法洛四联症青少年健康相关生活质量的预测因素。
Predictors of health-related quality of life in adolescents with tetralogy of Fallot.
机构信息
Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
Department of Cardiology, Boston Children's Hospital, Boston, MA.
出版信息
J Pediatr. 2015 Jan;166(1):132-8. doi: 10.1016/j.jpeds.2014.09.034. Epub 2014 Oct 28.
OBJECTIVE
To assess health-related quality of life (HRQoL) of adolescents with repaired tetralogy of Fallot (TOF) and whether impairments in HRQoL domains are associated with neurocognitive and medical factors.
STUDY DESIGN
Parents of subjects with TOF and healthy referents 13-16 years of age completed the Child Health Questionnaire-Parent Form 50, generating psychosocial (PsS) and physical (PhS) health summary scores. Adolescents completed the Child Health Questionnaire-Child Form 87 and concurrent in-person neurocognitive testing. We analyzed relationships of PsS and PhS scores with neurocognitive performance and medical factors.
RESULTS
Compared with referents (n = 85), adolescents with TOF without a genetic diagnosis (n = 66) had lower PsS (50.9 ± 9.4 vs 57.2 ± 4.2, P < .001) and PhS scores (49.4 ± 9.5 vs 55.8 ± 4.9; P < .001). Compared with a normative sample, these adolescents with TOF had similar PsS scores (P = .52) but significantly lower PhS scores (P = .01). Within adolescents with TOF without genetic disorders, lower PsS scores were highly associated with worse neurocognitive measures, particularly the parent-reported Behavior Rating Inventory of Executive Function composite (r = -0.66, P < .001) and Parent Conners' attention deficit-hyperactivity disorder Index T score (r = -0.54, P < .001), whereas associations of PhS scores with neurocognitive measures were weaker.
CONCLUSIONS
Psychosocial health status in adolescents with TOF without genetic disorders was worse than in healthy referents without risk factors for brain injury but similar to a normative sample; physical health status was worse in these adolescents than in either comparison group. Within these subjects with TOF, worse psychosocial health status was most highly associated with concurrent executive dysfunction and attention deficit-hyperactivity disorder. Optimizing HRQoL constitutes another indication for attention to neurodevelopment in children with congenital heart disease.
目的
评估修复法洛四联症（TOF）后青少年的健康相关生活质量（HRQoL），以及 HRQoL 各领域的损害是否与神经认知和医学因素相关。
研究设计
TOF 患者的父母和 13-16 岁的健康对照者完成了儿童健康问卷-家长形式 50 项，生成了心理社会（PsS）和身体（PhS）健康总结评分。青少年完成了儿童健康问卷-儿童形式 87 项，并同时进行了现场神经认知测试。我们分析了 PsS 和 PhS 评分与神经认知表现和医学因素的关系。
结果
与对照者（n=85）相比，无遗传诊断的 TOF 青少年（n=66）的 PsS（50.9±9.4 比 57.2±4.2，P<.001）和 PhS 评分（49.4±9.5 比 55.8±4.9；P<.001）较低。与常模样本相比，这些 TOF 青少年的 PsS 评分相似（P=.52），但 PhS 评分显著较低（P=.01）。在无遗传疾病的 TOF 青少年中，较低的 PsS 评分与更差的神经认知测量结果高度相关，尤其是父母报告的执行功能综合评定量表（r=-0.66，P<.001）和父母康纳斯注意缺陷多动障碍指数 T 分（r=-0.54，P<.001），而 PhS 评分与神经认知测量结果的相关性较弱。
结论
无遗传障碍的 TOF 青少年的心理社会健康状况较无脑损伤危险因素的健康对照者差，但与常模样本相似；这些青少年的身体健康状况比任何对照组都差。在这些 TOF 患者中，较差的心理社会健康状况与当前的执行功能障碍和注意力缺陷多动障碍关系最为密切。优化 HRQoL 是关注先天性心脏病儿童神经发育的另一个指征。
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