Fernández-Jiménez E, Pérez-San-Gregorio M A, Martín-Rodríguez A, Domínguez-Cabello E, Navarro-Mascarell G, Bernardos-Rodríguez A
Faculty of Psychology, Department of Personality, University of Seville, Seville, Spain.
Transplant Proc. 2012 Nov;44(9):2609-11. doi: 10.1016/j.transproceed.2012.09.051.
We aimed to compare quality of life in two clinical conditions treated with immunosuppressants: cadaveric liver transplant recipients and multiple sclerosis patients. We also assessed the clinical significance of these results regarding a representative age-adjusted sample of the general Spanish population.
Using a cross-sectional design, the SF-36 Health Survey was used to evaluate 62 patients with these chronic conditions (31 in each group) who were matched for gender. An analysis of covariance was performed to control for the influence of time from multiple sclerosis diagnosis and liver transplantation surgery until assessment. Student t test of covariate-adjusted mean values was used as the statistical test and Cohen's d effect size index, to assess the magnitude of intergroup differences and assess clinical significance.
Significantly worse scores were observed among the neurological patients compared with transplant recipients regarding role-physical (P = .038), general health (P = .003), vitality (P = .034), and physical functioning (P = .049), with medium effect sizes (Cohen's ds from -0.511 to -0.785). Against normative values, liver transplant recipients displayed relevant differences in all SF-36 subscales (Cohen's ds from -0.569 to -0.974) except for mental health (small effect size). Likewise, multiple sclerosis patients showed much greater differences versus the general population (Cohen's ds from -0.846 to -1.760).
Liver transplant recipients showed better quality of life than multiple sclerosis patients (medium effect sizes) in physical quality-of-life dimensions. Interestingly, despite having controlled for time from diagnosis/transplantation, both medical conditions showed clinically significant impairments (large and medium effect sizes) in physical and psychosocial quality-of-life domains. We concluded that transplant recipients belong to a population that still requires special health care because, even after having undergone their treatment of choice, they do not achieve normal levels of biopsychosocial functioning.
我们旨在比较接受免疫抑制剂治疗的两种临床疾病患者的生活质量：尸体肝移植受者和多发性硬化症患者。我们还评估了这些结果对于西班牙普通人群中具有代表性的年龄调整样本的临床意义。
采用横断面设计，使用SF-36健康调查对62例患有这些慢性病的患者（每组31例）进行评估，这些患者按性别匹配。进行协方差分析以控制从多发性硬化症诊断和肝移植手术到评估的时间影响。使用协变量调整后均值的学生t检验作为统计检验，并使用科恩d效应量指标来评估组间差异的大小并评估临床意义。
与移植受者相比，神经疾病患者在角色-身体（P = 0.038）、总体健康（P = 0.003）、活力（P = 0.034）和身体功能（P = 0.049）方面的得分明显更差，效应量中等（科恩d值从-0.511到-0.785）。与标准值相比，肝移植受者在除心理健康外的所有SF-36子量表中均显示出显著差异（科恩d值从-0.569到-0.974）（效应量小）。同样，多发性硬化症患者与普通人群相比差异更大（科恩d值从-0.846到-1.760）。
在身体生活质量维度上，肝移植受者的生活质量优于多发性硬化症患者（效应量中等）。有趣的是，尽管已控制了从诊断/移植开始的时间，但这两种疾病在身体和心理社会生活质量领域均显示出具有临床意义的损害（效应量大和中等）。我们得出结论，移植受者属于仍需要特殊医疗保健的人群，因为即使他们接受了选择的治疗，他们也无法达到生物心理社会功能的正常水平。
