季瑋珠賴美淑臺灣大學：高芷華Kao, Tze-WahTze-WahKao2007-11-282018-06-292007-11-282018-06-292005http://ntur.lib.ntu.edu.tw//handle/246246/59241研究背景及目的 健康相關生活品質影響末期腎病病患的結果及存活。本研究目的為探討經濟、社會及心理因素與北台灣血液透析病患之健康相關生活品質的關係。 研究對象及方法 研究對象為在北台灣14家透析中心接受長期血液透析兩個月或以上的病患，研究方法為透過問卷調查方式收集病患的人口學、經濟、社會及心理資料，並以貝克憂鬱量表及Medical Outcomes Study Short-Form 36 (SF-36)來測量病患的憂鬱狀況和健康相關生活品質。SF-36包含八個量表，分別為身體生理功能(PF)、因身體生理問題角色受限(RP)、身體疼痛(BP)、一般健康狀況(GH)、活力(VT)、社會功能(SF)、因情緒問題角色受限(RE)和心理健康(MH)。此八個量表可再進一步分為兩大量表：Physical Component Summary (PCS)及Mental Component Summary (MCS)。分析方法為使用單變項線性迴歸來評估PCS、MCS、八個量表與經濟、社會及心理變項的關係，再以多變項線性迴歸來尋找與健康相關生活品質有顯著關係的各種變項。 結果 有861位血液透析病患參與此研究，平均年齡為59.42 ± 13.18歲 (14.77至89.33歲)，男性有373人(43.32%)。大部分病患為已婚(71.93%)，60.5%有不同程度的憂鬱症。血液透析病患在SF-36八個量表的得分均比台灣一般民眾的得分低。年齡與身體功能相關的生活品質量表有負相關(P<0.01)。離婚病患在PF(P<0.05)、BP(P<0.01)和PCS(P<0.05)的得分較高，而單身病患在RP(P<0.05)和PCS(P<0.05)的得分數低。較高的月收入與RE、MH和MCS有正面關係(P<0.01)。較常參與社交活動與SF也有正面關係(P<0.05)。憂慮的事情越多，則SF(P<0.05)、MH(P<0.01)和MCS(P<0.01)的得分越低。貝克憂鬱量表的分數越高，SF-36八個量表、PCS及MCS的分數則越低(P<0.01)。 結論 較高的月收入及較常參與社交活動兩者均與血液透析病患較好的健康相關生活品質有關，而憂慮的事情越多及較高的貝克憂鬱量表得分則與較差的健康相關生活品質有關。Background and Purpose of Study Health-related quality of life (HRQOL) affects outcome and survival of end-stage renal disease patients. This study aimed to evaluate the associations between economic, social, psychological factors and HRQOL of hemodialysis (HD) patients in northern Taiwan. Patients and Study Methods Patients who had received maintenance HD for at least 2 months at 14 dialysis centers in northern Taiwan were invited to join the study. Demographic, economic, social and psychological data of the patients were collected by questionnaires. Depression status was assessed by the Beck Depression Inventory (BDI). HRQOL was measured by the Medical Outcomes Study Short-Form 36 (SF-36) which consists of eight dimensions, namely physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE) and mental health (MH). These dimensions are further compressed into two scales: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Simple linear regression analyses were used to evaluate the associations between scores of PCS, MCS, the eight dimensions of the SF-36 and economic, social and psychological variables. Multiple linear regression analyses were used to search for significant associations between HRQOL and variables of interest after adjusting for demographic and clinical factors. Results Eight hundred and sixty one HD patients completed the study. There were 373 male (43.32%). The mean age was 59.42 ± 13.18 years (14.77 to 89.33 years). Most of them were married (71.93%). 60.5% of all patients had various degrees of depression. HD patients had lower scores in all eight dimensions of the SF-36 compared with the general population sample in Taiwan. Age was inversely associated with physical function-related QOL dimensions (P<0.01). Divorced patients scored better in PF (P<0.05), BP (P<0.01) and PCS (P<0.05) whereas single patients scored worse in RP (P<0.05) and PCS (P<0.05). Higher monthly income was positively associated with RE, MH and MCS (P<0.01). Increased frequency of joining social activities was positively associated with SF (P<0.05). More things worried was inversely associated with SF (P<0.05), MH (P<0.01) and MCS (P<0.01). Higher BDI scores were strongly inversely associated with lower scores of PCS, MCS and all eight dimensions of the SF-36 (P<0.01). Conclusion Higher monthly income and increased frequency of joining social activities are associated with better HRQOL, whereas more things worried and higher BDI scores are associated with worse HRQOL of HD patients.Abstract P. 2 中文摘要 P. 3 Acknowledgement P. 4 Contents P.5-12 Chapter 1: Introduction 1.1 End-Stage Renal Disease and Hemodialysis in Taiwan P.13 1.2 Health-Related Quality of Life of Hemodialysis Patients in Taiwan P.13-14 Chapter 2: Literature Review 2.1 Definition of Health-Related Quality of Life P.15 2.2 Measurement of Health-Related Quality of Life P.15 2.2.1 Generic Instruments P.15-16 2.2.2 Renal Disease Specific Instruments P.16-17 2.2.3 Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) P.17-18 2.3 Health-Related Quality of Life of End-Stage Renal Disease Patients P.18-19 2.4 Importance of Health-Related Quality of Life of Hemodialysis Patients P.19 2.5 Factors That Are Associated with Health-Related Quality of Life of Hemodialysis Patients P.19-20 2.5.1 Demographic Factors 2.5.1.1 Sex P.20-21 2.5.1.2 Age P.21-22 2.5.1.3 Ethnicity / Race P.22-23 2.5.1.4 Marital / Living Status P.23 2.5.1.5 Educational Level P.23 2.5.2 Economic / Financial Factor P.23-24 2.5.2.1 Work / Employment Status P.24 2.5.2.2 Socioeconomic Status P.24-25 2.5.3 Social Factors P.25 2.5.3.1 Social Support P.25 2.5.3.2 Social Activity P.26 2.5.4 Psychological Factors P.26 2.5.4.1 Self-Esteem, Perceived-Control and Hostility P.26 2.5.4.2 Psychiatric Disorders (Depression / Anxiety / Somatoform Disorder) P.26 2.5.4.3 Spirituality and Religiosity P.27 2.5.5 Clinical Factors P.27 2.5.5.1 Comorbid Diseases P.27-28 2.5.5.2 Dialysis Adequacy P.28-29 2.5.5.3 Dialysis Duration P.30 2.5.5.4 Dialysis-Related Symptoms P.30-31 2.5.5.5 Residual Renal Function P.31 2.5.5.6 Nutritional Status P.31-32 2.5.5.7 Hemoglobin / Hematocrit Level P.32-33 2.5.5.8 Erythropoietin or Erythropoietin Responsiveness P.33 2.6 Interventions To Improve Health-Related Quality of Life of Hemodialysis Patients P.34 2.6.1 Adaptation Training Program P.34 2.6.2 Exercise P.34-35 Chapter 3: Study Purpose and Hypothesis 3.1 Purpose of Study P.36 3.2 Hypothesis P.36 3.3 Study Design P.36 Chapter 4: Materials and Methods 4.1 Patients P.37 4.2 Collections and Management of Study Data P.37-38 4.2.1 Collections of Demographic Parameters P.38 4.2.2 Collections of Economic and Social Parameters P.38-39 4.2.3 Collections of Psychological Parameters P.39 4.2.4 Collections of Clinical Parameters P.39-40 4.2.5 Measurement of HRQOL P.40 4.2.6 Data Management P.40 4.3 Statistical Analysis P.40-41 Chapter 5: Results 5.1 Descriptive Results P.42-43 5.2 Analytical Results P.43 5.2.1 Factors Associated with Physical Functioning (PF) P.43-44 5.2.2 Factors Associated with Role Physical (RP) P.44 5.2.3 Factors Associated with Bodily Pain (BP) P.44 5.2.4 Factors Associated with General Health (GH) P.44-45 5.2.5 Factors Associated with Vitality (VT) P.45 5.2.6 Factors Associated with Social Functioning (SF) P.45 5.2.7 Factors Associated with Role Emotional (RE) P.45-46 5.2.8 Factors Associated with Mental Health (MH) P.46 5.2.9 Factors Associated with Physical Component Summary (PCS) P.46-47 5.2.10 Factors Associated with Mental Component Summary (MCS) P.47 Chapter 6: Discussion 6.1 Mean SF-36 Scores of HD Patients Versus General Population P.48 6.2 Demographic Factors That Are Associated with HRQOL P.48 6.2.1 Sex P.48 6.2.2 Age P.48-49 6.2.3 Marital Status P.49 6.2.4 Educational Level P.50 6.3 Economic Factors That Are Associated with HRQOL P.50 6.3.1 Work Status P.50 6.3.2 Monthly Income P.50-51 6.4 Social Factors That Are Associated with HRQOL P.51 6.4.1 Social Support P.51 6.4.2 Frequency of Joining Social Activities P.52 6.5 Psychological Factors That Are Associated with HRQOL P.52 6.5.1 Number of Things Worried P.52-53 6.5.2 Depression Status P.53 6.6 Clinical Factors That Are Associated with HRQOL P.54 6.6.1 Comorbid Diseases P.54 6.6.2 Serum Albumin Level P.54 6.7 Implications of Our Study P.55 6.8 Limitations of Our Study P.55 6.9 Future Research P.55-56 6.10 Conclusion P.56 References P.57-69 Table 2.1 Instruments Used to Assess Health-Related Quality of Life of Dialysis Patients P.70 Table 2.2 Use of SF-36 in ESRD Patients in Different Countries/Cities P.71 Table 2.3 Advantages of using SF-36 to Measure Health-Related Quality of Life P.71 Table 2.4 The Association between Sex and Health-Related Quality of Life of Chronic Hemodialysis Patients P.72-73 Table 2.5 The Association between Age and Health-Related Quality of Life of Chronic Hemodialysis Patients P.74-75 Table 2.6 The Association between Ethnicity and Health-Related Quality of Life of Chronic Hemodialysis PatientsP.76 Table 2.7 The Association between Marital/Living Status and Health-Related Quality of Life of Chronic Hemodialysis Patients P.77 Table 2.8 The Association between Educational Level and Health-Related Quality of Life of Chronic Hemodialysis Patients P.78 Table 2.9 The Association between Work/Employment Status and Health-Related Quality of Life of Chronic Hemodialysis Patients P.79 Table 2.10 The Association between Economic/Financial Status and Health-Related Quality of Life of Chronic Hemodialysis Patients P.80 Table 2.11 The Association between Social Support and Health-Related Quality of Life of Chronic Hemodialysis Patients P.81 Table 2.12 The Association between Social Activity and Health-Related Quality of Life of Chronic Hemodialysis Patients P.82 Table 2.13 The Association between Self-Esteem, Perceived-Control and Hostility and Health-Related Quality of Life of Chronic Hemodialysis Patients P.82 Table 2.14 The Association between Psychiatric Disorders and Health-Related Quality of Life of Chronic Hemodialysis Patients P.83 Table 2.15 The Association between Spirituality and Religiosity and Health-Related Quality of Life of Chronic Hemodialysis Patients P.84 Table 2.16 The Association between Comorbid Diseases and Health-Related Quality of Life of Chronic Hemodialysis Patients P.85-86 Table 2.17 The Association between Dialysis Adequacy and Health-Related Quality of Life of Chronic Hemodialysis Patients P.87 Table 2.18 The Association between Dialysis Duration and Health-Related Quality of Life of Chronic Hemodialysis Patients P.88 Table 2.19 The Association between Dialysis-Related Symptoms and Health-Related Quality of Life of Chronic Hemodialysis Patients P.89 Table 2.20 The Association between Residual Renal Function and Health-Related Quality of Life of Chronic Hemodialysis Patients P.90 Table 2.21 The Association between Nutritional Status and Health-Related Quality of Life of Chronic Hemodialysis Patients P.91 Table 2.22 The Association between Hemoglobin / Hematocrit Level and Health-Related Quality of Life of Chronic Hemodialysis Patients P.92 Table 2.23 The Association between Erythropoietin or Erythropoietin Responsiveness and Health-Related Quality of Life of Chronic Hemodialysis Patients P.93 Table 2.24 The Association between Adaptation Training Program and Health-Related Quality of Life of Chronic Hemodialysis Patients P.94 Table 2.25 The Association between Exercise Training and Health-Related Quality of Life of Chronic Hemodialysis Patients P.95 Figure 3.1 Hypothesis of Our Study P.96 Table 5.1 Patients Distribution in Different Study Hospitals P.97 Table 5.2 Demographic Characteristics of Study HD Patients P.98 Table 5.3 Types of Religion of Study HD Patients P.98 Table 5.4 Economic Characteristics of Study HD Patients P.99 Table 5.5 Social Characteristics of Study HD Patients P.99 Table 5.6 Number of Sources of Social Support of Study HD Patients P.100 Table 5.7 Psychological Characteristics of Study HD Patients P.100 Table 5.8 Number of Things Worried in Study HD Patients P.101 Table 5.9 Clinical Characteristics of Study HD Patients P.101 Table 5.10 Number of Comorbid Diseases of Study HD Patients P.102 Table 5.11 Number of Symptoms of Study HD Patients P.102 Table 5.12 Laboratory Data of Study HD Patients P.103 Table 5.13 Mean Values of The 8 Dimensions, PCS and MCS of The SF-36 of Study HD Patients, and Mean Values of The 8 Dimensions of The General Taiwan Population Sample P.103 Table 5.14 The Associations between Physical Functioning and Different Factors Using Simple Linear Regression P.104 Table 5.15 Significant Associations between Physical Functioning and Different Factors Using Multiple Linear Regression P.105 Table 5.16 The Associations between Role Physical and Different Factors Using Simple Linear Regression P.106 Table 5.17 Significant Associations between Role Physical and Different Factors Using Multiple Linear Regression P.107 Table 5.18 The Associations between Bodily Pain and Different Factors Using Simple Linear Regression P.108 Table 5.19 Significant Associations between Bodily Pain and Different Factors Using Multiple Linear Regression P.109 Table 5.20 The Associations between General Health and Different Factors Using Simple Linear Regression P.110 Table 5.21 Significant Associations between General Health and Different Factors Using Multiple Linear Regression P.111 Table 5.22 The Associations between Vitality and Different Factors Using Simple Linear Regression P.112 Table 5.23 Significant Associations between Vitality and Different Factors Using Multiple Linear Regression P.113 Table 5.24 The Associations between Social Functioning and Different Factors Using Simple Linear Regression P.114 Table 5.25 Significant Associations between Social Functioning and Different Factors Using Multiple Linear Regression P.115 Table 5.26 The Associations between Role Emotional and Different Factors Using Simple Linear Regression P.116 Table 5.27 Significant Associations between Role Emotional and Different Factors Using Multiple Linear Regression P.117 Table 5.28 The Associations between Mental Health and Different Factors Using Simple Linear Regression P.118 Table 5.29 Significant Associations between Mental Health and Different Factors Using Multiple Linear Regression P.119 Table 5.30 The Associations between the Physical Component Summary and Different Factors Using Simple Linear Regression P.120 Table 5.31 Significant Associations between Physical Component Summary and Different Factors Using Multiple Linear Regression P.121 Table 5.32 The Associations between the Mental Component Summary and Different Factors Using Simple Linear Regression P.122 Table 5.33 Significant Associations between Mental Component Summary and Different Factors Using Multiple Linear Regression P.123 Appendix: Informed Consent and Questionnaires in Chinese P.124610425 bytesapplication/pdfen-US生活品質血液透析health-related quality of lifehemodialysis[SDGs]SDG3thesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/59241/1/ntu-94-R91846018-1.pdf