Fernández-Jiménez E, Pérez-San-Gregorio M A, Martín-Rodríguez A, Pérez-Bernal J, Izquierdo G
Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatments, University of Seville, Spain.
Transplant Proc. 2013;45(10):3616-9. doi: 10.1016/j.transproceed.2013.10.027.
We aimed to compare the evolution of quality of life in 2 medical conditions under immunotherapy (cadaveric renal transplantation [G1] and multiple sclerosis [G2]), and to assess the clinical significance of the results compared with a representative age-adjusted sample of the general Spanish population (G3).
Using a mixed design (2 × 2), the SF-36 Health Survey was administered to 60 patients with one of these clinical conditions (30 in each group; the patient group factor), matched for gender, and homogenized regarding age and working status. All renal patients had undergone transplantation 6 months before the first assessment, and all neurological patients presented a relapsing-remitting course and a mild-moderate disability level. Both patient groups were assessed a second time 6 months later (the phase factor). A mixed analysis of covariance was computed controlling for age as a covariate. Cohen's d was reported as an effect size index and to analyze the clinical significance regarding a representative age-adjusted sample of the general Spanish population (n = 5821).
Statistically significant differences were found between patient groups in vitality, bodily pain, social functioning, and mental health (P < .01), in which worse levels were displayed by patients with multiple sclerosis in both phases (Cohen's ds1-2 from 0.61 to 1.40). Likewise, an interactive effect was observed in physical functioning [F(1,57) = 12.93; P = .001], such that the performance of daily physical activities improved in renal recipients after 6 months, but it decreased in neurological patients. Patients with multiple sclerosis showed higher, clinically significant impairment in all SF-36 dimensions in both phases compared with renal recipients (Cohen's ds2-3 from -0.50 to -1.61), who presented clinically significant impairment in general health, role-physical, and role-emotional (Cohen's ds1-3 from -0.73 to -1.28).
Renal transplant recipients need specialized health care 1 year after transplantation because they still display relevant impairment in daily functioning compared with the general population.
我们旨在比较接受免疫治疗的两种疾病（尸体肾移植[G1]和多发性硬化症[G2]）患者生活质量的变化情况，并与西班牙普通人群的代表性年龄调整样本（G3）相比，评估结果的临床意义。
采用混合设计（2×2），对60例患有上述其中一种临床疾病的患者（每组30例；患者组因素）进行SF-36健康调查，这些患者按性别匹配，且在年龄和工作状态方面同质化。所有肾移植患者在首次评估前6个月接受了移植手术，所有神经科患者均呈现复发缓解病程且残疾程度为轻度至中度。两组患者在6个月后进行了第二次评估（阶段因素）。计算协方差混合分析，并将年龄作为协变量进行控制。报告Cohen's d作为效应量指标，以分析与西班牙普通人群的代表性年龄调整样本（n = 5821）相关的临床意义。
在活力、身体疼痛、社会功能和心理健康方面，患者组之间存在统计学上的显著差异（P <.01），在两个阶段中，多发性硬化症患者的这些方面水平更差（Cohen's d从0.61到1.40）。同样，在身体功能方面观察到交互作用[F(1,57) = 12.93；P =.001]，即肾移植受者在6个月后的日常身体活动表现有所改善，但神经科患者的身体活动表现下降。与肾移植受者相比，多发性硬化症患者在两个阶段的所有SF-36维度上均表现出更高的、具有临床意义的损害（Cohen's d从 -0.50到 -1.61），肾移植受者在总体健康、角色-身体和角色-情感方面表现出具有临床意义的损害（Cohen's d从 -0.73到 -1.28）。
肾移植受者在移植后1年需要专业的医疗护理，因为与普通人群相比，他们在日常功能方面仍表现出明显的损害。
