慢性肺源性心脏病患者生命质量与临床客观指标的相关性研究

摘要

目的：了解慢性肺源性心脏病（CPHD）患者生命质量与临床客观指标的相关性。方法选取2010年1月—2011年3月，昆明医科大学第一附属医院和昆明医科大学第二附属医院呼吸内科收治的急性加重期 CPHD 患者140例。对患者进行问卷调查，内容包括基本情况和慢性病患者生命质量测定量表体系中的 CPHD 量表（2版）〔QLICD - CPHD（ V2.0）〕，其中 QLICD - CPHD（ V2.0）包括生理功能（ PHD）、心理功能（ PSD）、社会功能（SOD）、疾病特异模块（SPD）4个领域。通过查阅病历收集患者的临床客观指标，包括血常规、尿常规、血生化检查、血气分析及肺功能检查等。采用简单相关分析和典型相关分析探讨 QLICD - CPHD（V2.0）各领域及量表总得分与临床客观指标的相关性。结果 CPHD 患者 PHD、PSD、SOD、SPD 及总量表的标准化得分分别为（54.5±13.1）、（59.5±16.1）、（63.0±15.5）、（59.0±16.6）、（58.9±12.5）分。简单相关分析结果显示，氯离子、pH 与患者 PHD得分呈线性正相关，二氧化碳分压（PCO2）、体温（TEMP）与患者 PHD 得分呈线性负相关（P ﹤0.05）；氯离子、红细胞计数与 PSD 得分呈线性正相关，TEMP 与 PSD 得分呈线性负相关（P ﹤0.05）；尿比重与 SOD 得分呈线性负相关，氧分压（PO2）、第1秒用力呼气末容积与用力肺活量比值（ FEV1/ FVC）与 SOD 得分呈线性正相关（ P ﹤0.05）；ALT、AST、总胆红素、氯离子与 SPD 得分呈线性正相关，TEMP 与 SPD 得分呈线性负相关（ P ﹤0.05）；ALT、钠离子、氯离子与量表总得分呈线性正相关，TEMP 与量表总得分呈线性负相关（P ﹤0.05）。典型相关分析共获得4对典型变量，其中1对典型变量的典型相关系数 r1=0.411，P ﹤0.05。典型变量与原变量的相关性分析结果显示，典型变量的相关关系主要表现为钠离子、氯离子与 PHD、PSD、SPD 得分间的正相关，PCO2、TEMP 与 PHD、PSD、SPD 得分间的负相关。结论 CPHD 患者的 PHD 得分最低，钠离子、氯离子、PCO2、TEMP 与患者生命质量的相关性较高，治疗过程中应重点关注，以提高 CPHD 患者的生命质量。%Objective To investigate the correlation between quality of life and values of clinical objective indicators in chronic pulmonary heart disease( CPHD). Methods One hundred and forty acute exacerbated CPHD patients admitted to Department of Respiratory Medicine,First Affiliated Hospital of Kunming Medical University and Department of Respiratory Medicine,Second Affiliated Hospital Kunming Medical University from January 2010 to March 2011 were enrolled in this study. A questionnaire survey was conducted in the patients,which included the basic conditions,and QLICD - CPHD(V2. 0),one of the quality of life instruments,covering 4 domains,such as PHD,PSD,SOD and SPD. The values of patients' clinical objective indicators consisted of routine blood tests,routine urine examination,blood biochemical tests,blood gas analysis and pulmonary function tests were also collected from the medical records. The relationship between total score, the domains scores of QLICD - CPHD(V 2. 0)and the results of clinical objective indicators were analyzed via statistical methods of simple correlation and canonical correlation. Results The standard scores of PHD,PSD,SOD and SPD and the total score of quality of life in CPHD patients were(54. 5 ± 13. 1), (59. 5 ± 16. 1), (63. 0 ± 15. 5), (59. 0 ± 16. 6), (58. 9 ± 12. 5),respectively. Simple correlation analysis results showed that levels of chloridion and pH had a positive linear correlation whereas partial pressure of carbon dioxide(PCO2 )and temperature( TEMP)had a negative linear correlation with PHD scores( P ﹤ 0. 05);levels of chloridion and red blood cell count were positively and linearly while TEMP was negatively and linearly correlated with PSD scores (P ﹤ 0. 05);specific gravity of urine presented a negative linear correlation while partial pressure of oxygen( PO2 )and FEV1 / FVC ratio demonstrated a positive linear correlation with SOD scores( P ﹤ 0. 05 );the levels of ALT,AST,total bilirubin and chloridion had a positive linear correlation while TEMP had a negative linear correlation with SPD scores( P ﹤0. 05);the levels of ALT,sodion,and chloridion were positively and linearly while TEMP was negatively and linearly correlated with the total score of quality of life( P ﹤ 0. 05). A total of 4 pairs of canonical variables were obtained through canonical correlation analysis,of which,the canonical coefficient r1 of 1 pair of canonical variables was 0. 411,P ﹤ 0. 05. Correlation analysis of canonical variables with original variables demonstrated that,levels of sodion and chloridion presented positive correlations while PCO2 and TEMP showed negative correlations with PHD,PSD,SPD scores. Conclusion The scores of PHD of CPHD patients are lowest of the 4 domains. The levels of sodium,chlorine,PCO2 and TEMP are strongly correlated with quality of life,so in the treatment of CPHD,these indicators should be given significant attention in order to improve the quality of life.