本文選題：銀屑病　切入點(diǎn)：病恥感　出處：《中南大學(xué)》2010年博士論文

【摘要】：目的： 1.翻譯并修訂銀屑病恥辱感體驗(yàn)問卷(Feeling of stigmatization of psoriasis FSQ),研究建立適合我國(guó)銀屑病患者病恥感的測(cè)量工具。 2.從社會(huì)人口學(xué)特征、患病情況等方面研究影響銀屑病患者病恥感的主要影響因素。 3.研究生物、心理、社會(huì)學(xué)因素對(duì)銀屑病患者生活質(zhì)量的影響及其可能機(jī)制。為臨床銀屑病患者健康提供理論依據(jù)。 方法 1.按照量表翻譯程序?qū)︺y屑病恥辱感體驗(yàn)問卷(FSQ)進(jìn)行漢化,形成FSQ中文版。采用隨機(jī)抽樣法,于2008年10-12月抽取長(zhǎng)沙市和常德市共3所醫(yī)院皮膚科門診就診銀屑病患者185名,填寫中文版FSQ。采用主成分分析、Cattell陡階檢驗(yàn)等方法對(duì)FSQ中文版進(jìn)行修訂,形成FSQ中文修訂量表。 2.采用隨機(jī)抽樣方法,于2009年1-10月抽取長(zhǎng)沙市和常德市共3所醫(yī)院銀屑病住院患者144名,對(duì)他們進(jìn)行問卷調(diào)查和疾病嚴(yán)重度評(píng)價(jià)。問卷調(diào)查內(nèi)容包括一般情況、患病情況、社會(huì)支持、醫(yī)學(xué)應(yīng)對(duì)、心理測(cè)量和生活質(zhì)量。測(cè)量工具包括社會(huì)支持量表、醫(yī)學(xué)應(yīng)對(duì)量表、FSQ中文修訂問卷、皮膚病生活質(zhì)量問卷。疾病嚴(yán)重度評(píng)價(jià)由醫(yī)生計(jì)算]PASI得分完成。對(duì)FSQ中文修訂量表進(jìn)行信效度評(píng)價(jià)。 3.采用單因素和多元線性回歸分析篩選出影響銀屑病患者病恥感、醫(yī)學(xué)應(yīng)對(duì)、社會(huì)支持和生活質(zhì)量的因素；探討疾病嚴(yán)重度、病恥感、醫(yī)學(xué)應(yīng)對(duì)和社會(huì)支持對(duì)銀屑病患者生活質(zhì)量的影響,并采用結(jié)構(gòu)方程專用分析軟件Amos 18作結(jié)構(gòu)方程模型(structural equation modeling,SEM),對(duì)它們之間的關(guān)系進(jìn)行路徑分析。 結(jié)果 1.通過漢化和初步因子分析,確定包含4個(gè)維度27個(gè)條目的FSQ中文修訂量表。 2.信度檢驗(yàn)：(1)重測(cè)信度：各分量表和總量表重測(cè)信度在0.747-0.890之間。(2)分半信度：兩個(gè)分半子量表得分的分半信度(經(jīng)Spearman-Brown公式校正)系數(shù)0.66。(3)Cronbach's a系數(shù)：各分量表和總量表a系數(shù)在0.73～0.90之間。(4)分量表的一致性：各條目與分量表間的相關(guān)系數(shù)在0.550～0.852之間；各分量表間的相關(guān)系數(shù)在0.027～0.254之間；分量表與總量表的相關(guān)系數(shù)在0.385-0.853之問。 3.效度檢驗(yàn)：(1)內(nèi)容效度：修訂量表與源量表的相關(guān)系數(shù)為0.984,修訂量表各維度與源量表相應(yīng)維度的相關(guān)系數(shù)在0.843-1之間。(2)結(jié)構(gòu)效度：驗(yàn)證性因子分析結(jié)果表明病恥感4因子模型的χ(?)=12.21,df=3, GFI、NFI、RFI、IFI、CFI各項(xiàng)擬合指標(biāo)顯示擬合良好。 4.銀屑病患者病恥感平均89.44±16.08分,多元線性回歸分析結(jié)果顯示,皮損出血、瘙癢、有被拒絕經(jīng)歷、皮損暴露等進(jìn)入回歸方程,R2=0.386。 5銀屑病患者社會(huì)支持總平均得分39.09±10.19,與常模差異無統(tǒng)計(jì)學(xué)意義。多元線性回歸分析結(jié)果顯示,影響銀屑病患者社會(huì)支持的因素有：皮損暴露、付費(fèi)方式、家族史、合并癥、疾病嚴(yán)重度、出血,R2=0.489。 6.多元線性回歸分析結(jié)果顯示,影響銀屑病患者“回避”應(yīng)對(duì)的因素有：皮損暴露、年齡、家族史、病程、職業(yè),R2=0.404。影響患者“屈服”應(yīng)對(duì)的因素有：被拒絕經(jīng)歷、皮損暴露、職業(yè)、瘙癢程度、出血、經(jīng)濟(jì)收入,R2=0.414。影響患者“面對(duì)”應(yīng)對(duì)的因素有：性別、受教育水平、工作狀態(tài)、經(jīng)濟(jì)收入、家族史、瘙癢程度、病程,R2=0.492。 7.銀屑病患者皮膚病生活質(zhì)量平均11.90±5.79,多元線性回歸分析結(jié)果顯示,影響銀屑病患者生活質(zhì)量的因素有：年齡、受教育水平、經(jīng)濟(jì)收入、工作狀態(tài)、疾病嚴(yán)重度、出血、瘙癢程度、皮損暴露、關(guān)節(jié)受損、被拒絕經(jīng)歷、合并癥,R2=0.696。 8. Pearson相關(guān)分析結(jié)果顯示,銀屑病患者病恥感與醫(yī)學(xué)應(yīng)對(duì)、社會(huì)支持和生活質(zhì)量相關(guān),相關(guān)系數(shù)在0.27～0.62之間。銀屑病患者皮膚病生活質(zhì)量與疾病嚴(yán)重程度、醫(yī)學(xué)應(yīng)對(duì)、社會(huì)支持、病恥感相關(guān),相關(guān)系數(shù)在0.23～0.67之間。 9.結(jié)構(gòu)方程模型(SEM)分析結(jié)果顯示,病情嚴(yán)重程度對(duì)生活質(zhì)量有直接(正向)效應(yīng)(β=0.192,P0.01),同時(shí)嚴(yán)重度還可通過影響恥辱感、社會(huì)支持間接影響生活質(zhì)量；醫(yī)學(xué)應(yīng)對(duì)方式可通過影響恥辱感或社會(huì)支持間接影響生活質(zhì)量；恥辱感(β=-0.642,P0.01)和社會(huì)支持(β=-0.311,P0.01)對(duì)生活質(zhì)量有直接效應(yīng)。恥辱感、社會(huì)支持作為中介變量(mediated variable)調(diào)節(jié)病情嚴(yán)重程度與生活質(zhì)量的關(guān)系。 結(jié)論 1.FSQ中文修訂量表具有較好的信度和效度。 2.影響銀屑病患者病恥感的因素有性別、年齡、受教育水平、工作狀態(tài)、出血和瘙癢、皮損暴露、有被拒絕的經(jīng)歷。 3.銀屑病患者“面對(duì)”、“回避”、“屈服”的應(yīng)對(duì)方式均高于常模。 4.年輕和年老、受教育水平低、無工作、經(jīng)濟(jì)收入低、病情嚴(yán)重、皮損出血、瘙癢程度、皮損暴露、發(fā)病年齡大于45歲、有并發(fā)癥、有被拒絕的經(jīng)歷是銀屑病患者生活質(zhì)量下降的危險(xiǎn)因素。 5.病情嚴(yán)重程度、恥辱感、社會(huì)支持、醫(yī)學(xué)應(yīng)對(duì)方式對(duì)生活質(zhì)量存在直接和/或間接效應(yīng)。 6.恥辱感、社會(huì)支持作為中介變量調(diào)節(jié)病情嚴(yán)重程度與生活質(zhì)量的關(guān)系。
[Abstract]:Objective:
1. translated and revised psoriasis shame experience questionnaire (Feeling of stigmatization of psoriasis FSQ), study the establishment of measurement tools for China's stigma of patients with psoriasis.
2. from the social demographic characteristics, prevalence of effects of main influence factors of stigma of patients with psoriasis.
3. to study the effect of biological, psychological and sociological factors on the quality of life of patients with psoriasis and its possible mechanism, providing a theoretical basis for the health of patients with clinical psoriasis.
Method
1. according to the scale of translation program experience questionnaire of psoriasis (FSQ) finished, shame FSQ Chinese version. Using random sampling, in 2008 10-12 months from Changsha city and Changde city a total of 3 patients with psoriasis in the outpatient department of dermatology in 185 hospitals, fill in the Chinese version of FSQ. using principal component analysis, Cattell test and other steep steps method for revision of the FSQ Chinese version, FSQ Chinese revised scale.
2. random sampling method was adopted in 2009 1-10 months from Changsha city and Changde City, a total of 3 inpatients with psoriasis hospital 144, questionnaire survey and evaluation of the severity of the disease. They survey included general condition, prevalence, social support, medical coping, psychological measurement and measurement tools including the social quality of life. Support scale, medical coping scale, FSQ Chinese revised questionnaire, dermatology life quality questionnaire. The severity of the disease was evaluated by]PASI score. The doctor calculated on FSQ Chinese scale reliability and validity evaluation.
3. by univariate and multivariate linear regression analysis was used to determine the stigma of psoriasis patients, medical coping, social support and quality of life; to investigate the severity of the disease, stigma, coping and social support on quality of life in patients with psoriasis, and using structural equation analysis software Amos 18 special structural equation model (structural equation modeling, SEM), the path analysis of the relationship between them.
Result
1. by Sinization and preliminary factor analysis, the Chinese revised scale of FSQ, which contains 4 dimensions and 27 items, is determined.
2. reliability test: (1) the test-retest reliability of each subscale and the test-retest reliability was 0.747-0.890. (2) the split half reliability: two divided half scale split half reliability (after Spearman-Brown correction coefficient formula) 0.66. (3) Cronbach's a factor: all subscales of a coefficient of 0.73 ~ 0.90. (4) the consistency of subscales of each item and subscale of the correlation coefficients among 0.550 ~ 0.852; each subscale of the correlation coefficients among 0.027 ~ 0.254; correlation coefficient of subscales and total scale in 0.385-0.853.
3. validity: (1) the content validity: the correlation coefficient of scale and scale revision was 0.984, correlation coefficient of scale and the dimensions of the corresponding dimension of the source scale revised in 0.843-1. (2) the confirmatory factor analysis showed that the stigma of the 4 factor model of X (=12.21?) df=3, GFI, NFI, RFI, IFI, CFI, the fitting index showed that the fitting is good.
4. the stigma of psoriasis patients was 89.44 + 16.08, multiple linear regression analysis showed that the lesions of bleeding, itching, skin lesions have rejected experience, etc. into the regression equation, R2=0.386.
5 psoriasis patients social support total average score of 39.09 + 10.19, no statistical significance compared with the norm. Multiple linear regression analysis showed that the influencing factors of social support in patients with psoriasis are: skin lesions, payment methods, family history, comorbidity, severity of disease, blood, R2=0.489.
6. multiple linear regression analysis showed that patients with psoriasis "avoidance" response factors: skin lesions, age, family history, course of disease, occupation, R2=0.404. factors influencing patients' coping strategy are: rejection experience, skin lesions, itching degree, occupation, income, hemorrhage, R2=0.414. patients "in the face of" coping factors: gender, education level, work status, income, family history, the degree of itching, course of disease, R2=0.492.
7. patients with psoriasis skin disease quality of life was 11.90 + 5.79, multiple linear regression analysis showed that factors affecting the quality of life of patients with psoriasis are: age, education level, income, work status, disease severity, bleeding, itching, skin exposure, joint damage, rejection experience, complications, R2=0.696.
8. Pearson correlation analysis showed that the stigma of psoriasis patients and medical coping, social support and quality of life in 0.27 ~ 0.62, the correlation coefficient between the patients with psoriasis skin disease. The quality of life and disease severity, medical coping, social support, stigma, correlation coefficient in 0.23 ~ 0.67.
9. structural equation model (SEM) analysis showed that the severity of the disease has a direct effect on the quality of life (positive) (beta =0.192, P0.01), at the same time also can affect the severity of the stigma and the indirect effects of social support on quality of life; medical coping style can affect the sense of shame or social support indirectly affect the quality of life; shame (beta =-0.642, P0.01) and social support (beta =-0.311, P0.01) has a direct effect on the quality of life. A sense of shame, social support as a mediator (mediated variable) adjusts the relationship between disease severity and quality of life.
conclusion
The Chinese revised scale of 1.FSQ has good reliability and validity.
2. factors affecting the stigma of patients with psoriasis include gender, age, education level, work status, bleeding and itching, skin exposure, the experience of being rejected.
3. the patients with psoriasis "face", "avoid", and "yield" are all higher than the norm.
4., young and old, low education level, no job, low income, serious illness, skin lesions, bleeding, itching, skin lesions exposure, age over 45 years old, complications and rejection experience are risk factors for quality of life in psoriasis patients.
5. the severity, stigma, social support, and medical coping styles have direct and / or indirect effects on the quality of life.
6. the sense of stigma, social support as an intermediary variable to regulate the relationship between the severity of the disease and the quality of life.

【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2010
【分類號(hào)】：R758.63

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