紅斑性狼瘡患者的生活品質預測模式 – 運用路徑分析

Abstract

研究背景與目的: 紅斑性狼瘡為病因不明之慢性免疫系統疾病，過去40年來，隨著醫藥之進步，死亡率逐漸下降。然而，紅斑性狼瘡患者受到疾病影響，除了生理健康的不適外，也造成心理健康的改變。生活品質為一個人對生活滿意度的詮釋。疾病症狀如疲勞、疼痛、憂鬱，以及焦慮，最常被提及為影響紅斑性狼瘡患者生活品質之預測因子。許多學者嘗試建構症狀與生活品質相關之機制，然而先前研究結果並沒有清楚的架構出生活品質模式，因此本篇研究的目的為利用路徑分析驗證生理健康、心理健康、社會關係，以及環境生活品質模式。研究方法: 本研究94位個案來自台大醫院內科門診。個案符合以下收案標準: (1) 符合1982年美國風濕醫學會診斷標準；(2) 年齡20歲以上；(3) 教育程度小學五年級以上；(4) 簡短版認知功能分數高於等於24分；(5)正參與風濕免疫科門診追蹤治療。個案由醫師評估疾病活性量表(SLEDAI-2000)，再評估七個量表，分別為疲乏量表、疼痛量表、貝氏憂鬱量表(第二版)、貝氏焦慮量表、職能自我評估量表、自我掌控感量表，以及台灣簡明版世界衛生組織生活品質量表。此研究使用SPSS 第19版以及LISREL 第8.51版本軟體分析。結果: 本篇研究發現自我勝任感在四個生活品質層面皆為重要之預測因子，且疲勞、疼痛、憂鬱、焦慮藉由自我勝任感間接影響生活品質。在4個層面生活品質中可發現，疲勞、憂鬱、自我勝任感，以及環境衝擊分別為影響生理健康、心理健康、社會關係，以及環境生活品質重要因子。結論: 藉由此研究發現，臨床可對於影響生活品質最鉅之預測因子評估並針對症狀進行介入，改善患者生活品質並增進患者生活參與。

Background/Purpose: Systemic lupus erythematosus (SLE) is an autoimmune disease with unknown etiology. Within these 40 years, along with the progress of diagnosis, the mortality rate declined. However, the uncertainty of disease causes physical discomfort and mental health distress. Quality of life (QOL) describes how a person interprets its life satisfaction. Fatigue, pain, and depression symptoms are mentioned to be predictors of QOL in patients with SLE. Although many researchers want to find out the mechanism how symptoms lead to QOL. However, result is still unclear. Thus, the purpose of our study is to apply path analysis to verity our predictive QOL models. Methods: There were 94 participants in our study. Participants were recruited from an outpatient clinic of National Taiwan University Hospital and met the following criteria: (1) confirmed SLE diagnosis based on ACR; (2) aged above 20; (3) reached education level above 5th grade of elementary school; (4) reached a minimum score of 24 on MMSE; (5) stably followed up in clinics. Participant evaluated disease activity (SLEDAI-2000) by clinician. Patients evaluated fatigue (FACIT-F), pain (Pain-NRS), depression (BDI-II), anxiety (BAI), sense of competence (OSA-myself), environmental impact (OSA-environment), sense of mastery (Mastery scale), and QOL (WHOQOL-BREF-TW). We applied SPSS 19 and LISREL 8.51 to conduct data analysis. Results: The finding of study found sense of competence a critical predictor of QOL, and fatigue, pain, depression, and anxiety all indirectly influence QOL via sense of competence. Fatigue, depression, sense of competence, and environmental impact are the most influential predictors in physical health, psychological health, social relationships, and environmental domains of QOL. Conclusion: We hope by the confirmation of the predictive model of the study would provide directions for clinicians to derive strategies aiming at improving QOL for patients with SLE.