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題名 | 血友病關節病變與健康相關生活品質之相關性研究=Health-Related Quality of Life and Hemophilic Arthropathy in Hemophilia Patients |
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作者 | 張智雅; 蘇惠怡; 吳永燦; 陳宇欽; 陳良城; 張幸初; 李宗穎; | 書刊名 | 臺灣復健醫學雜誌 |
卷期 | 41:4 2013.12[民102.12] |
頁次 | 頁235-242 |
分類號 | 415.625 |
關鍵詞 | 血友病; 血友病關節病變; 36條健康狀況簡明調查問卷; 健康相關生活品質; Hemophilia; Hemophilic arthropathy; Short form-36; SF-36; Health-related quality of life; |
語文 | 中文(Chinese) |
中文摘要 | 血友病是一種性聯遺傳的凝血功能障礙的疾病,第八因子缺乏稱為A型血友病,第九因子缺乏稱為B型血友病,發生率約為萬分之一至三。早期血友病患最大的問題是出血,血液製劑使用後,經血傳染的疾病如肝炎及愛滋病成為血友病患者另一個問題。基因工程合成的凝血因子上市後,感染的問題減少了,但是重度血友病人60%出血發生在關節,反覆性關節出血造成血友病關節病變,影響病患生活甚鉅。本研究欲探討血友病關節病變與生活品質的相關性。本研究於年度整體醫療時招募血友病患者進行研究,86位均為男性(A型血友病81位,B型血友病5位),其平均年齡為30.6 ± 14.1歲(18-66歲),身高為164.9 ± 13.4公分(cm),體重為65.3 ± 17.8公斤(kg),身體質量指數為23.6 ± 5.1 kg/m^2。其中6位有凝血因子抗體。安排雙側肩、肘、髖、膝、踝關節活動度、X光檢查及評估Pettersson量表分數,並於當天完成36條健康狀況簡明調查問卷(short form-36,SF-36)。結果發現65位病人(75.6%)有血友病關節病變,以踝(57位,66.3%)、肘(46位,53.5%)、膝(41位,47.7%)關節最為常見;血友病患者的SF-36生活品質分數低於台灣常模其生活品質(SF-36)分別與關節病變嚴重度(Pettersson score)(r = -0.560,P < .001)、總關節活動角度(r = 0.538,P < .001)以及年齡(r = -0.426,P < .001)呈現相關性;生活品質與血友病嚴重度及凝血因子抗體則無顯著相關。本研究結果顯示血友病患者健康相關之生活品質與關節病變嚴重度及活動角度有關,宜積極預防及治療血友病關節病變,並維持關節活動度,以增進血友病患者之生活品質。 |
英文摘要 | Introduction: Hemophilia is an X-linked recessive bleeding disorder caused by a deficiency of coagulation factor VIII (hemophilia A) or IX (hemophilia B). The prevalence of hemophilia is approximately 1 per 105 in the general population. Repeated joint bleeding leads to chronic synovitis, cartilage damage, and bone destruction, yielding reduced range of motion (ROM), painful joints, and muscle atrophy. Hemophilic arthropathy can negatively influence perceptions of health-related quality of life (HRQOL) among hemophilia patients. This study explored the correlation between hemophilic arthropathy and HRQOL among hemophilia patients in Taiwan. Methods: The participants comprised 86 patients enrolled from a hemophilia center. We collected clinical information regarding their age, hemophilia type, disease severity, and factor inhibitor, and their responses to the short form 36 (SF-36). On the same day, the bilateral shoulders, elbows, hips, knees, and ankles were evaluated regarding ROM and assigned a Pettersson score based on an X-ray film. The relations among the SF-36 results and the clinical variables were assessed using the Spearman’s correlation coefficient. Results: Eighty-one hemophilia A and 5 hemophilia B patients were enrolled. The mean age was 30.6 ± 14.1 years. Regarding hemophilic arthropathy, the most commonly affected joints were the ankle (66.3%), elbow (53.5%), and knee (47.7%). The SF-36 scores of the hemophilia patients were worse compared with Taiwanese normative values. The summarized SF-36 and Pettersson scores (r = -0.560, P < .001), ROM (r = 0.538, P < .001), and age (r = -0.426, P < .001) exhibited significant correlations. No significant correlation was observed between hemophilia severity and SF-36. Conclusion: A high Pettersson score, reduced ROM, and increased age were correlated to a low HRQOL among hemophilia patients. The worse the arthropathy was, the lower the HRQOL was. If hemophilic arthropathy can be appropriately managed to prevent ROM deterioration, it could yield a substantial quality of life improvement for hemophilia patients. |
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