[心脏移植后的健康相关生活质量]

Tegtbur U, Pethig K, Jung K, Machold H, Haverich A, Busse M W, Brinkmeier U

Medizinische Hochschule Hannover, Sportmedizinisches Zentrum, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.

Z Kardiol. 2003 Aug;92(8):660-7. doi: 10.1007/s00392-003-0934-3.

BACKGROUND

Quality of life late after heart transplantation is reported to be comparable with that of the general population. However, peak exercise capacity remained approximately 60% of what was normal between 1 and 10 years after transplantation. The gap between patients' good quality of life and their impaired exercise tolerance is not yet explained. The purpose of our study was to examine the relation between quality of life and exercise- related variables in heart transplant recipients (HTR). Then, the results of these examinations were compared with those of patients having congestive heart failure (CHF), with the use of controls (C), respectively.

METHODS

(Mean values+/-SD) 29 HTR 4.4 +/- 2.1 years after transplantation, 29 CHF (NYHA II n = 22, III n = 7) and 29 C (age 54 +/- 9, 61 +/- 10, 56 +/- 10 years, body mass index 28 +/- 3, 29 +/- 5, 28 +/- 4 kg x m(-2), body fat 25 +/- 4, 27 +/- 6, 26 +/- 5%, respectively) performed cardiopulmonary exercise testing and were interviewed with the standardized German "Quality of life profile for chronic diseases" questionnaire.

RESULTS

Peak oxygen consumption was impaired in HTR and in CHF compared with C (19.0 +/- 4.5, 18.6 +/- 4.3, and 30.2 +/- 6.6 ml x min x kg(-1), respectively; p < 0.01 vs. C each). HTR and CHF patients' quality of life in the physical scores were both impaired (p < 0.05 or p < 0.01 vs. C, respectively), but HTRs have reported better scores than CHF (p < 0.05). In the psychological role, CHF was impaired against C (p < 0.05), and HTR scores were comparable with C. In social functioning HTR and CHF patients both showed reduced quality of life dimensions. The Pearson correlation analysis showed that quality of life in physical functioning was related to peak oxygen consumption (p < 0.001) and percentage of predicted workload (p < 0.001). Quality of life in the social and psychological domains showed no association to exercise-related values.

CONCLUSIONS

In HTR and in CHF, exercise testing variables were dominant predictors among the physical scales in quality of life, but not among social or psychological scales. Therefore, even late after heart transplantation, improving physical capacity should be a therapeutic goal with the intention of further increasing the quality of life.

背景

据报道，心脏移植术后晚期的生活质量与普通人群相当。然而，移植后1至10年，峰值运动能力仍约为正常水平的60%。患者良好的生活质量与受损的运动耐量之间的差距尚无法解释。我们研究的目的是探讨心脏移植受者（HTR）生活质量与运动相关变量之间的关系。然后，分别将这些检查结果与充血性心力衰竭（CHF）患者以及对照组（C）的结果进行比较。

方法

（均值±标准差）29名移植后4.4±2.1年的HTR、29名CHF患者（纽约心脏协会II级n = 22，III级n = 7）和29名C组受试者（年龄分别为54±9、61±10、56±10岁，体重指数分别为28±3、29±5、28±4 kg·m⁻²，体脂分别为25±4、27±6、26±5%）进行了心肺运动测试，并使用标准化的德国“慢性病生活质量概况”问卷进行了访谈。

结果

与C组相比，HTR组和CHF组的峰值耗氧量均受损（分别为19.0±4.5、18.6±4.3和30.2±6.6 ml·min·kg⁻¹；与C组相比，p均<0.01）。HTR组和CHF组患者身体评分方面的生活质量均受损（分别与C组相比，p<0.05或p<0.01），但HTR组报告的评分优于CHF组（p<0.05）。在心理角色方面，CHF组与C组相比受损（p<0.05），而HTR组的评分与C组相当。在社会功能方面，HTR组和CHF组患者的生活质量维度均降低。Pearson相关性分析表明，身体功能方面的生活质量与峰值耗氧量（p<0.001）和预计工作量百分比（p<0.001）相关。社会和心理领域的生活质量与运动相关值无关联。