支气管哮喘患者生命质量评估及其用药依从性的研究
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摘要
随着医学模式的转变,生命质量已成为评价药物及其它治疗方案的一个关键参数,是反映疾病以及治疗措施对躯体、心理和社会活动影响的综合性指标。患者依从性是患者行为中最重要的方面之一。哮喘患者用药依从性的好坏是影响其治疗效果的重要因素之一。因此,探讨哮喘患者用药依从性对其生命质量水平、肺功能、炎症介质含量的影响,评估健康教育对提高患者用药依从性从而改善生命质量的效果,为制定哮喘教育管理模式提供理论依据和临床指导具有重要意义。
本次研究采用横断面研究和随访研究两种方法,解决以下问题:(1)呼吸科门诊哮喘患者生命质量水平及其影响因素;(2)用药依从性对患者使用吸入性糖皮质激素治疗的影响,主要从肺功能、生命质量水平、血清和诱导痰中炎症介质含量三方面分析;(3)针对用药依从性差的原因及患者需求,制定相应健康教育干预模式,实施并评估干预效果。
第一章哮喘患者生命质量评估及影响因素的研究
1.对象与方法
1.1我院哮喘专科门诊就诊的128例支气管哮喘患者,年龄在14-80岁,符合中华医学会制定的《支气管哮喘防治指南》诊断标准并且患病时间超过1年以上;达到哮喘慢性持续期严重程度分级Ⅱ级或以上;同意接受包括吸入激素在内的长期控制药物治疗;使用激素吸入剂时间均为1个月以上。
1.2横断面研究采用一般情况调查表,哮喘控制测试(ACT~(TM))表,哮喘患者生命质量(AQLQ)量表,用药依从性评分表。
1.3统计分析:资料数据输入统计软件SPSS12.0处理分析,均数比较采用t检验、方差分析。采用Pearson相关,分析依从性得分、认知水平、ACT得分与生命质量得分的关系。采用多元逐步回归分析进行生命质量影响因素分析。指标体系的重测信度和标准关联效度采用Pearson相关分析,分半信度及克郎巴赫系数α采用SPSS中Scale-reliability分析,构想效度采用主成分分析法。P＜0.05,差异有统计学意义。
2.结果
2.1患者生命质量、ACT、用药依从性基本情况比较
不同性别患者生命质量、ACT、依从性得分,不同年龄组患者生命质量水平,受教育程度不同的患者生命质量水平、ACT得分,病程长短不同的患者生命质量水平,不同人均月收入的患者生命质量水平,不同居住状况的患者生命质量水平,差别均有统计学意义。
2.2用药依从性、ACT得分、生命质量影响相关性研究
用药依从性与活动受限(r=0.365)、与回避刺激物(r=0.559)、与哮喘症状(r=0.426)、与心理情绪(r=0.477)、与刺激物反应(r=0.163)及对疾病的担心(r=0.447)领域的相关系数有统计学意义。认知水平与依从性(r=0.412),认知水平与活动受限(r=0.360)、与回避刺激物(r=0.340)领域的相关系数有统计学意义。依从性与ACT得分(r=0.387),ACT得分与活动受限(r=0.464)、与回避刺激物(r=0.755)、与哮喘症状(r=0.586)、与心理情绪(r=0.661)、与刺激物反应(r=0.426)及对疾病的担心(r=0.684)领域及总分(r=0.367)相关性均有统计学意义。且以上都呈正相关。
2.3生命质量影响因素分析
生命质量总分重要影响因素中,用药依从性作用最大,Beta值为0.241,其次为病程,Beta值为-0.223,及受教育程度,Beta值为0.213。活动受限领域重要影响因素中,病程作用最大,Beta值为-0.298,其次为受教育程度,Beta值为0.242。回避刺激物领域重要影响因素中,用药依从性作用最大,Beta值为0.249,其次为受教育程度,Beta值为0.226。哮喘症状领域重要影响因素中,用药依从性作用最大,Beta值为0.314,其次为病程,Beta值为-0.280。心理情绪领域影响因素中,用药依从性作用最大,Beta值为0.248,其次为居住状况,Beta值为0.221。对疾病的担心领域重要影响因素中,受教育程度作用最大,Beta值为0.289,其次为病程,Beta值为-0.198。
2.4哮喘患者生命质量评价指标体系效度、信度分析
生命质量两次测量的重测信度相关系数在0.346-0.590之间;分半信度R为0.8215;内部一致性信度(克郎巴赫系数α)在0.6327-0.9485之间。与标准表测得生命质量总分相关系数为0.852;将六个领域的33个条目采用主成分分析,提取6个主成分,累积贡献率为70.194%。
3.结论
3.1影响哮喘患者生命质量的因素比较多,主要有年龄、性别、文化程度、病程长短、居住状况、人均月收入等。
3.2在生命质量总体水平和各领域影响因素中,用药依从性、病程长短及受教育程度的作用较大,其中受教育程度和病程长短客观存在,无法人为影响外,用药依从性可给予干预行为,从而提高哮喘患者生命质量。
3.3生命质量构建的指标体系在信度、效度、可行性方面符合要求。可继续用于今后的调查研究。
第二章用药依从性与吸入性激素治疗效果的纵向研究
1.对象与方法
1.1门诊就诊哮喘患者共20例,诊断及分期符合中华医学会制定的《支气管哮喘防治指南》诊断标准,未使用过吸入性糖皮质激素。同时选择无过敏性疾病及心、肺疾病史的健康者8例作为对照组。
1.2检测指标:肺功能,用药依从性,生命质量,ACT评分,血清和诱导痰中炎症介质TNF-α、IFN-γ、IL-6、IL-10浓度的测定,采用酶联免疫吸附法(ELISA)。对照组进行与哮喘组除用药依从性、生命质量评估及哮喘控制测试(ACT)评分外相同项目的检测。共进行4次测量,分别在治疗前、治疗1个月、治疗3个月、治疗6个月。
1.3资料数据采用SPSS12.0统计软件进行处理。采用Pearson相关,分析各炎症介质含量,AQLQ评分,ACT评分,FEV_1占预计值%、FEV_1/FVC、PEF占预计值%之间的关系。采用多变量重复测量的方差分析,分析各变量随治疗时间的变化情况及用药依从性对治疗效果的影响。
2.结果
2.1依从性对肺功能的影响
对照组肺功能值均高于哮喘组,差别有统计学意义。哮喘组FEV_1%、PEF%及FEV_1/FVC四次测量间差异有统计学意义,值依次增高;四次测量与用药依从性的交互作用有统计学意义。用药依从性对肺功能四次测量值的主效应无统计学意义。用药依从性差的患者四次测量肺功能值差别无统计学意义。用药依从性好的患者在治疗3、6个月时FEV1%、PEF%值与治疗前及治疗1个月差别有统计学意义;治疗3个月FEV_1/FCV值与治疗前及治疗1个月,治疗6个月与治疗3个月差别有统计学意义。
2.2哮喘组用药依从性对生命质量、ACT得分的影响
生命质量、ACT四次测量间差异均有统计学意义。四次测量与用药依从性交互作用有统计学意义。用药依从性对生命质量、ACT四次测量得分的主效应有统计学意义。用药依从性好的患者组方差分析得到,用药1个月ACT得分与治疗前的,治疗3个月的与治疗1个月的,治疗6个月的与治疗3个月的,差别有统计学意义;生命质量总分、活动受限、哮喘症状领域得分治疗3个月与治疗前、治疗1个月,治疗6个月与治疗3个月差别有统计学意义;回避刺激物、刺激物反应领域得分在治疗3、6个月与治疗前、治疗1个月差别有统计学意义;对疾病担心领域得分治疗1、3、6个月与治疗前,治疗6个月与治疗1个月差别有统计学意义。
2.3用药依从性对的血清及诱导痰中炎症介质含量的影响分析
对照组血清及诱导痰中炎症介质含量均低于哮喘组,差别有统计学意义。炎症介质含量四次测量间差异均有统计学意义。四次测量与用药依从性交互作用有统计学意义,用药依从性对血清及诱导痰中炎症介质四次测量含量的主效应均有统计学意义。血清、诱导痰中IL-6、IL-10随用药时间有不同程度的增加,IFN-γ、TNF-α含量下降。血清中IL-6、IL-10值在用药1个月后随治疗时间延长而增加;IFN-γ值在用药3个月后随治疗时间而降低;TNF-α含量从用药1个月后随治疗时间的延长而降低。诱导痰中IL-6值从用药1个月后随治疗时间延长增高;IL-10值在治疗3个月时增加,之后无明显变化;IFN-γ、TNF-α值在用药3个月后随时间延长而降低。
2.4炎症介质与肺功能、生命质量相关分析
血清中IL-10含量与ACT得分在治疗后1、3和6个月的相关系数有统计学意义(r=0.639,r=0.660,r=0.665);血清中IFN-γ含量与FEV_1%在治疗前、治疗6个月相关系数有统计学意义(r=0.650,r=0.669)。诱导痰中IL-6含量与FEV_1/FVC在治疗3和6个月相关系数有统计学意义(r=0.588,r=0.595);诱导痰中IFN-γ含量与ACT得分在治疗6个月相关有统计学意义(r=0.607);诱导痰中TNF-α含量与对疾病的担心功领域得分在治疗3和6个月(r=-0.578,r=-0.743),与ACT得分在治疗前相关有统计学意义(r=-0.649),呈负相关。
3.结论
3.1随着用药时间的延长,与依从性差的组相比,依从性好的患者肺功能、生命质量、哮喘控制水平改善幅度较大;血清及诱导痰中IL-6、IL-10含量上升幅度较大,IFN-γ、TNF-α含量下降幅度较大。用药依从性好的组治疗效果优于依从性差的组。3.2吸入布地奈德干粉剂治疗6个月时,血清、诱导痰中炎症介质含量显著增加或下降,提示治疗中出现显著效果需要的时间。
3.3哮喘患者血清及诱导痰中炎症介质含量,随患者肺功能、生命质量、哮喘控制水平的改善而增加或减少。
第三章健康教育干预效果评估的研究
1.对象与方法
选取门诊哮喘患者95人(使用吸入性糖皮质激素治疗6个月以上,纳入及排除条件同第一部分),按照随机分组分为对照组和干预组,每位患者至少随访6个月。实施干预前后监测指标:认知水平、AQL、ACT得分、用药依从性得分及肺功能(FEV_1占预计值%)。采用SPSS12.0统计软件进行统计分析,进行t检验、方差分析、卡方检验和Pearson相关分析。
2.结果
2.1曾经接受过知识教育占20.0%,未接受过占80.0%。获取知识途径中,医务人员个别指导、专家门诊途径占总次数的50.0%,报纸书刊、广播电视、网络和哮喘知识手册途径分别占总选择次数的35.0%。用药依从性差的原因中,病情好转而停药占45.7%,因各种原因遗忘和未及时复诊配药占17.4%,长期用药的副反应占13.0%,只在发作期使用及用药指导不到位占6.5%,
2.2干预组认知水平、用药依从性、肺功能、生命质量各领域评分、总分及ACT评分与对照组差别有统计学意义,干预组对医生的信任度及其服务的满意度与对照组有显著性差异。
2.3认知水平与生命质量中的活动受限、回避刺激物领域及生命质量总分相关系数有统计学意义,呈正相关。
3.结论
实施健康教育干预,认知水平、对医生信任度及服务的满意度、用药依从性、肺功能、生命质量各领域评分、总分及ACT评分均有显著提高。认知水平掌握越好,用药依从性越好,生命质量越好,哮喘控制越理想。患者对健康教育的需求是迫切的,健康教育对于提高患者用药依从性,改善患者生命质量水平,增加肺功能具有重要的意义。
In the wake of resolution of medical model,quality of life already have become the critical parameter of appreciation drug and other therapeutic regimen,the comprehensiveness index to reflect the effect of disease and therapeutic measure to body、psychological and social activities. Patient's compliance of asthma patients is one of the significant influencing factors to therapeutic efficacy.Therefore,investigating the influence of patients compliance to quality of life、pulmonary function、content of mediators of inflammation,evaluation the effectiveness of patient's health education to increase patient's compliance,accordingly improving life quality of asthma patients,are significant to provide theory evidence and clinical guidance for making the mode of asthma education management.
The research includes two methods of cross-sectional study and follow-up investigation, objective(1)the level of life quality of asthma patients and risk factors of quality of life;(2) influence of patient's compliance to inhale hormone therapy,includes three parts,quality of life、pulmonary function、content of mediators of inflammation in serum and sputum;(3)According to the reason of bad patient's compliance and demand of patients,planning and practicing the mode of asthma education management,evaluating effectiveness of intervention.
PARTⅠStudy on evaluating quality of life of asthma patients and risk factors Sampling and methods
128 bronchial asthma patients aged 14-80 years were tested with proportional in out-patient clinic of first affiliated hospital of ShanXi medical university,according with Chinese guideline of prevention and management established by Chinese Medical Association,simultaneously course of disease was more than one year;being chronic persistent period severity gradeⅡand more;agreeing with using long-term control medication including inhaled cortex hormone;using inhaled cortex hormone more than one month.Using questionnaire of general state of health, ACT~(TM),quality of life and patient's compliance on cross-sectional study.Multiple databases were established based on EPIDATA,SPSS12.0 software was used in statistical analysis.Used t-test or ANOVA,Pearson correlation analysis,multivariant stepwise regression analysis, Scale-reliability analysis and principal component analysis.The sensitivity and specificity of the screening instrument was more than 95%.
Results
1.The score of life quality,ACT~(TM),patient's compliance in different sex,the score of life quality in different age group,the score of life quality,ACT~(TM)in different education,the score of life quality in different course of disease,the score of life quality in different income,the score of life quality in different habitation,the difference have statistical significance.
2.The study of dependability with patient's compliance、ACT~(TM)and quality of life
The coefficient correlation of patient's compliance has the statistical significance with the domain of limitation of activity(LOM)(r=0.365)、avoidance stimulus(r=0.559)、symptoms of asthma(SOA)(r=0.426)、psychological emotion(EM)(r=0.477)、stimulus reaction(r=0.163) and worry about disease(r=0.447).The coefficient correlation of cognition has the statistical significance with patient's compliance(r=0.412),the domain of limitation of activity(r=0.360)、avoidance stimulus(r=0.340).The coefficient correlation of patient's compliance has the statistical significance with ACT~(TM)(r=0.387),The coefficient correlation of ACT~(TM)has the statistical significance with the domain of limitation of activity(r=0.464)、avoidance stimulus (r=0.755)、symptoms of asthma(r=0.586)、psychological emotion(r=0.661)、stimulus reaction (r=0.426)、worry about disease(r=0.684)and the score of life quality(r=0.367).Moreover, all of them are positive correlation.
3.The study of influential factor analysis on quality of life
Among influential factors on quality of life,the contribution of patient's compliance is max, Beta=0.241,next is course of disease,Beta=-0.223,and education,Beta=0.213.Influential factors on the domain of limitation of activity,the contribution of course of disease is max,Beta=-0.298, next is education,Beta=0.242.Influential factors on the domain of avoidance stimulus,the contribution of patient's compliance is max,Beta=0.249,next is education,Beta=0.226. Influential factors on the domain of symptoms of asthma,the contribution of patient's compliance is max,Beta=0.314,next is course of disease,Beta=-0.280.Influential factors on the domain of psychological emotion,the contribution of patient's compliance is max,Beta=0.248,next is habitation,Beta=0.221.Influential factors on the domain of worry about disease,the contribution of education is max,Beta=0.289,next is course of disease,Beta=-0.198.
4.The analysis of validity and reliability in index about quality of life of asthma patient
The coefficient correlation of test-retest reliability is between 0.346-0.590;split-half reliability R=0.8215;Cronbach's is between 0.6327-0.9485.Criterion-related validity is 0.852;using principal component analysis extracts six principal constituents from 33 items of 6 domains,and the accum contribution is 70.194%.
Conclusions
1.There is a great deal of influence factors to quality of life of asthma patients,principally age、sex、education、course of disease、habitation、income and so on.
2.Among the influence factors,patient's compliance、course of disease and education of patients have the comparatively large contribution,education and course of disease are objectively present,and can not be influenced,however patient's compliance can be supplied. intervention,accordingly life quality is improved.
3.The validity、reliability and feasibility of index about quality of life is according with requirement,can be used in follow investigate and discuss.
PARTⅡA follow-up investigation on patient's compliance and therapeutic efficacy of glucocorticosteroid
Sampling and methods
20 bronchial asthma patients,diagnosing and staging are both according with Chinese guideline of prevention and management established by Chinese Medical Association. Simultaneous select 8 health without anaphylactic disease、cardiac and pulmonary disease as control group.Detecting index include pulmonary function、patient's compliance、quality of life、ACT、and density of mediators of inflammation:TNF-α、IFN-γ、IL-6、IL-10 of serum and sputum,detected with enzyme linked immunosorbent assay(ELISA).Determinations have four times in all,prior treatment、after therapy 1 month、3 months and 6 months.SPSS12.0 software was used in statistical analysis.Used Pearson correlation analysis,multi variable repeated measures.
Results
1.The effect of patient's compliance to pulmonary function
The measure of FEV_1%、PEF%and FEV_1/FVC in four times,the difference have statistical significance,the value increases gradually.The interaction of measurements with patient's compliance of four times has statistical significance.After therapy 1 month good compliance patients' FEV_1%、PEF%has statistical significance with therapy 3 months and 6 months; FEV_1/FVC of therapy 3 months has statistical significance with 1 month,6 months with 3 months.
2.The effect of patient's compliance to quality of life and ACT
The differences of quality of life and ACT have statistical significance in four times.The interaction of measurements with patient's compliance of four times has statistical significance. The main effect of patient's compliance with quality of life and ACT has statistical significance. After therapy 1-month good compliance patients' ACT has statistical significance with prior treatment,therapy 3 months has statistical significance with 1 month,6 months with 3 months. The score of quality of life、limitation of motion、symptoms of asthma in therapy 3 months has statistical significance with prior treatment、1 month、6 months;Avoidance stimulus、stimulus reaction in 3、6 months has statistical significance with prior treatment and 1month;Worry about disease in 1、3、6 months has statistical significance with prior treatment,6 months with 1 month.
3.The effect of patient's compliance to density of mediators of inflammation in serum and sputum
The density of IL-6、IL-10 in serum and sputum increase with the time of therapy,the density of IFN-γ、TNF-αin serum and sputum decrease.The density of IL-6、IL-10 increase after 1 month in serum,the density of IFN-γdecrease after 3 months in serum;The density of TNF-αdecrease after 1 month in serum.The density of IL-6 increases after 1 month in sputum.The density of IL-10 increase at 3 months,do not change after 3 months in sputum.The density of IFN-γ、TNF-αdecrease after 3 months in sputum.
4.The correlation analysis of mediators of inflammation with pulmonary function and quality of life
The coefficient correlation has statistical significance of the density of IL-10 in serum with ACT at 1、3、6 months(r=0.639,r=0.660,r=0.665);The coefficient correlation has statistical significance of the density of IFN-γin serum with FEV_1%at 1、6 months,(r=0.650,r=0.669). The coefficient correlation has statistical significance of the density of IL-6 in sputum with FEV_1/FVC at 3、6 months(r=0.588,r=0.595).The coefficient correlation has statistical significance of the density of IFN-γin sputum with ACT at 6 months(r=0.607);The coefficient correlation has statistical significance of the density of TNF-αin sputum with worry about disease at 3、6 months(r=-0.578,r=-0.743),with ACT at prior treatment(r=-0.649),are negative correlation.
Conclusions
1.With the lasting of therapy time,compared to bad compliance group,pulmonary function、quality of life、asthma control level of good group improve greatly;The density of IL-6、IL-10 in serum and sputum rise comparatively,The density of IFN-γ、TNF-αdecrease greatly.All in all the therapeutic efficacy of good compliance group has an advantage than bad group.
2.At 6 months of using budesonide,the mediators of inflammation both in serum and sputum change significantly,indicating the time of emerging predominance.
3.The density of mediators of inflammation in serum and sputum increase or decrease with the change of pulmonary function、quality of life、asthma control level of patients.
PARTⅢThe investigation on evaluation of intervention effect of health education Data and methods
95 bronchial asthma patients,according to randomization,separate them into two parties:control group and intervention group,being follow-up visited for at lest 6 months.Evaluate index are cognition level、AQL、ACT、patient's compliance and pulmonary function.All data were analyzed using Excel and SPSS12.0 software.Used t-test、ANOVA、chi square test and Pearson correlation analysis.
Results
1.20.0%patients have accepted asthma knowledge education.The way of obtain knowledge, 50.0%is medical member,specialist,35.0%is newspaper、broadcast、internet and handbook of asthma knowledge.In the reasons of bad compliance,discontinuation because of improve of condition is 45.7%,forgetting because of various kinds reason is 17.4%,the adverse reaction of long-term medication is 13.0%,Medication only during period of onset is 6.5%.
2.The cognition level、patient's compliance、pulmonary function、AQL and ACT of intervention group has statistical significance with control group,the confidence and gratification to doctor of intervention group has statistical significance with control group.
3.Coefficient correlation of cognition level with limitation of motion、avoidance stimulus and quality of life has statistical significance,and is positive correlation.
Conclusions
Through practicing intervention of health education,the score of cognition level、the confidence and gratification to doctor、patient's compliance、pulmonary function、quality of life and ACT have being raised predominantly.The better grasping cognition,the higher score of quality of life;the better patient's compliance,the higher score of quality of life.The demand to health education of asthma patients is exigent.Health education has significant meaning for raising patient's compliance,improving level of life quality,increasing pulmonary function of patients.
本次研究采用横断面研究和随访研究两种方法,解决以下问题:(1)呼吸科门诊哮喘患者生命质量水平及其影响因素;(2)用药依从性对患者使用吸入性糖皮质激素治疗的影响,主要从肺功能、生命质量水平、血清和诱导痰中炎症介质含量三方面分析;(3)针对用药依从性差的原因及患者需求,制定相应健康教育干预模式,实施并评估干预效果。
第一章哮喘患者生命质量评估及影响因素的研究
1.对象与方法
1.1我院哮喘专科门诊就诊的128例支气管哮喘患者,年龄在14-80岁,符合中华医学会制定的《支气管哮喘防治指南》诊断标准并且患病时间超过1年以上;达到哮喘慢性持续期严重程度分级Ⅱ级或以上;同意接受包括吸入激素在内的长期控制药物治疗;使用激素吸入剂时间均为1个月以上。
1.2横断面研究采用一般情况调查表,哮喘控制测试(ACT~(TM))表,哮喘患者生命质量(AQLQ)量表,用药依从性评分表。
1.3统计分析:资料数据输入统计软件SPSS12.0处理分析,均数比较采用t检验、方差分析。采用Pearson相关,分析依从性得分、认知水平、ACT得分与生命质量得分的关系。采用多元逐步回归分析进行生命质量影响因素分析。指标体系的重测信度和标准关联效度采用Pearson相关分析,分半信度及克郎巴赫系数α采用SPSS中Scale-reliability分析,构想效度采用主成分分析法。P＜0.05,差异有统计学意义。
2.结果
2.1患者生命质量、ACT、用药依从性基本情况比较
不同性别患者生命质量、ACT、依从性得分,不同年龄组患者生命质量水平,受教育程度不同的患者生命质量水平、ACT得分,病程长短不同的患者生命质量水平,不同人均月收入的患者生命质量水平,不同居住状况的患者生命质量水平,差别均有统计学意义。
2.2用药依从性、ACT得分、生命质量影响相关性研究
用药依从性与活动受限(r=0.365)、与回避刺激物(r=0.559)、与哮喘症状(r=0.426)、与心理情绪(r=0.477)、与刺激物反应(r=0.163)及对疾病的担心(r=0.447)领域的相关系数有统计学意义。认知水平与依从性(r=0.412),认知水平与活动受限(r=0.360)、与回避刺激物(r=0.340)领域的相关系数有统计学意义。依从性与ACT得分(r=0.387),ACT得分与活动受限(r=0.464)、与回避刺激物(r=0.755)、与哮喘症状(r=0.586)、与心理情绪(r=0.661)、与刺激物反应(r=0.426)及对疾病的担心(r=0.684)领域及总分(r=0.367)相关性均有统计学意义。且以上都呈正相关。
2.3生命质量影响因素分析
生命质量总分重要影响因素中,用药依从性作用最大,Beta值为0.241,其次为病程,Beta值为-0.223,及受教育程度,Beta值为0.213。活动受限领域重要影响因素中,病程作用最大,Beta值为-0.298,其次为受教育程度,Beta值为0.242。回避刺激物领域重要影响因素中,用药依从性作用最大,Beta值为0.249,其次为受教育程度,Beta值为0.226。哮喘症状领域重要影响因素中,用药依从性作用最大,Beta值为0.314,其次为病程,Beta值为-0.280。心理情绪领域影响因素中,用药依从性作用最大,Beta值为0.248,其次为居住状况,Beta值为0.221。对疾病的担心领域重要影响因素中,受教育程度作用最大,Beta值为0.289,其次为病程,Beta值为-0.198。
2.4哮喘患者生命质量评价指标体系效度、信度分析
生命质量两次测量的重测信度相关系数在0.346-0.590之间;分半信度R为0.8215;内部一致性信度(克郎巴赫系数α)在0.6327-0.9485之间。与标准表测得生命质量总分相关系数为0.852;将六个领域的33个条目采用主成分分析,提取6个主成分,累积贡献率为70.194%。
3.结论
3.1影响哮喘患者生命质量的因素比较多,主要有年龄、性别、文化程度、病程长短、居住状况、人均月收入等。
3.2在生命质量总体水平和各领域影响因素中,用药依从性、病程长短及受教育程度的作用较大,其中受教育程度和病程长短客观存在,无法人为影响外,用药依从性可给予干预行为,从而提高哮喘患者生命质量。
3.3生命质量构建的指标体系在信度、效度、可行性方面符合要求。可继续用于今后的调查研究。
第二章用药依从性与吸入性激素治疗效果的纵向研究
1.对象与方法
1.1门诊就诊哮喘患者共20例,诊断及分期符合中华医学会制定的《支气管哮喘防治指南》诊断标准,未使用过吸入性糖皮质激素。同时选择无过敏性疾病及心、肺疾病史的健康者8例作为对照组。
1.2检测指标:肺功能,用药依从性,生命质量,ACT评分,血清和诱导痰中炎症介质TNF-α、IFN-γ、IL-6、IL-10浓度的测定,采用酶联免疫吸附法(ELISA)。对照组进行与哮喘组除用药依从性、生命质量评估及哮喘控制测试(ACT)评分外相同项目的检测。共进行4次测量,分别在治疗前、治疗1个月、治疗3个月、治疗6个月。
1.3资料数据采用SPSS12.0统计软件进行处理。采用Pearson相关,分析各炎症介质含量,AQLQ评分,ACT评分,FEV_1占预计值%、FEV_1/FVC、PEF占预计值%之间的关系。采用多变量重复测量的方差分析,分析各变量随治疗时间的变化情况及用药依从性对治疗效果的影响。
2.结果
2.1依从性对肺功能的影响
对照组肺功能值均高于哮喘组,差别有统计学意义。哮喘组FEV_1%、PEF%及FEV_1/FVC四次测量间差异有统计学意义,值依次增高;四次测量与用药依从性的交互作用有统计学意义。用药依从性对肺功能四次测量值的主效应无统计学意义。用药依从性差的患者四次测量肺功能值差别无统计学意义。用药依从性好的患者在治疗3、6个月时FEV1%、PEF%值与治疗前及治疗1个月差别有统计学意义;治疗3个月FEV_1/FCV值与治疗前及治疗1个月,治疗6个月与治疗3个月差别有统计学意义。
2.2哮喘组用药依从性对生命质量、ACT得分的影响
生命质量、ACT四次测量间差异均有统计学意义。四次测量与用药依从性交互作用有统计学意义。用药依从性对生命质量、ACT四次测量得分的主效应有统计学意义。用药依从性好的患者组方差分析得到,用药1个月ACT得分与治疗前的,治疗3个月的与治疗1个月的,治疗6个月的与治疗3个月的,差别有统计学意义;生命质量总分、活动受限、哮喘症状领域得分治疗3个月与治疗前、治疗1个月,治疗6个月与治疗3个月差别有统计学意义;回避刺激物、刺激物反应领域得分在治疗3、6个月与治疗前、治疗1个月差别有统计学意义;对疾病担心领域得分治疗1、3、6个月与治疗前,治疗6个月与治疗1个月差别有统计学意义。
2.3用药依从性对的血清及诱导痰中炎症介质含量的影响分析
对照组血清及诱导痰中炎症介质含量均低于哮喘组,差别有统计学意义。炎症介质含量四次测量间差异均有统计学意义。四次测量与用药依从性交互作用有统计学意义,用药依从性对血清及诱导痰中炎症介质四次测量含量的主效应均有统计学意义。血清、诱导痰中IL-6、IL-10随用药时间有不同程度的增加,IFN-γ、TNF-α含量下降。血清中IL-6、IL-10值在用药1个月后随治疗时间延长而增加;IFN-γ值在用药3个月后随治疗时间而降低;TNF-α含量从用药1个月后随治疗时间的延长而降低。诱导痰中IL-6值从用药1个月后随治疗时间延长增高;IL-10值在治疗3个月时增加,之后无明显变化;IFN-γ、TNF-α值在用药3个月后随时间延长而降低。
2.4炎症介质与肺功能、生命质量相关分析
血清中IL-10含量与ACT得分在治疗后1、3和6个月的相关系数有统计学意义(r=0.639,r=0.660,r=0.665);血清中IFN-γ含量与FEV_1%在治疗前、治疗6个月相关系数有统计学意义(r=0.650,r=0.669)。诱导痰中IL-6含量与FEV_1/FVC在治疗3和6个月相关系数有统计学意义(r=0.588,r=0.595);诱导痰中IFN-γ含量与ACT得分在治疗6个月相关有统计学意义(r=0.607);诱导痰中TNF-α含量与对疾病的担心功领域得分在治疗3和6个月(r=-0.578,r=-0.743),与ACT得分在治疗前相关有统计学意义(r=-0.649),呈负相关。
3.结论
3.1随着用药时间的延长,与依从性差的组相比,依从性好的患者肺功能、生命质量、哮喘控制水平改善幅度较大;血清及诱导痰中IL-6、IL-10含量上升幅度较大,IFN-γ、TNF-α含量下降幅度较大。用药依从性好的组治疗效果优于依从性差的组。3.2吸入布地奈德干粉剂治疗6个月时,血清、诱导痰中炎症介质含量显著增加或下降,提示治疗中出现显著效果需要的时间。
3.3哮喘患者血清及诱导痰中炎症介质含量,随患者肺功能、生命质量、哮喘控制水平的改善而增加或减少。
第三章健康教育干预效果评估的研究
1.对象与方法
选取门诊哮喘患者95人(使用吸入性糖皮质激素治疗6个月以上,纳入及排除条件同第一部分),按照随机分组分为对照组和干预组,每位患者至少随访6个月。实施干预前后监测指标:认知水平、AQL、ACT得分、用药依从性得分及肺功能(FEV_1占预计值%)。采用SPSS12.0统计软件进行统计分析,进行t检验、方差分析、卡方检验和Pearson相关分析。
2.结果
2.1曾经接受过知识教育占20.0%,未接受过占80.0%。获取知识途径中,医务人员个别指导、专家门诊途径占总次数的50.0%,报纸书刊、广播电视、网络和哮喘知识手册途径分别占总选择次数的35.0%。用药依从性差的原因中,病情好转而停药占45.7%,因各种原因遗忘和未及时复诊配药占17.4%,长期用药的副反应占13.0%,只在发作期使用及用药指导不到位占6.5%,
2.2干预组认知水平、用药依从性、肺功能、生命质量各领域评分、总分及ACT评分与对照组差别有统计学意义,干预组对医生的信任度及其服务的满意度与对照组有显著性差异。
2.3认知水平与生命质量中的活动受限、回避刺激物领域及生命质量总分相关系数有统计学意义,呈正相关。
3.结论
实施健康教育干预,认知水平、对医生信任度及服务的满意度、用药依从性、肺功能、生命质量各领域评分、总分及ACT评分均有显著提高。认知水平掌握越好,用药依从性越好,生命质量越好,哮喘控制越理想。患者对健康教育的需求是迫切的,健康教育对于提高患者用药依从性,改善患者生命质量水平,增加肺功能具有重要的意义。
In the wake of resolution of medical model,quality of life already have become the critical parameter of appreciation drug and other therapeutic regimen,the comprehensiveness index to reflect the effect of disease and therapeutic measure to body、psychological and social activities. Patient's compliance of asthma patients is one of the significant influencing factors to therapeutic efficacy.Therefore,investigating the influence of patients compliance to quality of life、pulmonary function、content of mediators of inflammation,evaluation the effectiveness of patient's health education to increase patient's compliance,accordingly improving life quality of asthma patients,are significant to provide theory evidence and clinical guidance for making the mode of asthma education management.
The research includes two methods of cross-sectional study and follow-up investigation, objective(1)the level of life quality of asthma patients and risk factors of quality of life;(2) influence of patient's compliance to inhale hormone therapy,includes three parts,quality of life、pulmonary function、content of mediators of inflammation in serum and sputum;(3)According to the reason of bad patient's compliance and demand of patients,planning and practicing the mode of asthma education management,evaluating effectiveness of intervention.
PARTⅠStudy on evaluating quality of life of asthma patients and risk factors Sampling and methods
128 bronchial asthma patients aged 14-80 years were tested with proportional in out-patient clinic of first affiliated hospital of ShanXi medical university,according with Chinese guideline of prevention and management established by Chinese Medical Association,simultaneously course of disease was more than one year;being chronic persistent period severity gradeⅡand more;agreeing with using long-term control medication including inhaled cortex hormone;using inhaled cortex hormone more than one month.Using questionnaire of general state of health, ACT~(TM),quality of life and patient's compliance on cross-sectional study.Multiple databases were established based on EPIDATA,SPSS12.0 software was used in statistical analysis.Used t-test or ANOVA,Pearson correlation analysis,multivariant stepwise regression analysis, Scale-reliability analysis and principal component analysis.The sensitivity and specificity of the screening instrument was more than 95%.
Results
1.The score of life quality,ACT~(TM),patient's compliance in different sex,the score of life quality in different age group,the score of life quality,ACT~(TM)in different education,the score of life quality in different course of disease,the score of life quality in different income,the score of life quality in different habitation,the difference have statistical significance.
2.The study of dependability with patient's compliance、ACT~(TM)and quality of life
The coefficient correlation of patient's compliance has the statistical significance with the domain of limitation of activity(LOM)(r=0.365)、avoidance stimulus(r=0.559)、symptoms of asthma(SOA)(r=0.426)、psychological emotion(EM)(r=0.477)、stimulus reaction(r=0.163) and worry about disease(r=0.447).The coefficient correlation of cognition has the statistical significance with patient's compliance(r=0.412),the domain of limitation of activity(r=0.360)、avoidance stimulus(r=0.340).The coefficient correlation of patient's compliance has the statistical significance with ACT~(TM)(r=0.387),The coefficient correlation of ACT~(TM)has the statistical significance with the domain of limitation of activity(r=0.464)、avoidance stimulus (r=0.755)、symptoms of asthma(r=0.586)、psychological emotion(r=0.661)、stimulus reaction (r=0.426)、worry about disease(r=0.684)and the score of life quality(r=0.367).Moreover, all of them are positive correlation.
3.The study of influential factor analysis on quality of life
Among influential factors on quality of life,the contribution of patient's compliance is max, Beta=0.241,next is course of disease,Beta=-0.223,and education,Beta=0.213.Influential factors on the domain of limitation of activity,the contribution of course of disease is max,Beta=-0.298, next is education,Beta=0.242.Influential factors on the domain of avoidance stimulus,the contribution of patient's compliance is max,Beta=0.249,next is education,Beta=0.226. Influential factors on the domain of symptoms of asthma,the contribution of patient's compliance is max,Beta=0.314,next is course of disease,Beta=-0.280.Influential factors on the domain of psychological emotion,the contribution of patient's compliance is max,Beta=0.248,next is habitation,Beta=0.221.Influential factors on the domain of worry about disease,the contribution of education is max,Beta=0.289,next is course of disease,Beta=-0.198.
4.The analysis of validity and reliability in index about quality of life of asthma patient
The coefficient correlation of test-retest reliability is between 0.346-0.590;split-half reliability R=0.8215;Cronbach's is between 0.6327-0.9485.Criterion-related validity is 0.852;using principal component analysis extracts six principal constituents from 33 items of 6 domains,and the accum contribution is 70.194%.
Conclusions
1.There is a great deal of influence factors to quality of life of asthma patients,principally age、sex、education、course of disease、habitation、income and so on.
2.Among the influence factors,patient's compliance、course of disease and education of patients have the comparatively large contribution,education and course of disease are objectively present,and can not be influenced,however patient's compliance can be supplied. intervention,accordingly life quality is improved.
3.The validity、reliability and feasibility of index about quality of life is according with requirement,can be used in follow investigate and discuss.
PARTⅡA follow-up investigation on patient's compliance and therapeutic efficacy of glucocorticosteroid
Sampling and methods
20 bronchial asthma patients,diagnosing and staging are both according with Chinese guideline of prevention and management established by Chinese Medical Association. Simultaneous select 8 health without anaphylactic disease、cardiac and pulmonary disease as control group.Detecting index include pulmonary function、patient's compliance、quality of life、ACT、and density of mediators of inflammation:TNF-α、IFN-γ、IL-6、IL-10 of serum and sputum,detected with enzyme linked immunosorbent assay(ELISA).Determinations have four times in all,prior treatment、after therapy 1 month、3 months and 6 months.SPSS12.0 software was used in statistical analysis.Used Pearson correlation analysis,multi variable repeated measures.
Results
1.The effect of patient's compliance to pulmonary function
The measure of FEV_1%、PEF%and FEV_1/FVC in four times,the difference have statistical significance,the value increases gradually.The interaction of measurements with patient's compliance of four times has statistical significance.After therapy 1 month good compliance patients' FEV_1%、PEF%has statistical significance with therapy 3 months and 6 months; FEV_1/FVC of therapy 3 months has statistical significance with 1 month,6 months with 3 months.
2.The effect of patient's compliance to quality of life and ACT
The differences of quality of life and ACT have statistical significance in four times.The interaction of measurements with patient's compliance of four times has statistical significance. The main effect of patient's compliance with quality of life and ACT has statistical significance. After therapy 1-month good compliance patients' ACT has statistical significance with prior treatment,therapy 3 months has statistical significance with 1 month,6 months with 3 months. The score of quality of life、limitation of motion、symptoms of asthma in therapy 3 months has statistical significance with prior treatment、1 month、6 months;Avoidance stimulus、stimulus reaction in 3、6 months has statistical significance with prior treatment and 1month;Worry about disease in 1、3、6 months has statistical significance with prior treatment,6 months with 1 month.
3.The effect of patient's compliance to density of mediators of inflammation in serum and sputum
The density of IL-6、IL-10 in serum and sputum increase with the time of therapy,the density of IFN-γ、TNF-αin serum and sputum decrease.The density of IL-6、IL-10 increase after 1 month in serum,the density of IFN-γdecrease after 3 months in serum;The density of TNF-αdecrease after 1 month in serum.The density of IL-6 increases after 1 month in sputum.The density of IL-10 increase at 3 months,do not change after 3 months in sputum.The density of IFN-γ、TNF-αdecrease after 3 months in sputum.
4.The correlation analysis of mediators of inflammation with pulmonary function and quality of life
The coefficient correlation has statistical significance of the density of IL-10 in serum with ACT at 1、3、6 months(r=0.639,r=0.660,r=0.665);The coefficient correlation has statistical significance of the density of IFN-γin serum with FEV_1%at 1、6 months,(r=0.650,r=0.669). The coefficient correlation has statistical significance of the density of IL-6 in sputum with FEV_1/FVC at 3、6 months(r=0.588,r=0.595).The coefficient correlation has statistical significance of the density of IFN-γin sputum with ACT at 6 months(r=0.607);The coefficient correlation has statistical significance of the density of TNF-αin sputum with worry about disease at 3、6 months(r=-0.578,r=-0.743),with ACT at prior treatment(r=-0.649),are negative correlation.
Conclusions
1.With the lasting of therapy time,compared to bad compliance group,pulmonary function、quality of life、asthma control level of good group improve greatly;The density of IL-6、IL-10 in serum and sputum rise comparatively,The density of IFN-γ、TNF-αdecrease greatly.All in all the therapeutic efficacy of good compliance group has an advantage than bad group.
2.At 6 months of using budesonide,the mediators of inflammation both in serum and sputum change significantly,indicating the time of emerging predominance.
3.The density of mediators of inflammation in serum and sputum increase or decrease with the change of pulmonary function、quality of life、asthma control level of patients.
PARTⅢThe investigation on evaluation of intervention effect of health education Data and methods
95 bronchial asthma patients,according to randomization,separate them into two parties:control group and intervention group,being follow-up visited for at lest 6 months.Evaluate index are cognition level、AQL、ACT、patient's compliance and pulmonary function.All data were analyzed using Excel and SPSS12.0 software.Used t-test、ANOVA、chi square test and Pearson correlation analysis.
Results
1.20.0%patients have accepted asthma knowledge education.The way of obtain knowledge, 50.0%is medical member,specialist,35.0%is newspaper、broadcast、internet and handbook of asthma knowledge.In the reasons of bad compliance,discontinuation because of improve of condition is 45.7%,forgetting because of various kinds reason is 17.4%,the adverse reaction of long-term medication is 13.0%,Medication only during period of onset is 6.5%.
2.The cognition level、patient's compliance、pulmonary function、AQL and ACT of intervention group has statistical significance with control group,the confidence and gratification to doctor of intervention group has statistical significance with control group.
3.Coefficient correlation of cognition level with limitation of motion、avoidance stimulus and quality of life has statistical significance,and is positive correlation.
Conclusions
Through practicing intervention of health education,the score of cognition level、the confidence and gratification to doctor、patient's compliance、pulmonary function、quality of life and ACT have being raised predominantly.The better grasping cognition,the higher score of quality of life;the better patient's compliance,the higher score of quality of life.The demand to health education of asthma patients is exigent.Health education has significant meaning for raising patient's compliance,improving level of life quality,increasing pulmonary function of patients.
引文
[1]蔡映云,李凡,刘震威.哮喘患者的生命质量及其评估.中华全科医师杂志,2003,2:9-11
[2]The World Health Organization Qquality of Life Assessment(WHOQOL):Development And General Psychometric Properties.S oc Sci Med.1998,46:1569-1585
[3]王红玉,刘远明.生物心理社会医学模式与全球哮喘防治策略.医学与社会,2002,15:23-24
[4]Mintz,-M;Garcia,-J;Diener,-P;Liao,-Y;Dupclay,-L;Georges,-Go Triamcinolone acetonide aqueous nasal spray improves nocturnal rhinitis-related quality of life in patients treated in a primary care.setting:the Quality of Sleep in Allergic Rhinitis study.Ann-Allergy-Asthma-Immunol.2004,92:255-261
[5]Belloch,-A;Perpina,-M;Martinez-Moragon,-E。 Gender differences in health-related quality of life among patients with asthma.J-Asthmao 2003,40:945-953
[6]朱元珏.评估生命质量逐渐成为临床试验的新标准.中华内科杂志,2003,42:753
[7]梁宗安,刘春涛,滕鸿等.健康教育对支气管哮喘患者生活质量的影响.中国呼吸与危重监护杂志,2003,2:18-20
[8]Orr,-L-C;Fowler,-S-J;Lipworth,-B-J.Relationship between changes in quality of life and measures of lung function and bronchial hyper-responsiveness during high-dose inhaled corticosteroid treatment in uncontrolled asthma.Am-J-Respir-Med.2003,5:433-438
[9]Yang,-M-L;Chiang,-C-H;Yao,-G;Wang,-K-Y.Effect of medical education on quality of life in adult asthma patients.J-Formos-Med-Assoc.2003,102:768-774
[10]李明华,殷凯生主编.哮喘病学.北京:人民卫生出版社,2000
[11]Juniper,-E-F;Jenkins,-C;Price,-M-J;James,-M-H.Impact of inhaled salmeterol/fluticasone propionate combination product versus budesonide on the health-related quality of life of patients with asthma.Am-J-Respir-Med.2002,6:435-440
[12]Gorelick -M-H,Brousseau -D-C,Stevens -M-W.Validity and responsiveness of a brief,asthma-specific quality-of-life instrument in children with acute asthma.Ann-AllergyAsthma-Immunol.2004,92:47-51
[13]Meszaros,-A;Orosz,-M;Magyar,-P;Mesko,-A;Vincze,-Z.Evaluation of asthma knowledge and quality of life in Hungarian asthmatics.Allergy.2003,58:624-628
[14]徐凯峰,雒晓春,陈燕等.Juniper哮喘生命质量问卷在中国哮喘患者中的初步应用.中华内科杂志,2003,42:760-763
[15]Juniper EF,Buist AS,Cox FM,et al.Validation of a standardized version of the Asthma Quality of Life Questionnaire.Chest,1999,115:1265-1270.
[16]李凡.蔡映云.支气管哮喘生存质量评估表的制定、评估和临床应用.现代康 复,2001,5:18219.
[17]Juniper EF,Buist AS.Health2related quality of life in moderate asthma:400 microg hydrofluoroalkane beclomethasone dipropionate vs 800 microg chlorofluorocarbon beclomethasone dipropionate.The Study Group.Chest,1999,116:129721303.
[18]Van Schayck CP,Van Der Heijden FM,Van Den Boom Get al.Underdiagnosis of asthma:is the doctor or the patient to blame? The DMCA project.Thorax,2000,55:562-565.
[19]母双,何权瀛,余兵等.三位一体支气管哮喘教育管理模式对病情控制水平和生命质量的影响.中华结核和呼吸杂志,2006,29(11):731-734.
[20]何权瀛.改变现有医疗服务模式以全面控制支气管哮喘.中华内科杂志,2005,44:322-323.
[21]何权瀛.我国十余年支气管哮喘教育和管理工作的回顾与展望.中华结核和呼吸杂志,2003,26:141-142.
[22]Bateman ED,Boushey HA,Bousquet J,et al.Can guideline defined asthma control be achieved? The Gaining Optimal Asthma Control Study.Am J Respir Crit Care Med,2004,170:836-844.
[23]Rabe KF,Adachi M,Lai CK,et al.Worldwide severity and control of asthma in children and adults:the global asthma insights and reality surveys.J Allergy Clin Immunol,2004,114:40-47.
[24]Lai CK,De Guia TS,Kim YY,et al.Asthma control in the Asia-Pacific region:the Asthma Insights and Reality in Asia-Pacific Study.J Allergy Clin Immunol,2003,111:263-268.
[1]徐凯峰,雒晓春,陈燕等.Juniper哮喘生命质量问卷在中国哮喘患者中的初步应用.中华内科杂志,2003,42(11):760-763
[2]Bjermer L,Bisgaard H,Bousquet J,Fabbri LM,Greening AP,Haahtela T,Holgate ST,Picado C,Menten J,Dass SB,Leff JA,Polos PG.Montelukastand fluticasone compared with salmeterol and fluticasone in protecting against asthma exacerbation in adults:one year,double blind,randomised,comparative trial.2003,327(7420):891.
[3]Finn A,Gross G,van Bavel J,Lee T,Windom H,Everhard F,Fowler-Taylor A,Liu J,Gupta N.Omalizumab improves asthma-related quality of life in patients with severe allergic asthma.J Allergy Clin Immunol.2003 111(2):278-84.
[4]Leigh R,Vethanayagam D,Yoshida M,Watson RM,Rerecich T,Inman MD,O'Byrne PM.Effects of montelukast and budesonide on airway responses and airway inflammation in asthma.Am J Respir Crit Care Med 2002,166(9):1212-7.
[5]Chalmers GW,Macleod KJ,Little SA,Thomson lJ,McSharry CP,Thomson NC.Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma.Thorax 2002,57(3):226-30
[6]李凡,蔡映云.支气管哮喘生命质量评估表的制定、评估和临床应用.现代康复,2001,5:18-19
[7]Nightingale JA,Rogers DF,Barnes PJ.Comparison of the effects of salmeterol and formoterol in patients with severe asthma.Chest 2002 121(5):1401-1406
[8]张继海,杨土保.生命质量研究的辩证思考.医学与哲学,2003,24(3):18-20
[9]Gibson PG,Coughlan J,Wilson AJ,Abramson M,Bauman A,Hensley MJ,et al.Self-management education and regular practitioner review for adults with asthma.Cochrane Database Syst Rev,2000,2:1117
[10]Cowie RL,Revitt SG,Underwood MF,Field SK.The effect of a peak flow-based action plan in the prevention of exacerbations of asthma.Chest 1999,112:1534-1537
[11]Gallefoss F,Bakke PS.Impact of patient education and selfman
[12]agement on morbidity in asthmatics and patients with chronic obstructive pulmonary disease[J].Respir Med,2000,94:287-297
[13]Duma Z,Ozcan s.Evaluation of self-management education for asthmatic patients[J].J Asthma,2003,40(6):631-643
[1]National Institutes of Health.Global Initiative for Asthma.Global strategy for asthma management and prevention(revised 2002).WHO/NHLBl workshop report.Clark M.D.Pub.NO 02-3659,2002:102-109.
[2]陆尉萱,张一杰,胡波等.应用哮喘生命质量问卷的临床体会.中华结核和呼吸杂志,2003,9:567-568.
[3]李莉,李鹏,荆涛等.支气管哮喘病人疾病知识和生活方式的相关性研究.中华护理杂志,2004,39:90-93.
[4]Kim SH,Han SY,Azam T,et al:Interleukin-32:a cytokine and inducers of TNF alpha.Immunity,2005,22:1313
[5]徐永健,谢俊刚.重视对支气管哮喘患者的生活质量评估.中华内科杂志,2005,44:324-325.
[6]何晓俐,刘建萍,沈嘉瑶.门诊支气管哮喘患者用药依从性的调查分析.齐齐哈尔医学院学报,2001,22(5):561-562.
[7]Muntner P,Sudre P,Perneger TV.Comparison of the psychometric properties of the Asthma Quality of Life Questionnaire(AQLQ)among 115 asthmatic adults assessed during acute hospitalization and as outpatients.Qual Life Res,2000,9:987-995.
[8]Fonseca JA,Delgado L,Costa-Pereira A,et al.Evaluation of the Asthma Life Quality test for the screening and severity assessment of asthma.Allergy,2004,126:1849-1854.
[9]Strine TW,Ford ES,Balluz L,et al,Risk behaviors and health-related quality of life among adults with asthma:the role of mental health status,Chest,2004,126:1849-1854.
[10]赵秀荣,高桂敏.健康教育对支气管哮喘病人生活质量的影响.护理研究,2005,19:1809-1810.
[11]Calverley P,Pauwels R,Vestbo J,et al.Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease:a randomised controlled trial.Lancet,2003,361:4492456.
[12]朱元珏.评估生命质量逐渐成为临床试验的新标准.中华内科杂志,2003,42(11):753
[13]支气管哮喘防治指南(支气管哮喘的定义、诊断、治疗及教育和管理方案).中华医学会呼吸病学分会哮喘学组.中华结核和呼吸杂志,2003,26(3):132-138
[14]李凡,蔡映云.中国在支气管哮喘和慢性阻塞性肺疾病患者生命质量研究中问题的分析.中华全科医师杂志,2004,3(3):133-134
[15]CKW,De Guia TS,Kim YY,et al.Asthma control in the asia-pacification:the asthma in sights and reality in asia-pacific study.J Allergy Clin Immunol.2003,111:263-68.
[16]钟南山主编.支气管哮喘-基础与临床.北京:人民卫生出版社.2006:911-932
[1]徐凯峰,雒晓春,陈燕等.Juniper哮喘生命质量问卷在中国哮喘患者中的初步应用.中华内科杂志,2003,42(11):760-763.
[2]Paul-Dauphin A,Guillemin F,Virion JM,Briancon S.Bias and precision in Visual Analogue Scales:a randomised controlled trial.Am J Epidemiol.1999,150:1117-27
[3]Sanjuas C,Alonso J,Prieto L,et al.Healt h2related quality of life in asthma:a comparison between the St George′ s Respiratory Questionnaire and t he Ast hma Quality of Life Questionnaire.Qual Life Res,2002,11:7292738.
[4]Apajasalo M,Rautonen J,Holmberg C,SinkkonenJ,Aalberg V,Pihko H,et all.Quality of life in pre-adolescence:a 17-dimensional health-related measure(17D).Qual Life Res.1996,5:532-8
[5]李凡,蔡映云,李海玲等.疾病特异性量表与SF36量表对支气管哮喘患者生命质量评估的比较.中华全科医师杂志,2005,4(40):213-216
[6]Buck D,Jacoby A,Massey A,et al.Evaluation of measures used to assess quality of life after stroke.Stroke.2000,21:2004-2010
[7]Espinosa De Los,Monteros MJ,Alonso J,et al.Quality of life inast hma:reliability and validity of t he short form generic questionnaire(SF236)applied to the population of asthmatics in a public health area.Arch Bronconeumol,2002,38:429.
[8]Nanda U,McLendon PM,Andresen EM,et al.The SIP68:an abbreviated sickness impact profile for disability outcomes research.Qual Life Res,2003,12:5832595.
[9]Raat H,Botterweck AM,Landgraf JM,et al.Reliability and validity of the short form of the child health questionnaire for parents(CHQ-PF28)in large random school based and general population samples.J Epidemiol Community Health.2005,59:75-82.
[10]Connolly MA,Johnson JA.Measuring quality of life in pediatric patients.Pharmacoeconomics.1999,16:605-25.
[11]Fekkes M,Theunissen NCM,Brugman E.et al.Development and psychometric evaluation of the TAPQOL:A health-related quality of life instrument for 1-5-year-old children.Qual Life Res.2000,9:961-972
[12]许军,李博,胡敏燕.自测健康评定量表修订版的信度研究.中国行为医学科学.2002,11(3):341-343
[13]Hays RD,Anderson R,Revicki D.Psychometric considerations in evaluating health-related quality of life measures.Qual Life Res.2003,2(2):441-449
[14]张文彤.世界优秀统计工具SPSS11统计分析教程(高级篇).北京:北京希望电子出版社.213-217
[15]Zhao H,Kanda K.Translation and validation of the standard Chinese version of the EORTC QLQ C30.Qual life Res.2000,9:129-137
[16]康德英,王家良,洪旗.健康相关生存质量及其评价方法.中华医学杂志.2001,81(13):820-830
[17]管小俊,李昌崇.支气管哮喘的生活质量量表的研究.国外医学呼吸系统分册,2004,24(6):65-67
[18]陆慰萱,张一杰,胡波等.应用哮喘生命质量问卷的临床体会.中华结核和呼吸杂志,2003,26(9):567-568
[19]张磊,邵晨,王博,等冲文版SF-36量表用于中国老年人生活质量调查信度与效度评价.中华老年医学杂志.2004,23(2):112-114
[1]中华医学会呼吸病学分会哮喘学组.支气管哮喘防治指南[J].中华结核和呼吸杂志,2003,26(3):132-138.
[2]袁如玉.呼吸功能测定.见:王曾礼,冯玉麟,主编.呼吸病诊疗手册.北京:人民卫生出版社,2000.101-102.
[3]Ford JG,Rennick D,Donaldson DD,et al.IL-13 and IFN-γ:interactions in lung inflammation[J].The Journal of Inmmunology,2001,167(3):1769-1777.
[4]Louis R,Lau LC,Bron AO,et al.The relationship between airways inflammation and asthma severity[J].Am J Respir Crit Care Med,2000,161(1):9-16.
[5]Tliba O,Panettieri RA Jr,Tliba S,et al.TNF-α differentially regulates the expression of pro-inflammatory genes in human airway smooth muscle cells by activation of IFN-γ-dependent CD38 pathway[J].Mol Pharmacol,2004,66(2):322-329.
[6]吴峰,林挺岩,李志鹰,等.支气管哮喘中诱导痰中TNF-α、IL-10及ECP浓度变化[J]。中国实用免疫变态反应和哮喘杂志,2003,7(1):9-15。
[7]Nie HX,Yang J,Hu SP,et al.Effects of theophylline on CD4+lymphocyte,interleukin-5,and interferon gamma in induced sputurm of asthmatic subjects[J].A tca Pharmacol Sin,2002,23(3):267-272.
[8]蒋轶文,孔灵菲,赵莹,等.支气管哮喘患者诱导痰嗜酸粒细胞阳离子蛋白及粒细胞-巨噬细胞集落刺激因子的变化[J]。中华结核和呼吸杂志,2005,287(7):490-492。
[9]Bartoli ML,Bacci E,Camevali S,et al.Clinical assessment of asthma severity partially corresponds to sputum eosinophilic airway inflammation.Respir Med,2004,98:184-193.
[10]Nelson HS,Chapman KR,Pyke SD,et al.Enhanced synergy between fluticasone propionate and salmeterol inhaled from a single inhaler versus separate inhalers[J].Allergy Clin Immunol,2003,112:29-36.
[11]钟南山,郑劲平,刘晓青,等.吸入沙美特罗替卡松干粉剂与联合吸入两种干粉剂治疗成人哮喘的疗效和安全性的对照研究[J]。中华结核和呼吸杂志,2002,25:371-374。
[12]Wong CK,Ip WK,Lam CW.Biochemical assessment of intracellular signal transduction pathways in eosinophils:implications for pharmacotherapy[J].Crit Rev Clin Lab Sci,2004,41(1):79-113.
[13]De la Fuente PT,Romagnoli M,Godard P,et al.Safety of inducing sputum in patients with asthma of varying sererity.Am J Respir Crit Care Med,1998,157(4):1127-1130.
[14]刘羽华,董竟成.诱导痰技术及其在评价气道炎症中的作用。中华结核和呼吸杂志,2004,27(5):336-339.
[15]Kelly MM,Lau LC,Bron AO,et al.Induced sputum:validity of fluid phase IL-5measurement.Allergy Clin Immunol,2000,105(6):1162-1168.
[16]林江涛,李龙芸,陈萍,等。吸入布地奈德/福莫特罗干粉剂与联合吸入两种干粉剂治疗支气管哮喘的疗效和安全性研究。中华结核和呼吸杂志,2006,29(6):421-423。
[17]Siergiejko Z,Michno T,Tomorowicz A.Differential cell count of sputum in patients with asthma challenged with allergen provcation.Pneumonol Alergol Pol,2001,69(3-4):92-185.
[18]Kuperman DA,Huang X,Koth LL,et al.Direct effects of interleukin-13 on epithelial cells cause airway hyperreactivity and mucus overproduction in asthma.Nat Med.2002,8(8):9-885.
[19]Kumar PK,Herbert C,Yang M,et al.Role of interleukin-13 in eosinophil accumulation and airway remodelling in a mouse model of chronic asthma.Clin Exp Allergy.2002,32(7):1104-1111.
[20]WHO/NHLBI Workshop Report.Global initiative for asthma management and prevention:pocket guide for asthma management and prevention in children.Maryland:National Institute of Health,National Heart,Lung,and Blood Institute,2002,6-9.
[21]Kollias G,Kontoyiannis D.Role of TNF/TNFR in autoimmunity:specific TNF receptor blockade may be advantageous to anti-YNF treatments.Cytokine Growth Factor Reviews,2002,13:315.
[22]Kim SH,Han SY,Azam T,et al:Interleukin-32:acytokine and inducer of TNF alpha.Immunity,2.5,22:1313.
[23]Garcia G,Godot V,Humbert M.New chemokine targets for asthma therapy.Curr Allergy Asthma Rep,2005,5:155-160.
[24]Wen FQ,Liu X,Manda W,et al.TH2 Cytokine-enhanced and TGF-beta-enhanced vascular endothelial growth factor production by cultured human airway smooth muscle cells is attenuated by IFN-gamma and corticosteroids.J Allergy Clin Immunol,2003,111:1307-1318.
[25]Nelson HS.Prospects for antihistamines in the treatment of asthma.J Allergy Clin Immunol,2003,112:s96-100.
[1]NHLBI/WHO Workshop Report.Global Strategy for Asthma Management and Prevention.NIH Publication No.02-3659,Feb 2002.
[2]中华医学会呼吸病学分会哮喘学组.支气管哮喘防治指南[J].中华结核和呼吸杂志,2003,26(3):132-138.
[3]MC Mann O,Eliasson K,Patel,et al.An evaluation of severity-modulated compliance with q.i.d,dosing of inhaled beclomethasone.Chest,1992,102:1342-1346.
[4]钟南山.支气管哮喘---基础与临床,人民卫生出版社,2006,8.
[5]Bisgaard H.A randomized trial of montelukast in respiratory syncytial vires postbronchiolitis.Am J Respir Crit Care Med,2003,167:379.
[6]Pauwels RA,Busse WW,O'Byrne PM,et al.The inhaled Steroid Treatment as Regular Therapy in early asthma study:rational and design.Control Clin Trials,2001,2(4):405.
[7]Kevin B,Weiss Evalyn N,Grant Tao Li.The effects of asthma experience and social demographic characteristics on responses to the Chicago Community Asthma Survey-32.Chest,1999,116(4):187.
[8]李丽,李鹏,荆涛等.支气管哮喘病人疾病知识和生活方式的相关性研究,中华护理杂志,2004,39(2):90-93.
[9]何权瀛.切实搞好我国的哮喘教育和管理工作.中国呼吸与危重监护杂志,2003,2:1-2.
[10]梁宗按,刘春涛,腾鸿等.健康教育对支气管哮喘患者生活质量的影响.中国呼吸与危重监护杂志,2003,2:18-20.
[11]欧阳修河,于立萍,郑文涛.医学教育对哮喘患者治疗依从性的影响.中国呼吸与危重监护杂志,2004,3(1):37-39.
[12]徐东,徐健,阮晓云等.哮喘自我处理方法的教育对患者哮喘发病及生存质量影响的研究.中国康复医学杂志,2005,20(3):211-212
[13]张帆,林耀广.哮喘的教育和管理.现代诊断与治疗,2005,16(4):228-230.
[14]Van Schayck CP,Van Der Heijden FM,Van Den Boom Get al.Underdiagnosis of asthma:is the doctor or the patient to blame? The DMCA project.Thorax,2000,55:562-565.
[15]母双,何权瀛,余兵等.三位一体支气管哮喘教育管理模式对病情控制水平和生命质量的影响.中华结核和呼吸杂志,2006,29(11):731-734.
[16]何权瀛.改变现有医疗服务模式以全面控制支气管哮喘.中华内科杂志,2005,44:322-323.
[17]何权瀛.我国十余年支气管哮喘教育和管理工作的回顾与展望.中华结核和呼吸杂志,2003,26:141-142.
[18]Bateman ED,Boushey HA,Bousquet J,et al.Can guideline defined asthma control be achieved? The Gaining Optimal Asthma Control Study.Am J Respir Crit Care Med, 2004,170:836-844.
[19]Rabe KF,Adachi M,Lai CK,et al.Worldwide severity and control of asthma in children and adults:the global asthma insights and reality surveys.J Allergy Clin Immunol,2004,114:40-47.
[20]Lai CK,De Guia TS,Kim YY,et al.Asthma control in the Asia-Pacific region:the Asthma Insights and Reality in Asia-Pacific Study.J Allergy Clin Immunoi,2003,111:263-268.
[21]Juniper EF,Svensson K,Mork AC,et al.Measurement properties and interpretation of three shortened versions of the asthma control questionnaire.Respir Med,2005,99:553-558.
[22]母双,何权瀛.支气管哮喘患者系统教育和管理效果评估.中国呼吸与危重监护杂志,2005,4(3):86-91.
[23]Duma Z,Ozcan S.Evaluation of self-management education for asthmatic patients.J Asthma,2003,40(6):631-643.
[24]Williams SG,Schmidt DK,Redd SC,et al.Key clinical activities for quality asthma care.Recommendations of the National Asthma Education and Prevention Program.MMWR Recomm Rep,2003,52:1-8.
[1]李明华,殷凯生主编.哮喘病学.北京:人民卫生出版社,2000
[2]蔡映云,李凡,刘震威.哮喘患者的生命质量及其评估.中华全科医师杂志,2003,2:9-11
[3]The World Health Organization Qquality of Life Assessment(WHOQOL):Development And General Psychometric Properties。 Soc Sci Medo 1998,46:1569-1585
[4]王红玉,刘远明.生物心理社会医学模式与全球哮喘防治策略.医学与社会,2002,15:23-24
[5]Mintz M,Garcia J,Diener P,Liao Y,et al.Triamcinolone acetonide aqueous nasal spray improves nocturnal rhinitis-related quality of life in patients treated in a primary care setting:the Quality of Sleep in Allergic Rhinitis study.Ann Allergy Asthma Immunol.2004,92:255-261.
[6]Belloch A,Perpina M,Martinez Moragon E。 Gender differences in health-related quality of life among patients with asthma[J].Asthma.2003,40:945-953.
[7]朱元珏.评估生命质量逐渐成为临床试验的新标准.中华内科杂志,2003,42:753
[8]梁宗安,刘春涛,滕鸿等.健康教育对支气管哮喘患者生活质量的影响.中国呼吸与危重监护杂志,2003,2:18-20
[9]Orr LC,Fowler S J,Lipworth BJ.Relationship between changes in quality of life and measures of lung function and bronchial hyper-responsiveness during high-dose inhaled corticosteroid treatment in uncontrolled asthma.Am J Respir Med.2003,5:433-438.
[10]Yang ML,Chiang CH,Yao G,Wang KY.Effect of medical education on quality of life in adult asthma patients.J Formos MedAssoc.2003,102:768-774
[11]Juniper EF,Jenkins C,Price MJ,James MH.Impact of inhaled salmeterol/fluticasone propionate combination product versus budesonide on the health-related quality of life of patients with asthma.Am J Respir Med.2002,6:435-440.
[12]Gorelick MH,Brousseau DC,Stevens MW.Validity and responsiveness of a brief,asthma-specific quality-of-life instrument in children with acute asthma.Ann-AllergyAsthma-Immunol.2004,2:47-51.
[13]Meszaros A,Orosz M,Magyar P,et al.Evaluation of asthma knowledge and quality of life in Hungarian asthmatics.Allergy.2003,58:624-628.
[14]徐凯峰,雒晓春,陈燕等。Juniper哮喘生命质量问卷在中国哮喘患者中的初步应用.中华内科杂志,2003,42:760-763
[15]Juniper EF,Buist AS,Cox FM,et al.Validation of a standardized version of the Asthma Quality of Life Questionnaire.Chest,1999,115:1265-1270.
[16]李凡,蔡映云.支气管哮喘生存质量评估表的制定、评估和临床应用.现代康 复,2001,5 :18219.
[17] Juniper EF, Buist AS. Health2related quality of life in moderate asthma: 400-microg hydrofluoroalkane beclome thasone dipropionate vs 800 microg chlorofluorocarbon beclomethasone dipropionate. The Study Group.Chest, 1999,116:129721303.
[2]The World Health Organization Qquality of Life Assessment(WHOQOL):Development And General Psychometric Properties.S oc Sci Med.1998,46:1569-1585
[3]王红玉,刘远明.生物心理社会医学模式与全球哮喘防治策略.医学与社会,2002,15:23-24
[4]Mintz,-M;Garcia,-J;Diener,-P;Liao,-Y;Dupclay,-L;Georges,-Go Triamcinolone acetonide aqueous nasal spray improves nocturnal rhinitis-related quality of life in patients treated in a primary care.setting:the Quality of Sleep in Allergic Rhinitis study.Ann-Allergy-Asthma-Immunol.2004,92:255-261
[5]Belloch,-A;Perpina,-M;Martinez-Moragon,-E。 Gender differences in health-related quality of life among patients with asthma.J-Asthmao 2003,40:945-953
[6]朱元珏.评估生命质量逐渐成为临床试验的新标准.中华内科杂志,2003,42:753
[7]梁宗安,刘春涛,滕鸿等.健康教育对支气管哮喘患者生活质量的影响.中国呼吸与危重监护杂志,2003,2:18-20
[8]Orr,-L-C;Fowler,-S-J;Lipworth,-B-J.Relationship between changes in quality of life and measures of lung function and bronchial hyper-responsiveness during high-dose inhaled corticosteroid treatment in uncontrolled asthma.Am-J-Respir-Med.2003,5:433-438
[9]Yang,-M-L;Chiang,-C-H;Yao,-G;Wang,-K-Y.Effect of medical education on quality of life in adult asthma patients.J-Formos-Med-Assoc.2003,102:768-774
[10]李明华,殷凯生主编.哮喘病学.北京:人民卫生出版社,2000
[11]Juniper,-E-F;Jenkins,-C;Price,-M-J;James,-M-H.Impact of inhaled salmeterol/fluticasone propionate combination product versus budesonide on the health-related quality of life of patients with asthma.Am-J-Respir-Med.2002,6:435-440
[12]Gorelick -M-H,Brousseau -D-C,Stevens -M-W.Validity and responsiveness of a brief,asthma-specific quality-of-life instrument in children with acute asthma.Ann-AllergyAsthma-Immunol.2004,92:47-51
[13]Meszaros,-A;Orosz,-M;Magyar,-P;Mesko,-A;Vincze,-Z.Evaluation of asthma knowledge and quality of life in Hungarian asthmatics.Allergy.2003,58:624-628
[14]徐凯峰,雒晓春,陈燕等.Juniper哮喘生命质量问卷在中国哮喘患者中的初步应用.中华内科杂志,2003,42:760-763
[15]Juniper EF,Buist AS,Cox FM,et al.Validation of a standardized version of the Asthma Quality of Life Questionnaire.Chest,1999,115:1265-1270.
[16]李凡.蔡映云.支气管哮喘生存质量评估表的制定、评估和临床应用.现代康 复,2001,5:18219.
[17]Juniper EF,Buist AS.Health2related quality of life in moderate asthma:400 microg hydrofluoroalkane beclomethasone dipropionate vs 800 microg chlorofluorocarbon beclomethasone dipropionate.The Study Group.Chest,1999,116:129721303.
[18]Van Schayck CP,Van Der Heijden FM,Van Den Boom Get al.Underdiagnosis of asthma:is the doctor or the patient to blame? The DMCA project.Thorax,2000,55:562-565.
[19]母双,何权瀛,余兵等.三位一体支气管哮喘教育管理模式对病情控制水平和生命质量的影响.中华结核和呼吸杂志,2006,29(11):731-734.
[20]何权瀛.改变现有医疗服务模式以全面控制支气管哮喘.中华内科杂志,2005,44:322-323.
[21]何权瀛.我国十余年支气管哮喘教育和管理工作的回顾与展望.中华结核和呼吸杂志,2003,26:141-142.
[22]Bateman ED,Boushey HA,Bousquet J,et al.Can guideline defined asthma control be achieved? The Gaining Optimal Asthma Control Study.Am J Respir Crit Care Med,2004,170:836-844.
[23]Rabe KF,Adachi M,Lai CK,et al.Worldwide severity and control of asthma in children and adults:the global asthma insights and reality surveys.J Allergy Clin Immunol,2004,114:40-47.
[24]Lai CK,De Guia TS,Kim YY,et al.Asthma control in the Asia-Pacific region:the Asthma Insights and Reality in Asia-Pacific Study.J Allergy Clin Immunol,2003,111:263-268.
[1]徐凯峰,雒晓春,陈燕等.Juniper哮喘生命质量问卷在中国哮喘患者中的初步应用.中华内科杂志,2003,42(11):760-763
[2]Bjermer L,Bisgaard H,Bousquet J,Fabbri LM,Greening AP,Haahtela T,Holgate ST,Picado C,Menten J,Dass SB,Leff JA,Polos PG.Montelukastand fluticasone compared with salmeterol and fluticasone in protecting against asthma exacerbation in adults:one year,double blind,randomised,comparative trial.2003,327(7420):891.
[3]Finn A,Gross G,van Bavel J,Lee T,Windom H,Everhard F,Fowler-Taylor A,Liu J,Gupta N.Omalizumab improves asthma-related quality of life in patients with severe allergic asthma.J Allergy Clin Immunol.2003 111(2):278-84.
[4]Leigh R,Vethanayagam D,Yoshida M,Watson RM,Rerecich T,Inman MD,O'Byrne PM.Effects of montelukast and budesonide on airway responses and airway inflammation in asthma.Am J Respir Crit Care Med 2002,166(9):1212-7.
[5]Chalmers GW,Macleod KJ,Little SA,Thomson lJ,McSharry CP,Thomson NC.Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma.Thorax 2002,57(3):226-30
[6]李凡,蔡映云.支气管哮喘生命质量评估表的制定、评估和临床应用.现代康复,2001,5:18-19
[7]Nightingale JA,Rogers DF,Barnes PJ.Comparison of the effects of salmeterol and formoterol in patients with severe asthma.Chest 2002 121(5):1401-1406
[8]张继海,杨土保.生命质量研究的辩证思考.医学与哲学,2003,24(3):18-20
[9]Gibson PG,Coughlan J,Wilson AJ,Abramson M,Bauman A,Hensley MJ,et al.Self-management education and regular practitioner review for adults with asthma.Cochrane Database Syst Rev,2000,2:1117
[10]Cowie RL,Revitt SG,Underwood MF,Field SK.The effect of a peak flow-based action plan in the prevention of exacerbations of asthma.Chest 1999,112:1534-1537
[11]Gallefoss F,Bakke PS.Impact of patient education and selfman
[12]agement on morbidity in asthmatics and patients with chronic obstructive pulmonary disease[J].Respir Med,2000,94:287-297
[13]Duma Z,Ozcan s.Evaluation of self-management education for asthmatic patients[J].J Asthma,2003,40(6):631-643
[1]National Institutes of Health.Global Initiative for Asthma.Global strategy for asthma management and prevention(revised 2002).WHO/NHLBl workshop report.Clark M.D.Pub.NO 02-3659,2002:102-109.
[2]陆尉萱,张一杰,胡波等.应用哮喘生命质量问卷的临床体会.中华结核和呼吸杂志,2003,9:567-568.
[3]李莉,李鹏,荆涛等.支气管哮喘病人疾病知识和生活方式的相关性研究.中华护理杂志,2004,39:90-93.
[4]Kim SH,Han SY,Azam T,et al:Interleukin-32:a cytokine and inducers of TNF alpha.Immunity,2005,22:1313
[5]徐永健,谢俊刚.重视对支气管哮喘患者的生活质量评估.中华内科杂志,2005,44:324-325.
[6]何晓俐,刘建萍,沈嘉瑶.门诊支气管哮喘患者用药依从性的调查分析.齐齐哈尔医学院学报,2001,22(5):561-562.
[7]Muntner P,Sudre P,Perneger TV.Comparison of the psychometric properties of the Asthma Quality of Life Questionnaire(AQLQ)among 115 asthmatic adults assessed during acute hospitalization and as outpatients.Qual Life Res,2000,9:987-995.
[8]Fonseca JA,Delgado L,Costa-Pereira A,et al.Evaluation of the Asthma Life Quality test for the screening and severity assessment of asthma.Allergy,2004,126:1849-1854.
[9]Strine TW,Ford ES,Balluz L,et al,Risk behaviors and health-related quality of life among adults with asthma:the role of mental health status,Chest,2004,126:1849-1854.
[10]赵秀荣,高桂敏.健康教育对支气管哮喘病人生活质量的影响.护理研究,2005,19:1809-1810.
[11]Calverley P,Pauwels R,Vestbo J,et al.Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease:a randomised controlled trial.Lancet,2003,361:4492456.
[12]朱元珏.评估生命质量逐渐成为临床试验的新标准.中华内科杂志,2003,42(11):753
[13]支气管哮喘防治指南(支气管哮喘的定义、诊断、治疗及教育和管理方案).中华医学会呼吸病学分会哮喘学组.中华结核和呼吸杂志,2003,26(3):132-138
[14]李凡,蔡映云.中国在支气管哮喘和慢性阻塞性肺疾病患者生命质量研究中问题的分析.中华全科医师杂志,2004,3(3):133-134
[15]CKW,De Guia TS,Kim YY,et al.Asthma control in the asia-pacification:the asthma in sights and reality in asia-pacific study.J Allergy Clin Immunol.2003,111:263-68.
[16]钟南山主编.支气管哮喘-基础与临床.北京:人民卫生出版社.2006:911-932
[1]徐凯峰,雒晓春,陈燕等.Juniper哮喘生命质量问卷在中国哮喘患者中的初步应用.中华内科杂志,2003,42(11):760-763.
[2]Paul-Dauphin A,Guillemin F,Virion JM,Briancon S.Bias and precision in Visual Analogue Scales:a randomised controlled trial.Am J Epidemiol.1999,150:1117-27
[3]Sanjuas C,Alonso J,Prieto L,et al.Healt h2related quality of life in asthma:a comparison between the St George′ s Respiratory Questionnaire and t he Ast hma Quality of Life Questionnaire.Qual Life Res,2002,11:7292738.
[4]Apajasalo M,Rautonen J,Holmberg C,SinkkonenJ,Aalberg V,Pihko H,et all.Quality of life in pre-adolescence:a 17-dimensional health-related measure(17D).Qual Life Res.1996,5:532-8
[5]李凡,蔡映云,李海玲等.疾病特异性量表与SF36量表对支气管哮喘患者生命质量评估的比较.中华全科医师杂志,2005,4(40):213-216
[6]Buck D,Jacoby A,Massey A,et al.Evaluation of measures used to assess quality of life after stroke.Stroke.2000,21:2004-2010
[7]Espinosa De Los,Monteros MJ,Alonso J,et al.Quality of life inast hma:reliability and validity of t he short form generic questionnaire(SF236)applied to the population of asthmatics in a public health area.Arch Bronconeumol,2002,38:429.
[8]Nanda U,McLendon PM,Andresen EM,et al.The SIP68:an abbreviated sickness impact profile for disability outcomes research.Qual Life Res,2003,12:5832595.
[9]Raat H,Botterweck AM,Landgraf JM,et al.Reliability and validity of the short form of the child health questionnaire for parents(CHQ-PF28)in large random school based and general population samples.J Epidemiol Community Health.2005,59:75-82.
[10]Connolly MA,Johnson JA.Measuring quality of life in pediatric patients.Pharmacoeconomics.1999,16:605-25.
[11]Fekkes M,Theunissen NCM,Brugman E.et al.Development and psychometric evaluation of the TAPQOL:A health-related quality of life instrument for 1-5-year-old children.Qual Life Res.2000,9:961-972
[12]许军,李博,胡敏燕.自测健康评定量表修订版的信度研究.中国行为医学科学.2002,11(3):341-343
[13]Hays RD,Anderson R,Revicki D.Psychometric considerations in evaluating health-related quality of life measures.Qual Life Res.2003,2(2):441-449
[14]张文彤.世界优秀统计工具SPSS11统计分析教程(高级篇).北京:北京希望电子出版社.213-217
[15]Zhao H,Kanda K.Translation and validation of the standard Chinese version of the EORTC QLQ C30.Qual life Res.2000,9:129-137
[16]康德英,王家良,洪旗.健康相关生存质量及其评价方法.中华医学杂志.2001,81(13):820-830
[17]管小俊,李昌崇.支气管哮喘的生活质量量表的研究.国外医学呼吸系统分册,2004,24(6):65-67
[18]陆慰萱,张一杰,胡波等.应用哮喘生命质量问卷的临床体会.中华结核和呼吸杂志,2003,26(9):567-568
[19]张磊,邵晨,王博,等冲文版SF-36量表用于中国老年人生活质量调查信度与效度评价.中华老年医学杂志.2004,23(2):112-114
[1]中华医学会呼吸病学分会哮喘学组.支气管哮喘防治指南[J].中华结核和呼吸杂志,2003,26(3):132-138.
[2]袁如玉.呼吸功能测定.见:王曾礼,冯玉麟,主编.呼吸病诊疗手册.北京:人民卫生出版社,2000.101-102.
[3]Ford JG,Rennick D,Donaldson DD,et al.IL-13 and IFN-γ:interactions in lung inflammation[J].The Journal of Inmmunology,2001,167(3):1769-1777.
[4]Louis R,Lau LC,Bron AO,et al.The relationship between airways inflammation and asthma severity[J].Am J Respir Crit Care Med,2000,161(1):9-16.
[5]Tliba O,Panettieri RA Jr,Tliba S,et al.TNF-α differentially regulates the expression of pro-inflammatory genes in human airway smooth muscle cells by activation of IFN-γ-dependent CD38 pathway[J].Mol Pharmacol,2004,66(2):322-329.
[6]吴峰,林挺岩,李志鹰,等.支气管哮喘中诱导痰中TNF-α、IL-10及ECP浓度变化[J]。中国实用免疫变态反应和哮喘杂志,2003,7(1):9-15。
[7]Nie HX,Yang J,Hu SP,et al.Effects of theophylline on CD4+lymphocyte,interleukin-5,and interferon gamma in induced sputurm of asthmatic subjects[J].A tca Pharmacol Sin,2002,23(3):267-272.
[8]蒋轶文,孔灵菲,赵莹,等.支气管哮喘患者诱导痰嗜酸粒细胞阳离子蛋白及粒细胞-巨噬细胞集落刺激因子的变化[J]。中华结核和呼吸杂志,2005,287(7):490-492。
[9]Bartoli ML,Bacci E,Camevali S,et al.Clinical assessment of asthma severity partially corresponds to sputum eosinophilic airway inflammation.Respir Med,2004,98:184-193.
[10]Nelson HS,Chapman KR,Pyke SD,et al.Enhanced synergy between fluticasone propionate and salmeterol inhaled from a single inhaler versus separate inhalers[J].Allergy Clin Immunol,2003,112:29-36.
[11]钟南山,郑劲平,刘晓青,等.吸入沙美特罗替卡松干粉剂与联合吸入两种干粉剂治疗成人哮喘的疗效和安全性的对照研究[J]。中华结核和呼吸杂志,2002,25:371-374。
[12]Wong CK,Ip WK,Lam CW.Biochemical assessment of intracellular signal transduction pathways in eosinophils:implications for pharmacotherapy[J].Crit Rev Clin Lab Sci,2004,41(1):79-113.
[13]De la Fuente PT,Romagnoli M,Godard P,et al.Safety of inducing sputum in patients with asthma of varying sererity.Am J Respir Crit Care Med,1998,157(4):1127-1130.
[14]刘羽华,董竟成.诱导痰技术及其在评价气道炎症中的作用。中华结核和呼吸杂志,2004,27(5):336-339.
[15]Kelly MM,Lau LC,Bron AO,et al.Induced sputum:validity of fluid phase IL-5measurement.Allergy Clin Immunol,2000,105(6):1162-1168.
[16]林江涛,李龙芸,陈萍,等。吸入布地奈德/福莫特罗干粉剂与联合吸入两种干粉剂治疗支气管哮喘的疗效和安全性研究。中华结核和呼吸杂志,2006,29(6):421-423。
[17]Siergiejko Z,Michno T,Tomorowicz A.Differential cell count of sputum in patients with asthma challenged with allergen provcation.Pneumonol Alergol Pol,2001,69(3-4):92-185.
[18]Kuperman DA,Huang X,Koth LL,et al.Direct effects of interleukin-13 on epithelial cells cause airway hyperreactivity and mucus overproduction in asthma.Nat Med.2002,8(8):9-885.
[19]Kumar PK,Herbert C,Yang M,et al.Role of interleukin-13 in eosinophil accumulation and airway remodelling in a mouse model of chronic asthma.Clin Exp Allergy.2002,32(7):1104-1111.
[20]WHO/NHLBI Workshop Report.Global initiative for asthma management and prevention:pocket guide for asthma management and prevention in children.Maryland:National Institute of Health,National Heart,Lung,and Blood Institute,2002,6-9.
[21]Kollias G,Kontoyiannis D.Role of TNF/TNFR in autoimmunity:specific TNF receptor blockade may be advantageous to anti-YNF treatments.Cytokine Growth Factor Reviews,2002,13:315.
[22]Kim SH,Han SY,Azam T,et al:Interleukin-32:acytokine and inducer of TNF alpha.Immunity,2.5,22:1313.
[23]Garcia G,Godot V,Humbert M.New chemokine targets for asthma therapy.Curr Allergy Asthma Rep,2005,5:155-160.
[24]Wen FQ,Liu X,Manda W,et al.TH2 Cytokine-enhanced and TGF-beta-enhanced vascular endothelial growth factor production by cultured human airway smooth muscle cells is attenuated by IFN-gamma and corticosteroids.J Allergy Clin Immunol,2003,111:1307-1318.
[25]Nelson HS.Prospects for antihistamines in the treatment of asthma.J Allergy Clin Immunol,2003,112:s96-100.
[1]NHLBI/WHO Workshop Report.Global Strategy for Asthma Management and Prevention.NIH Publication No.02-3659,Feb 2002.
[2]中华医学会呼吸病学分会哮喘学组.支气管哮喘防治指南[J].中华结核和呼吸杂志,2003,26(3):132-138.
[3]MC Mann O,Eliasson K,Patel,et al.An evaluation of severity-modulated compliance with q.i.d,dosing of inhaled beclomethasone.Chest,1992,102:1342-1346.
[4]钟南山.支气管哮喘---基础与临床,人民卫生出版社,2006,8.
[5]Bisgaard H.A randomized trial of montelukast in respiratory syncytial vires postbronchiolitis.Am J Respir Crit Care Med,2003,167:379.
[6]Pauwels RA,Busse WW,O'Byrne PM,et al.The inhaled Steroid Treatment as Regular Therapy in early asthma study:rational and design.Control Clin Trials,2001,2(4):405.
[7]Kevin B,Weiss Evalyn N,Grant Tao Li.The effects of asthma experience and social demographic characteristics on responses to the Chicago Community Asthma Survey-32.Chest,1999,116(4):187.
[8]李丽,李鹏,荆涛等.支气管哮喘病人疾病知识和生活方式的相关性研究,中华护理杂志,2004,39(2):90-93.
[9]何权瀛.切实搞好我国的哮喘教育和管理工作.中国呼吸与危重监护杂志,2003,2:1-2.
[10]梁宗按,刘春涛,腾鸿等.健康教育对支气管哮喘患者生活质量的影响.中国呼吸与危重监护杂志,2003,2:18-20.
[11]欧阳修河,于立萍,郑文涛.医学教育对哮喘患者治疗依从性的影响.中国呼吸与危重监护杂志,2004,3(1):37-39.
[12]徐东,徐健,阮晓云等.哮喘自我处理方法的教育对患者哮喘发病及生存质量影响的研究.中国康复医学杂志,2005,20(3):211-212
[13]张帆,林耀广.哮喘的教育和管理.现代诊断与治疗,2005,16(4):228-230.
[14]Van Schayck CP,Van Der Heijden FM,Van Den Boom Get al.Underdiagnosis of asthma:is the doctor or the patient to blame? The DMCA project.Thorax,2000,55:562-565.
[15]母双,何权瀛,余兵等.三位一体支气管哮喘教育管理模式对病情控制水平和生命质量的影响.中华结核和呼吸杂志,2006,29(11):731-734.
[16]何权瀛.改变现有医疗服务模式以全面控制支气管哮喘.中华内科杂志,2005,44:322-323.
[17]何权瀛.我国十余年支气管哮喘教育和管理工作的回顾与展望.中华结核和呼吸杂志,2003,26:141-142.
[18]Bateman ED,Boushey HA,Bousquet J,et al.Can guideline defined asthma control be achieved? The Gaining Optimal Asthma Control Study.Am J Respir Crit Care Med, 2004,170:836-844.
[19]Rabe KF,Adachi M,Lai CK,et al.Worldwide severity and control of asthma in children and adults:the global asthma insights and reality surveys.J Allergy Clin Immunol,2004,114:40-47.
[20]Lai CK,De Guia TS,Kim YY,et al.Asthma control in the Asia-Pacific region:the Asthma Insights and Reality in Asia-Pacific Study.J Allergy Clin Immunoi,2003,111:263-268.
[21]Juniper EF,Svensson K,Mork AC,et al.Measurement properties and interpretation of three shortened versions of the asthma control questionnaire.Respir Med,2005,99:553-558.
[22]母双,何权瀛.支气管哮喘患者系统教育和管理效果评估.中国呼吸与危重监护杂志,2005,4(3):86-91.
[23]Duma Z,Ozcan S.Evaluation of self-management education for asthmatic patients.J Asthma,2003,40(6):631-643.
[24]Williams SG,Schmidt DK,Redd SC,et al.Key clinical activities for quality asthma care.Recommendations of the National Asthma Education and Prevention Program.MMWR Recomm Rep,2003,52:1-8.
[1]李明华,殷凯生主编.哮喘病学.北京:人民卫生出版社,2000
[2]蔡映云,李凡,刘震威.哮喘患者的生命质量及其评估.中华全科医师杂志,2003,2:9-11
[3]The World Health Organization Qquality of Life Assessment(WHOQOL):Development And General Psychometric Properties。 Soc Sci Medo 1998,46:1569-1585
[4]王红玉,刘远明.生物心理社会医学模式与全球哮喘防治策略.医学与社会,2002,15:23-24
[5]Mintz M,Garcia J,Diener P,Liao Y,et al.Triamcinolone acetonide aqueous nasal spray improves nocturnal rhinitis-related quality of life in patients treated in a primary care setting:the Quality of Sleep in Allergic Rhinitis study.Ann Allergy Asthma Immunol.2004,92:255-261.
[6]Belloch A,Perpina M,Martinez Moragon E。 Gender differences in health-related quality of life among patients with asthma[J].Asthma.2003,40:945-953.
[7]朱元珏.评估生命质量逐渐成为临床试验的新标准.中华内科杂志,2003,42:753
[8]梁宗安,刘春涛,滕鸿等.健康教育对支气管哮喘患者生活质量的影响.中国呼吸与危重监护杂志,2003,2:18-20
[9]Orr LC,Fowler S J,Lipworth BJ.Relationship between changes in quality of life and measures of lung function and bronchial hyper-responsiveness during high-dose inhaled corticosteroid treatment in uncontrolled asthma.Am J Respir Med.2003,5:433-438.
[10]Yang ML,Chiang CH,Yao G,Wang KY.Effect of medical education on quality of life in adult asthma patients.J Formos MedAssoc.2003,102:768-774
[11]Juniper EF,Jenkins C,Price MJ,James MH.Impact of inhaled salmeterol/fluticasone propionate combination product versus budesonide on the health-related quality of life of patients with asthma.Am J Respir Med.2002,6:435-440.
[12]Gorelick MH,Brousseau DC,Stevens MW.Validity and responsiveness of a brief,asthma-specific quality-of-life instrument in children with acute asthma.Ann-AllergyAsthma-Immunol.2004,2:47-51.
[13]Meszaros A,Orosz M,Magyar P,et al.Evaluation of asthma knowledge and quality of life in Hungarian asthmatics.Allergy.2003,58:624-628.
[14]徐凯峰,雒晓春,陈燕等。Juniper哮喘生命质量问卷在中国哮喘患者中的初步应用.中华内科杂志,2003,42:760-763
[15]Juniper EF,Buist AS,Cox FM,et al.Validation of a standardized version of the Asthma Quality of Life Questionnaire.Chest,1999,115:1265-1270.
[16]李凡,蔡映云.支气管哮喘生存质量评估表的制定、评估和临床应用.现代康 复,2001,5 :18219.
[17] Juniper EF, Buist AS. Health2related quality of life in moderate asthma: 400-microg hydrofluoroalkane beclome thasone dipropionate vs 800 microg chlorofluorocarbon beclomethasone dipropionate. The Study Group.Chest, 1999,116:129721303.