Vermuelen Karin M, van der Bij Wim, Erasmus Michiel E, TenVergert Elisabeth M
Office for Medical Technology Assessment, University Medical Center Gronigen, University of Gronigen, The Netherlands.
J Heart Lung Transplant. 2007 Feb;26(2):188-93. doi: 10.1016/j.healun.2006.11.006.
Lung transplantation has proven to be an effective treatment option for patients with end-stage lung disease with profound effects on both survival and health-related quality of life (HRQL). Generally, studies have reported improved HRQL after lung transplantation. When assessing HRQL, physical, psychologic or social dimensions are usually included. However, it is unclear what predicts outcome, to what extent, and whether there are differences in predictors between dimensions of HRQL. Knowledge about these predictors may be useful when making choices regarding therapy. The research question in the present study was: What are the predicting variables of physical and psychologic dimensions of HRQL, and do they differ?
Results from studies of the physical dimension (the Nottingham Health Profile's energy and mobility scales) and the psychologic dimension (Zung depression and STAI anxiety scores) from 140 transplanted patients with a maximum follow-up of almost 10 years were assessed using mixed-model analysis. For both dimensions, the following variables were tested for their predictive value: age; gender; diagnosis; year of transplantation; time on the waiting list; type of transplantation; bronchiolitis obliterans syndrome; and pre-transplant HRQL scores.
With regard to the physical dimension after lung transplantation, presence of bronchiolitis obliterans syndrome (BOS), age and pre-transplant scores on the measure under study were significant predictors for both energy and mobility. For mobility, gender appeared to be an additional predictor. With regard to the psychologic dimension after lung transplantation, BOS was a predictor for both anxiety and depression. Pre-transplant depression was an additional predictor for post-transplant depression, and age was an additional predictor for anxiety.
Several variables were identified that predicted HRQL after lung transplantation. These variables differed between the physical and psychologic dimensions. The presence of BOS was a predictor for both dimensions. The present findings may be helpful when choosing or developing interventions aimed at improving HRQL after lung transplantation.
肺移植已被证明是终末期肺病患者的一种有效治疗选择，对生存率和健康相关生活质量（HRQL）都有深远影响。一般来说，研究报告称肺移植后HRQL有所改善。在评估HRQL时，通常会纳入身体、心理或社会维度。然而，尚不清楚哪些因素能预测结果、预测程度如何，以及HRQL各维度之间的预测因素是否存在差异。了解这些预测因素在进行治疗选择时可能会有所帮助。本研究的研究问题是：HRQL身体和心理维度的预测变量有哪些，它们是否不同？
使用混合模型分析评估了140例移植患者的身体维度（诺丁汉健康量表的精力和活动量表）和心理维度（zung抑郁量表和状态特质焦虑量表得分）的研究结果，这些患者的最长随访时间近10年。对于这两个维度，测试了以下变量的预测价值：年龄、性别、诊断、移植年份、等待名单上的时间、移植类型、闭塞性细支气管炎综合征以及移植前HRQL得分。
关于肺移植后的身体维度，闭塞性细支气管炎综合征（BOS）的存在、年龄以及所研究测量指标的移植前得分是精力和活动的显著预测因素。对于活动，性别似乎是一个额外的预测因素。关于肺移植后的心理维度，BOS是焦虑和抑郁的预测因素。移植前抑郁是移植后抑郁的一个额外预测因素，年龄是焦虑的一个额外预测因素。
确定了几个预测肺移植后HRQL的变量。这些变量在身体和心理维度之间有所不同。BOS的存在是两个维度的预测因素。本研究结果在选择或制定旨在改善肺移植后HRQL的干预措施时可能会有所帮助。
