文章摘要

青光眼患者手术和药物治疗与健康相关的生活质量相关因素

作者: 1吴 玲, 1徐 美琴, 1占 少梅
1 苏州大学附属高邮医院五官科,江苏 扬州 225600
通讯: 吴 玲 Email: werwzx0730@163.com
DOI: 10.3978/j.issn.2095-6959.2019.02.022

摘要

目的:分析青光眼患者手术治疗后与健康相关的生活质量(health-related quality of life,HRQOL)下降的相关因素。方法:收集苏州大学附属高邮医院2014年2月至2017年12月确诊为青光眼的患者86例,进行前瞻性队列研究。所有患者填写3份HRQOL问卷调查:25项国家眼科研究所视觉功能问卷调查(25-item National Eye Institute Visual Function Questionnaire,NEI-VFQ25)、中国成人斜视生存质量评估量表(Chinses Adult Strabismus Questionnaire,CAS-20)和复视问卷(Diplopia Questionnaire,DQ)调查。86例患者中37例接受了小梁切除术,其余49例接受药物治疗。多元回归分析与HRQOL相关的因素包括性别、年龄、治疗方式、视野、视力和复视等对HRQOL下降的影响。结果:86例患者中有51例女性,35例男性,女性占比59%;年龄(65 ±10)岁, 视野的平均偏差(mean dev iat ion,MD)是− 13(10) dB。HRQOL的下降与严重的复视[DQ得分,部分r2的范围(rp2)为0.207~0.069]、最佳眼的MD降低(rp2范围为0.379~0.027)、最差眼的MD降低( r p 2范围为0.242~0.046)、治疗方式(rp2范围为0.190~0.025)、最差眼的视力下降(rp2范围为0.063~0.025)、最佳眼的视力下降(rp2范围为0.032~0.017)以及较早的发病年龄(rp2范围为0.021~0.014)有关。在调整分析中,CAS-20量表的得分提示与药物治疗相比较,小梁切除术会导致更显著的HRQOL下降。结论:在青光眼患者中,无论是接受手术还是药物治疗,HRQOL的下降都很常见,其与更严重的复视、较低的视野平均偏差、双眼视力较差、治疗方式和较早的发病年龄有关。与药物治疗相比,小梁切除术与HRQOL的降低显著相关,在临床上选择手术方式时应该慎重考虑。
关键词: 青光眼;小梁切除术;健康相关的生活质量

Health-related quality of life related factors in glaucoma patients undergoing surgery and medication

Authors: 1WU Ling, 1XU Meiqin, 1ZHAN Shaomei
1 Department of Ophthalmology and Otorhinolaryngology, Gaoyou Hospital, Affiliated to Soochow University, Yangzhou Jiangsu 225600, China

CorrespondingAuthor:WU Ling Email: werwzx0730@163.com

Abstract

Objective: To analyze the related factors of health-related quality of life (HRQOL) after surgical treatment with glaucoma patients. Methods: A prospective cohort study was conducted in 86 patients with glaucoma diagnosed between February 2014 and December 2017. All patients completed 3 HRQOL questionnaires: 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ25), Chinses Adult Strabismus Questionnaire (CAS-20) and Diplopia Questionnaire (DQ) survey. Of the 86 patients, 37 received trabeculectomy, and the remaining 49 received medical treatment. Multiple regression analysis and HRQOL related factors included gender, age, treatment modalities, visual field, vision and diplopia on the decline of HRQOL. Results: Of the 86 patients, there were 35 men and 51 (59%) women; the average age of the patients was (65±10) years, and the mean deviation (MD) of the visual field was −13 (10) dB. The poor HRQOL was related with severe diplopia [partial r2 range (rp2), 0.207–0.069], lower best-eye MD (rp2 range, 0.379–0.027), lower worst-eye MD (rp2 range, 0.242–0.046), treatment group (rp2 range, 0.190–0.025), lower worst-eye visual acuity (rp2 range, 0.063–0.025), lower best-eye visual acuity (rp2 range, 0.032–0.017) and early onset age (rp2 range, 0.021–0.014). In adjusted analyses, the score of the CAS-20 scale suggested that compared with medication, trabeculectomy would lead to a poorer HRQOL. Conclusion: This study suggests that poor HRQOL is very common in glaucoma patients, whether undergoing surgery or medication. In general, the decrease of HRQOL in glaucoma patients is associated with more severe diplopia, lower visual average deviation, poor binocular vision, treatment and early onset age. Compared with drug therapy, trabeculectomy is particularly related to the poorer HRQOL. The choice of surgical methods in clinical practice should be carefully considered.
Keywords: glaucoma; trabeculectomy; health-related quality of life