【摘要】：目的將健康相關(guān)生命質(zhì)量（health related quality of life，HRQOL，又稱生命質(zhì)量、生活質(zhì)量）作為主要結(jié)局指標(biāo)，在前期研究基礎(chǔ)上，繼續(xù)追蹤觀察，并借助恰當(dāng)?shù)目v向數(shù)據(jù)統(tǒng)計(jì)分析模型，對(duì)阿爾茨海默病進(jìn)程進(jìn)行較全面的定量研究。將阿爾茨海默病(Alzheimer’sdisease，AD)進(jìn)程中的疾病狀態(tài)和生命質(zhì)量相結(jié)合，研究阿爾茨海默病對(duì)生命質(zhì)量的影響、生命質(zhì)量的主要影響因素、生命質(zhì)量隨狀態(tài)轉(zhuǎn)移的動(dòng)態(tài)變化規(guī)律等。為社區(qū)老年人AD預(yù)防、早期干預(yù)，制定不同時(shí)期AD防治對(duì)策，從而提高生命質(zhì)量提供理論依據(jù)。同時(shí)探討縱向數(shù)據(jù)統(tǒng)計(jì)分析模型——廣義估計(jì)方程和潛變量增長(zhǎng)模型在縱向數(shù)據(jù)分析中的優(yōu)勢(shì)。 方法抽取太原市三個(gè)社區(qū)的517名60歲及以上老年人作為研究對(duì)象，對(duì)其進(jìn)行隨訪調(diào)查，調(diào)查間隔期為6個(gè)月，共獲得3次隨訪的資料。針對(duì)3次隨訪的縱向資料，引入廣義估計(jì)方程和潛變量增長(zhǎng)模型，以認(rèn)知正常老化為狀態(tài)1、輕度認(rèn)知障礙為狀態(tài)2、中重度認(rèn)知障礙為狀態(tài)3、阿爾茨海默病為狀態(tài)4，重點(diǎn)研究AD進(jìn)程中健康相關(guān)生命質(zhì)量隨狀態(tài)轉(zhuǎn)移的動(dòng)態(tài)變化規(guī)律及其影響因素。 結(jié)果廣義估計(jì)方程分析結(jié)果：對(duì)老年人健康相關(guān)生命質(zhì)量有統(tǒng)計(jì)學(xué)意義的影響因素是夫妻關(guān)系、與子女關(guān)系、聽力、做家務(wù)情況、參加體育鍛煉、喝茶、飲酒、一級(jí)親屬癡呆、高血脂、MOCA、ADL、GDS。從各種認(rèn)知轉(zhuǎn)歸結(jié)局生命質(zhì)量的影響因素比較分析結(jié)果來(lái)看：對(duì)1組（狀態(tài)1→狀態(tài)2）健康相關(guān)生命質(zhì)量有統(tǒng)計(jì)學(xué)意義的影響因素是教育水平、離休前職業(yè)、業(yè)余愛好、喝茶、吸煙、鋁制炊具使用、控制食量、腦部疾患、ADL、GDS。對(duì)2組（狀態(tài)2→狀態(tài)3）有統(tǒng)計(jì)學(xué)意義的影響因素是婚姻、夫妻關(guān)系、出生胎次、參加體育鍛煉、一級(jí)親屬癡呆、ADL、GDS。對(duì)3組（狀態(tài)3→狀態(tài)4）有統(tǒng)計(jì)學(xué)意義的影響因素是教育水平、退休后第二職業(yè)、做家務(wù)情況、參加體育鍛煉、喝茶、一級(jí)親屬癡呆、高血脂、GDS。對(duì)4組（狀態(tài)3→狀態(tài)2）有統(tǒng)計(jì)學(xué)意義的影響因素是離休前職業(yè)、婚姻、參加娛樂(lè)公益活動(dòng)、吸煙、GDS。 潛變量增長(zhǎng)模型分析結(jié)果：總的來(lái)說(shuō)，初始狀態(tài)平均生命質(zhì)量為29.865，處于一般水平，并且存在顯著的個(gè)體差異，在隨訪的這一段時(shí)間，生命質(zhì)量有先升高后下降的趨勢(shì)，但變化速度卻不存在顯著的個(gè)體間差異，而且初始時(shí)生命質(zhì)量的高低與后來(lái)的變化速度之間相關(guān)不顯著。各轉(zhuǎn)移組初始狀態(tài)生命質(zhì)量存在著顯著的差異，，但2組（狀態(tài)2→狀態(tài)3）和3組（狀態(tài)3→狀態(tài)4）這兩個(gè)轉(zhuǎn)移組老年人生命質(zhì)量有明顯的先升高后下降趨勢(shì)，而且2組升高要較3組明顯；生命質(zhì)量的發(fā)展速度存在顯著的個(gè)體之間的差異。而1組（狀態(tài)1→狀態(tài)2）和4組（狀態(tài)3→狀態(tài)2）這兩個(gè)轉(zhuǎn)移組均未達(dá)到顯著水平。 結(jié)論AD進(jìn)程中健康相關(guān)生命質(zhì)量隨狀態(tài)轉(zhuǎn)移的動(dòng)態(tài)變化規(guī)律各有特點(diǎn)并且與多種因素相關(guān)，為更好地預(yù)防AD的發(fā)生，應(yīng)該根據(jù)不同認(rèn)知轉(zhuǎn)歸結(jié)局各自的發(fā)展變化及其影響因素，開展疾病分階段重點(diǎn)防治。廣義估計(jì)方程和潛變量增長(zhǎng)模型在縱向數(shù)據(jù)的分析中可以分別考慮到數(shù)據(jù)在個(gè)體內(nèi)的相關(guān)性和個(gè)體間差異，在應(yīng)用中顯示出其特有的優(yōu)勢(shì)。
[Abstract]:Objective to keep track of the health related quality of life (health related quality of life, HRQOL, quality of life and quality of life) on the basis of previous studies, and to carry out a comprehensive quantitative study on the Alzheimer's disease process with the help of appropriate longitudinal data statistical analysis model. Blzheimer The disease (Alzheimer 'sdisease, AD) process is combined with the quality of life to study the effect of Alzheimer's disease on the quality of life, the main influencing factors of the quality of life, the dynamic change of the quality of life with the state, and so on. For the elderly people in the community, the prevention of AD, the early intervention, and the formulation of the Countermeasures for the prevention and control of the AD in different periods, thus improve the prevention and control of AD. A theoretical basis for the quality of life is provided. At the same time, the advantages of the longitudinal data statistical analysis model, the generalized estimation equation and the latent variable growth model, are discussed in the longitudinal data analysis.
Methods a total of 517 people aged 60 and above in three communities in Taiyuan were selected as the research subjects. They were followed up with a follow-up survey of 6 months. A total of 3 follow-up data were obtained. According to the longitudinal data of the 3 follow-up, the generalized estimation equation and the latent variable growth model were introduced in order to recognize the normal aging condition 1 and the mild cognitive impairment. State 2, moderate to severe cognitive impairment was 3, Alzheimer's disease was 4. The dynamic changes of health related quality of life with state transfer in the AD process and its influencing factors were studied.
Results the results of generalized estimation equation: the influence factors on the health related quality of life of the elderly were marital relationship, relationship with children, hearing, doing housework, drinking tea, drinking, first-degree kinship dementia, hyperlipidemia, MOCA, ADL, GDS. from the comparison of the factors of life quality of various cognitive outcomes. The results showed that the 1 groups (state 1 to state 2) had statistical significance in health related life quality, such as educational level, pre occupation, hobby, tea drinking, smoking, aluminum cooking utensils, control of food, brain disease, ADL, and GDS., which had statistically significant factors in 2 groups (state 2 to 3) were marital, marital relations, Birth birth, participation in physical exercise, first-degree kinship dementia, ADL, and GDS. to 3 groups (state 3 to 4) were statistically significant factors affecting the level of education, the second career after retirement, doing housework, taking part in physical exercise, drinking tea, first-degree relatives dementia, hyperlipidemia, and GDS. on 4 groups (status 3 to state 2) with statistical significance Former occupation, marriage, entertainment and public welfare activities, smoking, GDS.
The analysis results of the latent variable growth model: in general, the average quality of life in the initial state is 29.865, at the general level, and there is a significant individual difference. In this period of follow-up, the quality of life rises first and then decreases, but the rate of change does not exist between the individuals and the high quality of life at the beginning. There were significant differences in the quality of life in the initial state of the transfer groups, but the 2 groups (state 2, state 3) and 3 groups (state 3 > state 4) had a significant increase in the quality of life in the two groups, and the 2 groups were significantly higher than the 3 groups; the speed of the development of the quality of life was faster. There was a significant difference in degree between individuals, but neither group 1 (state 1 state 2) nor group 4 (state 3 state 2) reached a significant level.
Conclusion the dynamic changes of the health related quality of life with state transfer in the AD process have their own characteristics and are related to various factors. In order to prevent the occurrence of AD better, it should be based on the development and changes of different cognitive outcomes and its influencing factors, and carry out the prevention and control of the disease in stages. The generalized estimation equation and the latent variable growth model should be carried out. In the analysis of longitudinal data, we can consider the relativity of data within individuals and the difference between individuals, and show its unique advantages in application.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R749.16

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 高菲菲;尚少梅;王志穩(wěn);張慧;;生活質(zhì)量測(cè)評(píng)在老年癡呆研究領(lǐng)域中的應(yīng)用[J];中國(guó)全科醫(yī)學(xué);2008年21期

2 劉紅云,孟慶茂;縱向數(shù)據(jù)分析方法[J];心理科學(xué)進(jìn)展;2003年05期

3 胡號(hào)應(yīng),苗國(guó)棟,唐牟尼,馬崔,胡文生,鄭洪波;老年性癡呆生活質(zhì)量量表修訂版的信度和效度分析[J];中國(guó)臨床心理學(xué)雜志;2005年04期

4 張立秀;劉雪琴;;蒙特利爾認(rèn)知評(píng)估量表中文版廣州市老人院人群劃界分探討[J];中國(guó)心理衛(wèi)生雜志;2008年02期

相關(guān)碩士學(xué)位論文 前1條

1 高建偉;多狀態(tài)Markov模型在輕度認(rèn)知障礙向阿爾茨海默病轉(zhuǎn)歸研究中的應(yīng)用[D];山西醫(yī)科大學(xué);2011年

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