病患者的健康相关生活质量受损。尽管针对身体和心理疾病的咨询被认为可以改善健康相关生活质量，但这从未得到证实。
使用问卷对英国100名炎症性肠病门诊患者、50名未患炎症性肠病的受试者以及由28名银屑病关节炎患者组成的疾病对照组进行身体和心理健康评估。炎症性肠病组的一半患者接受了由护士主导的特定咨询套餐，并在基线、6个月和12个月时评估健康相关生活质量。
炎症性肠病和银屑病关节炎患者有一系列身体疾病活动，尽管在研究过程中没有患者病情严重。在整个试验期间，两组的药物治疗相似。炎症性肠病患者心理健康的平均简明健康状况调查量表（SF - 36）得分较低；溃疡性结肠炎患者为62.9±9.1（标准差），克罗恩病患者为60±9.8（标准差），而健康对照组为72.4±7.2（标准差）（P<0.05）。克罗恩病患者社会功能的平均SF - 36得分也降低；克罗恩病患者为68.4±10.1（标准差），而健康对照组为87±10.1（标准差）（P<0.05）。正如预期的那样，银屑病关节炎患者的平均SF - 36得分显著低于健康对照组，分别为61.9±1.5（标准差）和82.4±14（标准差）（P<0.05）。克罗恩病患者比其他组明显更焦虑，克罗恩病患者的平均医院焦虑抑郁量表（HAD）得分为10±3.7（标准差），健康志愿者为6.86±3.5（标准差）（P<0.05），尽管所有组的抑郁平均HAD得分相似。相当一部分克罗恩病患者存在适应不良的应对机制。在随访中，克罗恩病患者心理疾病的所有方面都恢复到正常范围，而身体疾病平均指数没有显著变化。
通过提供由护士主导的咨询服务，健康相关生活质量在6个月内可以得到改善，但效果在12个月时未持续。
