手足口病重症患者健康相关生存质量评估

摘要

目的 评估手足口病重症患者的健康相关生存质量.方法 以全国传染病监测信息报告管理系统2012年1月1日至2013年12月31日报告的实验室确诊的6月龄至5岁手足口病重症患者为研究对象,采用代理欧洲五维度健康量表,包括EQ-5D健康描述系统和视觉模拟标尺法(Visual Analogue Scale,EQ-VAS),通过电话调查方式获得患者在患病期间的健康相关生存质量.结果 对685名手足口病重症患者进行调查,男性456例(66.6％),519例(75.8％)研究对象为≤3岁儿童.337例(49.2％)和407例(59.4％)手足口病重症患者在行动能力和日常活动维度报告有问题,569例(83.1％)和616例(89.9％)患者在疼痛/不适和焦虑/抑郁维度报告有问题.重症患者的平均健康效用值为0.58±0.23,EQ-VAS评分为53.6±25.7,随病程延长评分降低.手足口病重症患者患病期间平均质量调整生命年损失为(15.45±13.75)年/1 000人,各并发症患者的质量调整生命年损失(年/1 000人)分别为呼吸道感染11.17±8.83;无菌性脑膜炎13.56±11.99;脑干脑炎/急性弛缓性麻痹(acute flaccid paralysis,AFP) 15.31±12.63;心肌炎17.28±18.16;肺出血肺水肿17.34±14.98;心肺衰竭25.47±20.53.EV71相关患者的质量调整生命年损失为16.51±14.48,高于柯萨奇病毒A组16型(CoxA16)感染患者的13.02±11.45和其他肠道病毒感染患者的14.74±14.22(Z=11.83,P=0.003).结论 手足口病重症患者的健康相关生存质量受影响较大,且随着并发症的加重和病程的延长而加重.%Objective To evaluate the health related quality of life (HRQoL) for severe hand,foot and mouth disease (HFMD) patients with different complications.Methods A national telephone interview under the EQ-5D proxy2 questionnaire (EQ-SD and EQ-VAS),was conducted to obtain the HRQoL of lab-confirmed severe HFMD patients,aged between six months and five-year-olds from the national communicable disease surveillance system from January 1,2012 to December 31,2013.Results A total of 685 severe HFMD cases were included in the study.A total of 456 (66.6％) of them were males with 75.8％ of them younger than three years old.A total of 337 (49.2％) and 407 (59.4％) of the participants reported that they had problems in mobility or daily activities.A total of 569 (83.1％) and 616 (89.9％) of the cases reported having problems in pain/discomfort or anxiety/depression.The average EQ-5D and EQ-VAS scores were 0.58 ± 0.23 and 53.6 ± 25.7,both were positively associated with the duration of illness.Mean quality adjusted life years loss during the HFMD episode for the severe patients was (15.45 ± 13.75) years/1 000 persons.The QALY losses for severe patients with each of below complication were:respiratory diseases (11.17 ± 8.83) years/1 000 persons,aseptic meningitis (13.56 ± 11.99) years/1 000 persons,encephalitis/brainstem encephalitis/acute flaccid paralysis (AFP) (15.31 ± 12.63) years/1 000 persons,Myocarditis (17.28 ± 18.16) years/1 000 persons,pulmonary hemorrhage/pulmonary edema (17.34 ±14.98) years/1 000 persons,cardiopulmonary failure (25.47 ± 20.53) years/1 000 persons.Among patients with lab confirmed Entero virus A71 (EV71) (16.51 ± 14.48) years/l 000 persons,the QALY loss was seen higher than Coxsackie virus A16 (Cox A16) (13.02± 11.45) years/1 000 persons and other Enter virus (14.74 ± 14.22) years/1 000 persons (Z=11.83,P=0.003).Conclusion The HRQoL loss for severe HFMD patients substantially increased under complications exacerbation and related to the duration of illness.