间质性肺疾病患者健康相关生活质量下降的决定因素。
Determinants of health-related quality of life decline in interstitial lung disease.
机构信息
Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany.
Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Röntgenstr. 1, 69126, Heidelberg, Germany.
出版信息
Health Qual Life Outcomes. 2020 Oct 8;18(1):334. doi: 10.1186/s12955-020-01570-2.
BACKGROUND
Health-related quality of life (HRQL) in interstitial lung disease (ILD) patients is impaired. We aimed to identify baseline predictors for HRQL decline within a 12-month observation period.
METHODS
We analyzed 194 ILD patients from two German ILD-centers in the observational HILDA study. We employed the disease-specific King's Brief Interstitial Lung Disease questionnaire (K-BILD) with the subdomains 'psychological impact', 'chest symptoms' and 'breathlessness and activities', and the generic EQ-5D Visual Analog Scale (VAS). We evaluated how many patients experienced a clinically meaningful decline in HRQL. Subsequently, we investigated medical and sociodemographic factors as potential predictors of HRQL deterioration.
RESULTS
Within the study population (34.0% male, Ø age 61.7) mean HRQL scores hardly changed between baseline and follow up (K-BILD: 52.8 vs. 52.5 | VAS: 60.0 vs. 57.3). On the intra-individual level, 30.4% (n = 59) experienced a clinically relevant deterioration in K-BILD total score and 35.4% (n = 68) in VAS. Lower baseline forced vital capacity (FVC) % predicted determined HRQL decline in K-BILD total score (ß-coefficient: - 0.02, p = 0.007), VAS (ß-coefficient: - 0.03, p < 0.0001), and in the subdomain 'psychological impact' (ß-coefficient: - 0.02, p = 0.014). Lower baseline diffusing capacity of carbon monoxide (DLCO) % predicted determined deterioration in 'breathlessness and activities' (ß-coefficient: - 0.04, p = 0.003) and 'chest symptoms' (ß-coefficient: - 0.04, p = 0.002). Additionally, increasing age predicted decline in 'psychological impact' (ß-coefficient: 0.06, p < 0.007).
CONCLUSION
Around a third of ILD patients experienced a clinically relevant HRQL deterioration in a 12-month period, which was associated with baseline lung function values in all K-BILD domains. As lung function values are time-dependent variables with possible improvements, in contrast to age and ILD subtype, it, thus, seems important to improve lung function and prevent its decline in order to maintain HRQL on the possibly highest level.
背景
与健康相关的生活质量（HRQL）在间质性肺疾病（ILD）患者中受损。我们的目的是在 12 个月的观察期内确定 HRQL 下降的基线预测因素。
方法
我们分析了来自德国两个ILD 中心的 194 名ILD 患者，进行了观察性 HILDA 研究。我们使用了特定于疾病的 King's Brief Interstitial Lung Disease 问卷（K-BILD），包括“心理影响”、“胸部症状”和“呼吸困难和活动”以及通用的 EQ-5D 视觉模拟量表（VAS）。我们评估了有多少患者经历了 HRQL 的临床显著下降。随后，我们研究了医学和社会人口统计学因素作为 HRQL 恶化的潜在预测因素。
结果
在研究人群中（34.0%为男性，Ø 年龄 61.7），HRQL 评分在基线和随访之间几乎没有变化（K-BILD：52.8 对 52.5|VAS：60.0 对 57.3）。在个体水平上，30.4%（n=59）的患者 K-BILD 总分经历了临床相关的恶化，35.4%（n=68）的患者 VAS 恶化。较低的基线用力肺活量（FVC）%预测值决定了 K-BILD 总分（ß 系数：-0.02，p=0.007）、VAS（ß 系数：-0.03，p<0.0001）和“心理影响”（ß 系数：-0.02，p=0.014）的 HRQL 下降。较低的基线一氧化碳弥散量（DLCO）%预测值决定了“呼吸困难和活动”（ß 系数：-0.04，p=0.003）和“胸部症状”（ß 系数：-0.04，p=0.002）的恶化。此外，年龄的增加预测了“心理影响”（ß 系数：0.06，p<0.007）的下降。
结论
大约三分之一的 ILD 患者在 12 个月内经历了临床相关的 HRQL 恶化，这与所有 K-BILD 领域的基线肺功能值有关。由于肺功能值是具有可能改善的时间依赖性变量，与年龄和 ILD 亚型不同，因此，为了保持 HRQL 尽可能高的水平，改善肺功能和预防其下降似乎很重要。
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