Xiang Yu-Tao, Wong Tak-Shun, Tsoh Joshua, Ungvari Gabor S, Correll Christoph U, Sareen Jitender, Penner-Goeke Kirsten, Ko Fanny W S, Hui David S C, Chiu Helen F K
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China; Faculty of Health Sciences, University of Macau, Macao SAR, China.
Perspect Psychiatr Care. 2015 Apr;51(2):121-7. doi: 10.1111/ppc.12073. Epub 2014 May 30.
To date, there have been few studies examining quality of life (QOL) in older patients with chronic obstructive pulmonary disease (COPD) in China. The aim of the study was to assess QOL in Chinese older patients with COPD and explore its demographic and clinical correlates.
Case-control study of 142 outpatients with COPD and 218 matched control subjects without COPD. COPD patients were recruited from a prospective study sample hospitalized in Hong Kong for acute COPD exacerbation (≥ 2 major COPD symptoms or > 1 major + minor COPD symptoms for ≥ 2 consecutive days). Controls were recruited from social centers in Hong Kong. Activity of daily living was assessed with the Instrumental Activities of Daily Living Scale (IADL), life events were evaluated with the Life Event Scale, depressive disorders were diagnosed using the Geriatric Depression Scale (GDS), and QOL was measured using the Medical Outcomes Study Short Form-12 (SF-12) and St. George's Respiratory Questionnaire (SGRQ).
Compared to controls, patients had significantly lower scores in the physical (PCS score), but not in the mental (MCS score) QOL domain. Multivariate analyses showed that more hospitalizations in the past year significantly contributed to higher PCS score (p = .03), while higher GDS total score contributed to lower MCS score (p = .003). Severe and very severe COPD, more physical illnesses, and higher IADL total score each independently contributed to higher SGRQ total score, explaining 40.0% of the variance (p < .001).
Our results suggest that therapeutic and psychosocial interventions alleviating depressive symptoms, severe COPD, comorbidities, and improving IADL in Chinese patients with COPD are likely of considerable benefit for improving QOL in patients with COPD.
迄今为止，在中国针对老年慢性阻塞性肺疾病（COPD）患者的生活质量（QOL）进行研究的较少。本研究的目的是评估中国老年COPD患者的生活质量，并探讨其人口统计学和临床相关因素。
对142例COPD门诊患者和218例匹配的无COPD对照受试者进行病例对照研究。COPD患者来自香港一家医院因急性COPD加重（≥2种主要COPD症状或≥2天出现>1种主要+次要COPD症状）而住院的前瞻性研究样本。对照受试者来自香港的社会中心。使用日常生活能力量表（IADL）评估日常生活活动能力，使用生活事件量表评估生活事件，使用老年抑郁量表（GDS）诊断抑郁障碍，使用医学结局研究简明健康调查问卷（SF-12）和圣乔治呼吸问卷（SGRQ）测量生活质量。
与对照组相比，患者在生活质量的身体领域（PCS评分）得分显著较低，但在心理领域（MCS评分）得分无显著差异。多变量分析显示，过去一年住院次数越多，PCS评分越高（p = .03），而GDS总分越高，MCS评分越低（p = .003）。重度和极重度COPD、更多的躯体疾病以及更高的IADL总分均独立导致SGRQ总分升高，解释了40.0%的变异（p < .001）。
我们的结果表明，对于改善中国COPD患者的生活质量，缓解抑郁症状、重度COPD、合并症以及改善IADL的治疗和心理社会干预可能具有相当大的益处。
