脑肿瘤患者生活质量及其影响因素的研究
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摘要
目的:了解脑肿瘤病的基本流行现状,包括患病率、发病率和死亡率;了解脑肿瘤患者的生活质量水平,找出影响他们生活质量水平的主要因素。
方法:选取马鞍山市市区(包括花山区、雨山区和金家庄区)作为研究现场。采用SF-36量表、自编的基本情况及影响因素问卷对2006年1月1日至2006年12月31日之间发病或患病的66例原发性脑肿瘤患者和66例健康对照者进行调查。
结果:一,2006年马鞍山市脑肿瘤病的患病率约为18.2/10万人,发病率约为5.0/10万人,死亡率约为3.4/10万人。二,脑肿瘤患者的生活质量水平:(1)脑肿瘤患者的各维度得分及总分值明显低于健康对照者,差异有高度统计学意义,各维度水平从低到高依次为GH、RP、RE、VT、PF、BP、MH、SF。(2)女性患者VT和SF两个维度因子得分低于男性;(3)<50岁组在PF、BP及SF三个维度的得分高于≥50岁组;(4)婚姻状况的评分在各个维度上均无显著性差异;(5)文化程度不同的五组患者在PF和VT两个因子上得分有差异,运用LSD-t法进行组间比较,结果显示,PF得分:文盲组低于小学组、高中组和大专及以上组;RP评分:小学组低于高中组;BP评分:文盲组低于高中组和大专及以上组;GH评分:文盲组和小学组均低于高中组;VT评分:文盲组低于高中组和大专及以上组、小学组低于高中组、初中组低于高中和大专及以上组;SF评分:文盲组低于高中组;RE评分:文盲组低于高中组、初中组低于高中及大专及以上组;MH维度各组间无差异;(6)个人月收入在VT维度上显示差异性。运用LSD-t法进行组间比较,结果显示:PF评分:≤200元组低于1001-2000元组;BP评分:201-500元组的显著低于1001-2000元组及2000元以上组;VT评分:≤200元组低于2000元以上组,201-500元组低于1001-2000元组及2000元以上组,501-1000元组低于2000元以上组。(7)医保患者PF和RP评分高于自费患者;(8)疼痛严重者在生活质量八个维度的评分均显著低于身体疼痛轻微者;(9)“内心常压抑不愿表达”和“强行压抑内心痛苦不诉说”在除PF以外的七个维度上都呈现出显著差异;(10)经常过度紧张和焦虑患者的RE和MH得分低于无该情绪反应者。情绪沮丧郁闷的患者在RP、BP、GH、VT、SF、MH六个维度的因子得分显著低于没有该种情绪组;(11)单因素方差分析显示:文化程度、疼痛、性格内向患者【内心常压抑不愿表达、强行压抑内心痛苦不诉说】、情绪沮丧郁闷以及家庭支持的多少影响脑肿瘤患者生活质量的总分;(12)多元线性逐步回归分析发现,文化水平、疼痛程度、内心常压抑不愿表达、强行压抑内心痛苦不诉说和情绪沮丧郁闷是影响脑肿瘤患者生活质量的重要因素。
结论:一,脑肿瘤病的患病率、发病率高于国内外统计结果,有显著增高趋势,死亡率基本一致。二,本次研究结果表明,脑肿瘤患者的生活质量普遍比健康对照组差。婚姻状况(有无伴侣)对脑肿瘤患者生活质量没有影响。性别、年龄大小、有无医疗保障仅对生活质量的1-3个维度有影响。家庭支持的多少对患者生活质量的6个维度有显著影响,很可能是患者生活质量的一个影响因素。文化水平、疼痛程度、内心常压抑不愿表达、强行压抑内心痛苦不诉说和情绪沮丧郁闷是脑肿瘤患者生活质量的决定性影响因素。
Objectives:The purpose of this study were: (1)to describe the primarily epidemiology status of the intracranial tumors(brain tumors),including the prevalence rate,incidence rate and mortality rate in patients with intracranial tumors;(2) to quantificationally evaluate QOL of brain tumors patients and to discuss its impact factors.
Methods : The study was conducted in Ma’anshan city,including Huashan district,Yushan district and Jinjiazhuang district. Questionnaire cited on SF-36 instrument and on determinants of QOL were used to make surveys on 66 primary intracranial tumors patients who were alive between Jan 1st,2006 and Dec 31,2006 and 66 health subjects.
Results: 1.The prevalence rate,incidence rate and mortality rate in patients with intracranial tumors was respectively about 18.2/100000, 5.0/100000and 3.4/100000 in Ma’anshan city from Jan 1st,2006 and Dec 31,2006. 2.The QOL of the brain tumors patients:(1) Every domain and total SF-36 subscales of brain tumors patients were significantly lower than those in the health subjects group. The ascending order of dimensional subscales was GH、RP、RE、VT、PF、BP、MH and SF. (2)The scores of VT and SF domain were lower in female patients than in male patients.(3)The scores of PF,BP and SF domain were significantly higher in patients at the age of below 50 than those above 50.(4)There was no significant difference in any dimensional subscales in patients at aspect of marriage.(5)There were significant difference in PF and VT dimensional subscales in educational level in patients. LSD-t analysis indicated that the score of PF domain was lower in illiterate group than in primary school group, high school group and above college or university group; the score of RP domain was lower in primary school group than in high school group, the score of BP domain was lower in illiterate group than in high school group and above college or university group; the score of GH domain was lower in illiterate group and primary school group than in high school group; the score of VT domain was lower in illiterate group than in high school group and above college or university group, and lower in primary school group than in high school group, and lower in junior school group than in high school group and above college or university group; the score of SF domain was lower in illiterate group than in high school group; the score of RE domain was lower in illiterate group than in high school group, and lower in junior school group than in high school group and above college or university group; there was no significant difference in MH dimensional scores.(6) There was significant difference in VT dimensional subscales at aspect of month income of patients. LSD-t analysis indicated that the score of PF domain was significantly lower in≤200yuan group than in 1001-2000yuan group; the score of BP domain was significantly lower in 201-500yuan group than in 1001-2000yuan group and above 2000yuan group; the score of VT domain was significantly lower in≤200yuan group than in above 2000yuan group,and lower in 201-500yuan group than in 1001-2000yuan group and above 2000yuan group, and lower in 501-1000yuan than in above 2000yuan group. (7) The scores of PF and RP domain was higher in‘half at public expense/ at public expense’group than in‘all at one's own expenses’group. (8) Every domain and total SF-36 subscales in different pain degree patients were significantly lower in‘severe group’than in‘light group’.(9) The scores of seven domain except for PF domain were significantly difference in two variables,including‘whether always depressive but don't want to express or not’and‘whether always oppress his agony but don't pour out or not’. (10) The scores of RE and MH domain were significantly lower in‘always be excess tense and worrying group’ than in the control group. The scores of six domain except for PF and RE domain were significantly lower in‘mood always be depressed and gloomy group’than in the control group.(11)Multivariate linear stepwise regression analysis indicated that 5 variables had important impact on QOL of brain tumors: educational level, pain dergree, always depressive but don't want to express , always oppress his agony but don't pour out, and mood always be depressed and gloomy.
Conclusions:1. The prevalence rate and incidence rate in this study were significantly higher than the statistical datas, and mortality rate was a little lower than that. 2.Total life quality of patients with brain tumors worsened generally. The QOL of brain tumors patients wasn’t affected by their marriage status. Gender,age and medical insurance status have impact on 1-3 domains of QOL. Much or little of family support is likely to be an impact factor of QOL in brain tumor patients. Educational level, pain dergree, character (always depressive but don't want to express , always oppress his agony but don't pour out), and mood always be depressed and gloomy tend to be the important factors that influence the QOL of brain tumor patients.
方法:选取马鞍山市市区(包括花山区、雨山区和金家庄区)作为研究现场。采用SF-36量表、自编的基本情况及影响因素问卷对2006年1月1日至2006年12月31日之间发病或患病的66例原发性脑肿瘤患者和66例健康对照者进行调查。
结果:一,2006年马鞍山市脑肿瘤病的患病率约为18.2/10万人,发病率约为5.0/10万人,死亡率约为3.4/10万人。二,脑肿瘤患者的生活质量水平:(1)脑肿瘤患者的各维度得分及总分值明显低于健康对照者,差异有高度统计学意义,各维度水平从低到高依次为GH、RP、RE、VT、PF、BP、MH、SF。(2)女性患者VT和SF两个维度因子得分低于男性;(3)<50岁组在PF、BP及SF三个维度的得分高于≥50岁组;(4)婚姻状况的评分在各个维度上均无显著性差异;(5)文化程度不同的五组患者在PF和VT两个因子上得分有差异,运用LSD-t法进行组间比较,结果显示,PF得分:文盲组低于小学组、高中组和大专及以上组;RP评分:小学组低于高中组;BP评分:文盲组低于高中组和大专及以上组;GH评分:文盲组和小学组均低于高中组;VT评分:文盲组低于高中组和大专及以上组、小学组低于高中组、初中组低于高中和大专及以上组;SF评分:文盲组低于高中组;RE评分:文盲组低于高中组、初中组低于高中及大专及以上组;MH维度各组间无差异;(6)个人月收入在VT维度上显示差异性。运用LSD-t法进行组间比较,结果显示:PF评分:≤200元组低于1001-2000元组;BP评分:201-500元组的显著低于1001-2000元组及2000元以上组;VT评分:≤200元组低于2000元以上组,201-500元组低于1001-2000元组及2000元以上组,501-1000元组低于2000元以上组。(7)医保患者PF和RP评分高于自费患者;(8)疼痛严重者在生活质量八个维度的评分均显著低于身体疼痛轻微者;(9)“内心常压抑不愿表达”和“强行压抑内心痛苦不诉说”在除PF以外的七个维度上都呈现出显著差异;(10)经常过度紧张和焦虑患者的RE和MH得分低于无该情绪反应者。情绪沮丧郁闷的患者在RP、BP、GH、VT、SF、MH六个维度的因子得分显著低于没有该种情绪组;(11)单因素方差分析显示:文化程度、疼痛、性格内向患者【内心常压抑不愿表达、强行压抑内心痛苦不诉说】、情绪沮丧郁闷以及家庭支持的多少影响脑肿瘤患者生活质量的总分;(12)多元线性逐步回归分析发现,文化水平、疼痛程度、内心常压抑不愿表达、强行压抑内心痛苦不诉说和情绪沮丧郁闷是影响脑肿瘤患者生活质量的重要因素。
结论:一,脑肿瘤病的患病率、发病率高于国内外统计结果,有显著增高趋势,死亡率基本一致。二,本次研究结果表明,脑肿瘤患者的生活质量普遍比健康对照组差。婚姻状况(有无伴侣)对脑肿瘤患者生活质量没有影响。性别、年龄大小、有无医疗保障仅对生活质量的1-3个维度有影响。家庭支持的多少对患者生活质量的6个维度有显著影响,很可能是患者生活质量的一个影响因素。文化水平、疼痛程度、内心常压抑不愿表达、强行压抑内心痛苦不诉说和情绪沮丧郁闷是脑肿瘤患者生活质量的决定性影响因素。
Objectives:The purpose of this study were: (1)to describe the primarily epidemiology status of the intracranial tumors(brain tumors),including the prevalence rate,incidence rate and mortality rate in patients with intracranial tumors;(2) to quantificationally evaluate QOL of brain tumors patients and to discuss its impact factors.
Methods : The study was conducted in Ma’anshan city,including Huashan district,Yushan district and Jinjiazhuang district. Questionnaire cited on SF-36 instrument and on determinants of QOL were used to make surveys on 66 primary intracranial tumors patients who were alive between Jan 1st,2006 and Dec 31,2006 and 66 health subjects.
Results: 1.The prevalence rate,incidence rate and mortality rate in patients with intracranial tumors was respectively about 18.2/100000, 5.0/100000and 3.4/100000 in Ma’anshan city from Jan 1st,2006 and Dec 31,2006. 2.The QOL of the brain tumors patients:(1) Every domain and total SF-36 subscales of brain tumors patients were significantly lower than those in the health subjects group. The ascending order of dimensional subscales was GH、RP、RE、VT、PF、BP、MH and SF. (2)The scores of VT and SF domain were lower in female patients than in male patients.(3)The scores of PF,BP and SF domain were significantly higher in patients at the age of below 50 than those above 50.(4)There was no significant difference in any dimensional subscales in patients at aspect of marriage.(5)There were significant difference in PF and VT dimensional subscales in educational level in patients. LSD-t analysis indicated that the score of PF domain was lower in illiterate group than in primary school group, high school group and above college or university group; the score of RP domain was lower in primary school group than in high school group, the score of BP domain was lower in illiterate group than in high school group and above college or university group; the score of GH domain was lower in illiterate group and primary school group than in high school group; the score of VT domain was lower in illiterate group than in high school group and above college or university group, and lower in primary school group than in high school group, and lower in junior school group than in high school group and above college or university group; the score of SF domain was lower in illiterate group than in high school group; the score of RE domain was lower in illiterate group than in high school group, and lower in junior school group than in high school group and above college or university group; there was no significant difference in MH dimensional scores.(6) There was significant difference in VT dimensional subscales at aspect of month income of patients. LSD-t analysis indicated that the score of PF domain was significantly lower in≤200yuan group than in 1001-2000yuan group; the score of BP domain was significantly lower in 201-500yuan group than in 1001-2000yuan group and above 2000yuan group; the score of VT domain was significantly lower in≤200yuan group than in above 2000yuan group,and lower in 201-500yuan group than in 1001-2000yuan group and above 2000yuan group, and lower in 501-1000yuan than in above 2000yuan group. (7) The scores of PF and RP domain was higher in‘half at public expense/ at public expense’group than in‘all at one's own expenses’group. (8) Every domain and total SF-36 subscales in different pain degree patients were significantly lower in‘severe group’than in‘light group’.(9) The scores of seven domain except for PF domain were significantly difference in two variables,including‘whether always depressive but don't want to express or not’and‘whether always oppress his agony but don't pour out or not’. (10) The scores of RE and MH domain were significantly lower in‘always be excess tense and worrying group’ than in the control group. The scores of six domain except for PF and RE domain were significantly lower in‘mood always be depressed and gloomy group’than in the control group.(11)Multivariate linear stepwise regression analysis indicated that 5 variables had important impact on QOL of brain tumors: educational level, pain dergree, always depressive but don't want to express , always oppress his agony but don't pour out, and mood always be depressed and gloomy.
Conclusions:1. The prevalence rate and incidence rate in this study were significantly higher than the statistical datas, and mortality rate was a little lower than that. 2.Total life quality of patients with brain tumors worsened generally. The QOL of brain tumors patients wasn’t affected by their marriage status. Gender,age and medical insurance status have impact on 1-3 domains of QOL. Much or little of family support is likely to be an impact factor of QOL in brain tumor patients. Educational level, pain dergree, character (always depressive but don't want to express , always oppress his agony but don't pour out), and mood always be depressed and gloomy tend to be the important factors that influence the QOL of brain tumor patients.
引文
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44. Demling GT,Bowman KF,Sterns S,et al.Cancer-related health worries and psychological distress among older adult,long-term cancer survivors[J].Psychooncology,2006,15(4):306-320
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