Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo, Japan. yshinoha @ tachikawa-hosp.gr.jp
Cerebrovasc Dis. 2010;29(4):361-71. doi: 10.1159/000281834. Epub 2010 Feb 9.
The number of chronic-stage ischemic stroke patients in Japan continues to increase, because of decreasing mortality. This study was designed to ascertain health-related quality of life (HRQOL) in ischemic stroke patients and to analyze in detail factors affecting HRQOL.
2,069 outpatients (1,226 males, 843 females; mean age: 71 years; median duration after onset: 20.5 months) with chronic-stage ischemic stroke visiting 150 institutions in Japan were enrolled. HRQOL was evaluated using the second version of the patient self-administered Medical Outcome Study 36-Item Short-Form Health Survey (SF-36v2) questionnaire.
All 8 domain scores and the physical component summary (PCS) score of SF-36v2 in stroke patients were significantly lower than those of Japanese national norms (JNN). The PCS score (36.6 +/- 16.1) and mental component summary (MCS) score (50.0 +/- 10.2) were lower than those of age-matched JNN (p < 0.001). Age, modified Rankin Scale (mRS), duration after onset and Japan Stroke Scale Depression score (JSS-D) were significantly correlated with PCS, as were role limitation because of physical problem, bodily pain, vitality and role limitation because of emotional problem scores; duration after onset and JSS-D were significantly correlated with MCS. Negative factors for PCS were older age, higher mRS, presence of subjective symptoms, neurological signs, rehabilitation and concomitant antidepressants. Negative factors for MCS were presence of subjective symptoms, psychiatric signs and concomitant antidepressants.
HRQOL scores in ischemic stroke patients (chronic stage) are significantly correlated with not only age, mRS, duration after onset and JSS-D, but also presence of subjective symptoms and neurological/psychiatric signs, which could be targets for treatment.
由于死亡率降低，日本慢性期缺血性脑卒中患者的数量持续增加。本研究旨在确定缺血性脑卒中患者的健康相关生活质量（HRQOL），并详细分析影响 HRQOL 的因素。
本研究共纳入日本 150 家医疗机构的 2069 例慢性期缺血性脑卒中门诊患者（男性 1226 例，女性 843 例；平均年龄 71 岁；发病后中位时间 20.5 个月）。采用患者自评医疗结局研究 36 项简短健康调查量表（SF-36v2）第 2 版评估 HRQOL。
脑卒中患者的所有 8 个领域评分和 SF-36v2 的生理成分综合评分（PCS）均显著低于日本全国常模（JNN）（P<0.001）。脑卒中患者的 PCS 评分（36.6±16.1）和心理成分综合评分（MCS）评分（50.0±10.2）均低于年龄匹配的 JNN（P<0.001）。年龄、改良 Rankin 量表（mRS）、发病后时间和日本脑卒中量表抑郁评分（JSS-D）与 PCS 显著相关，躯体问题导致的角色受限、躯体疼痛、活力和情绪问题导致的角色受限评分也与 PCS 显著相关；发病后时间和 JSS-D 与 MCS 显著相关。影响 PCS 的负面因素包括年龄较大、mRS 较高、存在主观症状、神经体征、康复和合并使用抗抑郁药。影响 MCS 的负面因素包括存在主观症状、精神科体征和合并使用抗抑郁药。
缺血性脑卒中患者（慢性期）的 HRQOL 评分不仅与年龄、mRS、发病后时间和 JSS-D 相关，还与主观症状和神经/精神科体征相关，这些因素可能是治疗的靶点。
