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墨西哥瓜纳华托参考医院确诊的原发性免疫缺陷病患者的疾病负担

Disease burden for patients with primary immunodeficiency diseases identified at reference hospitals in Guanajuato, Mexico.

作者信息

Guaní-Guerra Eduardo, Jiménez-Romero Ana Isabel, García-Ramírez Ulises Noel, Velázquez-Ávalos José Manuel, Martínez-Guzmán Edgar, Sandoval-Ramírez Eunice, Camacho-Meza Ignacio

机构信息

Department of Immunology, Hospital Regional de Alta Especialidad del Bajío, León Guanajuato, México.

Department of Immuno-Alergology, Hospital Aranda de la Parra, León Guanajuato, México.

出版信息

PLoS One. 2017 Apr 27;12(4):e0175867. doi: 10.1371/journal.pone.0175867. eCollection 2017.

Abstract

BACKGROUND

In addition to the deleterious effect on health, there is considerable economic and psychosocial morbidity associated with primary immunodeficiency diseases (PID). Also, the cost of a late diagnosis frequently results in a heavy disease burden on the patient. The objective of this study was to collect and analyze data on patients with PID in the state of Guanajuato in Mexico, to indirectly estimate the burden of the disease.

METHODS

An observational, longitudinal, and comparative study was conducted. A total of 44 patients were included and grouped according to the updated classification of PID.

RESULTS

The median time elapsed from the onset of symptoms to the reference and diagnosis by a tertiary hospital was of 2.17 (IQR = 6.44) years. Before diagnosis, the number of hospitalizations/year per patient was 0.86 (IQR = 2.28), the number of visit to emergency room/year per patient was 0.92 (IQR = 1.77), the number of doctor's visits/year per patient was 15 (IQR = 11.25), whereas the school/work absence days per patient were reported in 52.72 (IQR = 56.35) days per year. After diagnosis, 20 patients (45.45%) received IVIG replacement therapy, and all of them presented a significant improvement (p <0.05) in all the mentioned variables. Characteristically, even when patients with PID received IVIG, there was still an important disease burden when comparing them against healthy controls. Complications secondary to PID were detected in 19 patients (43.18%). The reported overall mortality rate was 6.82% (n = 3).

CONCLUSIONS

We were able to indirectly estimate an important disease burden in patients with PID; which is considered to be preventable, at least in part, with effective interventions like health planning, research, collaboration with primary care providers, and generation of policies and practices, in order to improve the quality of life and care of families with PID.

摘要

背景

除了对健康产生有害影响外,原发性免疫缺陷病(PID)还伴有相当大的经济和心理社会发病率。此外,诊断延迟的成本常常给患者带来沉重的疾病负担。本研究的目的是收集和分析墨西哥瓜纳华托州PID患者的数据,以间接估计该疾病的负担。

方法

进行了一项观察性、纵向和对比性研究。共纳入44例患者,并根据PID的最新分类进行分组。

结果

从症状出现到三级医院转诊和诊断的中位时间为2.17年(四分位间距=6.44年)。诊断前,每位患者每年的住院次数为0.86次(四分位间距=2.28次),每位患者每年到急诊室就诊的次数为0.92次(四分位间距=1.77次),每位患者每年看医生的次数为15次(四分位间距=11.25次),而每位患者每年报告的缺课/缺勤天数为52.72天(四分位间距=56.35天)。诊断后,20例患者(45.45%)接受了静脉注射免疫球蛋白(IVIG)替代治疗,所有这些患者在上述所有变量方面均有显著改善(p<0.05)。典型情况是,即使PID患者接受了IVIG治疗,但与健康对照相比,他们仍有重要的疾病负担。19例患者(43.18%)检测到PID继发并发症。报告的总死亡率为6.82%(n=3)。

结论

我们能够间接估计PID患者的重要疾病负担;这种负担被认为至少部分是可预防的,可通过有效的干预措施,如卫生规划、研究、与初级保健提供者合作以及制定政策和措施,以改善PID患者家庭的生活质量和护理。

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