摘要：
目的 评估甲状腺相关眼病(thyroid-associated ophthalmopathy,TAO)患者健康相关生存质量(HRQOL)的影响因素.方法 横断面研究.选取2014年1月至2016年4月于南京医科大学第一附属医院眼科就诊的112例TAO患者(TAO组)和68例轻微眼病者(对照组),分别采用TAO生存质量评估量表(GO-QOL)进行调查.GO-QOL包括视功能和社会心理两个维度.比较TAO组与对照组在GO-QOL得分上的差异.分析多种因素对TAO患者GO-QOL得分的影响.结果 112例TAO患者中男性63例,女性49例,平均年龄(45.4±13.1)岁;对照组68例,男性36例,女性32例,平均年龄(39.5±10.8)岁.独立样本t检验分析示,TAO组GO-QOL视功能和社会心理维度得分分别为55.63±29.02、57.61±29.97,均比对照组的97.48±6.96、100±0.00明显降低(t值分别为-14.58、-14.97,P值均＜0.01);在TAO组中,吸烟者的社会心理维度得分明显低于不吸烟者(t=-2.284,P=0.024),第一眼位异常者的视功能和社会心理维度得分均比第一眼位正常者明显降低(t值分别为-3.979、-2.154,P值分别为＜0.01、0.034),眼球运动异常者的视功能维度得分明显低于眼球运动正常者(t=-2.975,P=O.004).单因素方差分析示,临床活动评分(CAS)评分越高,社会心理维度得分越低(F=3.178,P=0.018);与无上睑退缩者相比,上睑退缩者的社会心理维度得分明显降低(F=3.562,P=0.032).Pearson相关分析示,年龄与视功能维度得分呈明显负相关(r=-0.366,P＜0.01);TAO病程与视功能和社会心理维度得分均呈明显负相关(r分别为-0.235、-0.320,P值分别＜0.05、＜0.01);突眼度与社会心理维度得分呈明显负相关(r=-0.209,P＜0.05).多变量线性回归分析示,视功能维度得分仅与TAO病程、第一眼位存在明显相关性(P值分别为0.007、0.013),社会心理维度得分仅与TAO病程、CAS评分存在明显相关性(P值分别为0.024、0.022).结论 TAO患者的HRQOL明显下降,其主要危险因素包括TAO病程长、第一眼位异常、CAS评分高.%Objective To assess the risk factors associated with decreased quality-of-life in patients with thyroid-associated ophthalmopathy (TAO).Methods Cross-sectional study.One hundred and twelve patients with TAO and 68 controls were recruited to answer the Graves' ophthalmopathy quality-of-life questionnaire (GO-QOL) from January 2014 to April 2016.The GO-QOL included two subscales:the visual functioning and the psychosocial consequences.The differences in the GO-QOL scores between TAO patients and controls were analyzed.The influences of multiple factors on the GO-QOL scores among TAO patients were explored.Results Among 112 TAO patients,63 were male and 49 were female,with an average age of (45.4± 13.1) years.Among 68 controls,36 were male and 32 were female,with an average age of (39.5± 10.8) years.Independent sample t test showed that TAO patients had significantly lower scores than controls in the visual functioning subscale and the psychosocial consequences subscale (55.63±29.02 vs 97.48±6.96,t=-14.58,P＜0.01;57.61±29.97 vs 100± 0.00,t=-14.97,P＜0.01).Among TAO patients,smokers were associated with significantly lower psychological subscale scores than non-smokers (t=-2.284,P=0.024).Patients with abnormal primary position of eye scored significantly lower than those with normal alignment in functional (t=-3.979,P＜ 0.001) and psychological subscales (t=-2.154,P=0.034) Patients with abnormal eye movement had significantly lower functional scores than those without (t=-2.975,P=0.004).One-way analysis of variance showed that higher CAS scores were significantly related to lower psychological subscale scores (F=3.178,P=0.018).Patients with upper eyelid retraction had significantly lower psychological subscale scores than those without (F=3.562,P=0.032).Pearson correlation analysis showed that age was negatively correlated with functional subscale scores (r=-0.366;P＜0.01).TAO course was negatively correlated with functional (r=-0.235,P＜0.05) and psychological subscale scores (r=-0.320,P＜0.01).The degree of exophthalmos was negatively correlated with psychological subscale scores (r=-0.209,P＜0.01).Multivariable linear regression analysis showed that only primary position of eye (P=0.013) and TAO course (P=0.007) were negatively correlated with functional subscale scores and only CAS scores (P=0.022) and TAO course (P=0.024) were negatively correlated with psychological subscale scores.Conclusion Risk factors associated with lower quality-of-life among TAO patients included abnormal primary position of eye,higher CAS scores,and longer TAO course.
