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肺功能和生活质量在囊性纤维化的成年人。

Pulmonary Function and Quality of Life in Adults with Cystic Fibrosis.

机构信息

Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, AllergyAtlanta, GA, USA.

Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA.

出版信息

Lung. 2023 Dec;201(6):635-639. doi: 10.1007/s00408-023-00658-y. Epub 2023 Nov 16.

DOI:10.1007/s00408-023-00658-y
PMID:37973684
Abstract

PURPOSE

People living with cystic fibrosis (CF) experience impaired quality of life, but the extent to which pulmonary function is associated with quality of life in CF remains unclear METHODS: Using baseline data from a trial of specialist palliative care in adults with CF, we examined the association between pulmonary obstruction and quality of life (measured with the Functional Assessment of Chronic Illness Therapy Total Score).

RESULTS

Among 262 participants, median age was 33, and 78% were on modulator therapy. The median quality of life score was higher in those with mild obstruction (135, IQR 110-156) compared to moderate (125, IQR 109-146) and severe obstruction (120, IQR 106-136). In an unadjusted model, we observed a non-significant trend toward lower quality of life with increased obstruction-compared to participants with mild obstruction, those with moderate obstruction had quality of life score 7.46 points lower (95% CI -15.03 to 0.10) and those with severe obstruction had a score 9.98 points lower (95% CI -21.76 to 1.80). However, this association was no longer statistically significant in the adjusted model, which may reflect confounding due to sex, age, BMI, and modulator therapy. Comorbidities (depression and anxiety) and social determinants of health (financial insecurity and education) were also associated with quality of life.

CONCLUSION

Advancing our understanding of patient-centered markers of quality of life, rather than focusing on pulmonary function alone, may help identify novel interventions to improve quality of life in this patient population.

摘要

目的

囊性纤维化(CF)患者的生活质量受损,但肺部功能与 CF 患者生活质量的相关性尚不清楚。

方法

使用 CF 成人专科姑息治疗试验的基线数据,我们检查了肺阻塞与生活质量(用慢性疾病治疗功能评估总评分衡量)之间的关联。

结果

在 262 名参与者中,中位年龄为 33 岁,78%接受调节剂治疗。与中度(125,IQR109-146)和重度(120,IQR106-136)阻塞相比,轻度阻塞(135,IQR110-156)患者的生活质量评分更高。在未调整模型中,我们观察到随着阻塞程度的增加,生活质量呈下降趋势,但无统计学意义——与轻度阻塞患者相比,中度阻塞患者的生活质量评分低 7.46 分(95%CI-15.03 至 0.10),重度阻塞患者的评分低 9.98 分(95%CI-21.76 至 1.80)。然而,在调整后的模型中,这种关联不再具有统计学意义,这可能反映了性别、年龄、BMI 和调节剂治疗等混杂因素的影响。合并症(抑郁和焦虑)和健康的社会决定因素(经济不安全和教育)也与生活质量相关。

结论

深入了解以患者为中心的生活质量标志物,而不仅仅关注肺部功能,可能有助于确定改善该患者群体生活质量的新干预措施。

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本文引用的文献

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Integrating specialist palliative care to improve care and reduce suffering: cystic fibrosis (InSPIRe:CF) - study protocol for a multicentre randomised clinical trial.整合专科姑息治疗以改善护理和减轻痛苦:囊性纤维化(InSPIRe:CF)-一项多中心随机临床试验的研究方案。
BMJ Open Respir Res. 2022 Sep;9(1). doi: 10.1136/bmjresp-2022-001381.
2
Association of Body Mass Index With Clinical Outcomes in Patients With Cystic Fibrosis: A Systematic Review and Meta-analysis.体质指数与囊性纤维化患者临床结局的相关性:系统评价和荟萃分析。
JAMA Netw Open. 2022 Mar 1;5(3):e220740. doi: 10.1001/jamanetworkopen.2022.0740.
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CFTR modulator therapies - Effect on life expectancy in people with cystic fibrosis.
Lung. 2024 Feb;202(1):1-4. doi: 10.1007/s00408-024-00671-9. Epub 2024 Feb 2.
CFTR 调节剂治疗 - 对囊性纤维化患者预期寿命的影响。
Paediatr Respir Rev. 2022 Jun;42:3-8. doi: 10.1016/j.prrv.2020.05.002. Epub 2020 May 26.
4
Prevalence of unmet palliative care needs in adults with cystic fibrosis.成年囊性纤维化患者未满足的姑息治疗需求的患病率。
J Cyst Fibros. 2020 May;19(3):394-401. doi: 10.1016/j.jcf.2019.11.010. Epub 2019 Dec 18.
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Elexacaftor-Tezacaftor-Ivacaftor for Cystic Fibrosis with a Single Phe508del Allele.依伐卡托与泰比卡托和艾克卡托三联复方药物治疗携带单个 F508del 突变的囊性纤维化
N Engl J Med. 2019 Nov 7;381(19):1809-1819. doi: 10.1056/NEJMoa1908639. Epub 2019 Oct 31.
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Symptom Burden and Unmet Existential Needs in Adults With Cystic Fibrosis.囊性纤维化成人患者的症状负担与未满足的生存需求
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