【摘要】：目的:1.調(diào)查葡萄膜炎患者治療后的視覺相關(guān)生活質(zhì)量(VRQoL),分析其與視功能之間的關(guān)系及其影響因素。2.比較不同葡萄膜炎患者治療后的視覺相關(guān)生活質(zhì)量有無差異。3.調(diào)查葡萄膜炎患者的心理健康狀況,并分析葡萄膜炎患者的心理狀況與視覺相關(guān)生活質(zhì)量的相互關(guān)系。4.分析視覺相關(guān)生活質(zhì)量在眼科疾病應(yīng)用中的意義。方法:1.自2015年12月至2017年2月間,收集就診于天津市眼科醫(yī)院的葡萄膜炎患者104例。將所有患者分兩組,第一組進(jìn)行視覺相關(guān)生活質(zhì)量問卷調(diào)查;第二組患者進(jìn)行視覺相關(guān)生活質(zhì)量與心理狀態(tài)的問卷調(diào)查研究。2.第一組葡萄膜炎患者50例。所有患者均進(jìn)行眼科檢查,明確診斷,且患者符合入選標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)。所有入選者均被征得知情同意后,采用視覺相關(guān)生活質(zhì)量量表(NEI-VFQ-25)中文版進(jìn)行問卷調(diào)查。3.第二組葡萄膜炎患者54例,同樣接受眼科相關(guān)檢查,符合納入標(biāo)準(zhǔn)后,進(jìn)行問卷填寫調(diào)查。4.問卷調(diào)查:對患者的一般資料及相關(guān)病情進(jìn)行記錄,告知患者問卷的目的,所有患者在同一醫(yī)師的監(jiān)督下完視覺成兩個(gè)量表的填寫。5.應(yīng)用SPSS 18.0統(tǒng)計(jì)軟件對葡萄膜炎患者的VRQoL評分進(jìn)行統(tǒng)計(jì)分析,對量表中總分及各亞項(xiàng)得分用均數(shù)±標(biāo)準(zhǔn)差(_x±s)描述其平均水平和離散程度。所有患者的一般情況進(jìn)行分組,采用獨(dú)立樣本t檢驗(yàn)進(jìn)行比較,應(yīng)用Pearson相關(guān)分析法分析VRQoL評分與不同類型炎癥和視力損害程度之間的關(guān)系,應(yīng)用相關(guān)分析法分析視覺相關(guān)生活質(zhì)量與心理狀況的關(guān)系。以p≤0.05作為差異有統(tǒng)計(jì)學(xué)意義的界限。結(jié)果:(一)葡萄膜炎患者生活質(zhì)量比較1.不同疾病特征生活質(zhì)量比較:對患者一般資料分組進(jìn)行分析,合并全身疾病的患者的整體健康(21.6±14.0/47.3±23.9)有統(tǒng)計(jì)學(xué)意義(p=0.000),45歲及以上患者在總體視力、近距離活動(dòng)、遠(yuǎn)距離活動(dòng)、社會(huì)活動(dòng)、精神健康、依賴性和色覺亞項(xiàng)以及總分差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。2.不同疾病類型患者生活質(zhì)量比較:單眼受累和雙眼受累組在總體視力、近距離活動(dòng)、遠(yuǎn)距離活動(dòng)、社會(huì)活動(dòng)、駕駛車輛、色覺、周邊視力以及總均分差異有統(tǒng)計(jì)學(xué)意義(t=2.51~3.68,p0.05)。有無眼部并發(fā)癥患者除外總體健康、總體視力及社會(huì)活動(dòng)差異無統(tǒng)計(jì)學(xué)意義外(t=0.67~1.92,p0.05),其余亞項(xiàng)差異均有統(tǒng)計(jì)學(xué)意義(t=2.850~3.163,p0.05)。任一眼視力低于0.3的患者組與雙眼視力優(yōu)于0.3者除整體健康及眼痛項(xiàng)無統(tǒng)計(jì)學(xué)意義外(t=0.67~1.64,p0.05),其余各亞項(xiàng)差異均有統(tǒng)計(jì)學(xué)意義(t=2.50~4.72,p0.05)。3.相關(guān)分析比較:對患者視力損害與VRQoL得分進(jìn)行相關(guān)分析,顯示除整體健康和眼痛無相關(guān)外(p0.05),其余多項(xiàng)與眼部視力損害呈負(fù)相關(guān)(r=-0.45~-0.54,p0.05)。有眼部并發(fā)癥的患者除整體健康、眼痛、社會(huì)活動(dòng)和周邊視力無相關(guān)外(p0.05),其余各項(xiàng)均與VRQoL得分呈負(fù)相關(guān)(r=-0.29~0.40,p0.05)。年齡與各亞項(xiàng)進(jìn)行相關(guān)分析,除整體健康無相關(guān)外(p0.05),其余各項(xiàng)均與年齡呈負(fù)相關(guān)(r=-0.29~-0.49,p0.05)。(二)葡萄膜炎患者焦慮和抑郁比較1.焦慮抑郁得分:所有患者焦慮平均得分為4.63±3.73,抑郁平均得分為3.73±3.53。焦慮及抑郁患者各為9例,陽性率為17.6%。2.將葡萄膜炎患者的焦慮、抑郁得分與VRQoL總均分分別進(jìn)行相關(guān)分析,發(fā)現(xiàn)焦慮得分與總均分呈負(fù)相關(guān)關(guān)系,r值為-0.587,p0.01。抑郁得分與總均分呈負(fù)相關(guān)關(guān)系,r值為-0.617,p0.01。結(jié)論:1.葡萄膜炎患者的視覺相關(guān)生活質(zhì)量普遍較低,葡萄膜炎對患者的生活質(zhì)量產(chǎn)生了較嚴(yán)重的影響。2.葡萄膜炎患者的視力損害越嚴(yán)重,其視覺相關(guān)生活質(zhì)量得分越低。說明葡萄膜炎患者的視力損害嚴(yán)重影響了患者的日常生活質(zhì)量。3.葡萄膜炎視力損害、眼部并發(fā)癥、年齡與患者的視覺相關(guān)生活質(zhì)量都有一定的相關(guān)關(guān)系。患者年齡越大,VRQoL得分越低。無眼部并發(fā)癥患者得分較高。4.葡萄膜炎患者有一定程度的焦慮和抑郁改變,并且與視覺相關(guān)生活質(zhì)量呈負(fù)相關(guān),說明焦慮和抑郁是影響葡萄膜炎患者生活質(zhì)量的因素。5.NEI-VFQ-25問卷能敏感地反映和評價(jià)葡萄膜炎患者的VRQoL及其相關(guān)因素。6.根據(jù)葡萄膜炎患者視覺相關(guān)生活質(zhì)量以及心理狀態(tài)的改變,提示我們在治療葡萄膜炎疾病的同時(shí)應(yīng)關(guān)注葡萄膜炎患者的生活質(zhì)量和心理狀態(tài)。
[Abstract]:Objective: 1. To investigate the visual-related quality of life (VRQoL) in patients with uveitis after treatment, and to analyze the relationship between VRQoL and visual function and its influencing factors. 2. To compare the differences of visual-related quality of life among different uveitis patients after treatment. 3. To investigate the mental health status of patients with uveitis and analyze the psychological status of patients with uveitis. Methods: 1. From December 2015 to February 2017, 104 patients with uveitis were collected from Tianjin Ophthalmological Hospital. All patients were divided into two groups. The first group was given a questionnaire survey on the quality of life related to vision. Patients in the second group were investigated with visual-related quality of life and psychological status questionnaire. 2. 50 patients with uveitis in the first group. All patients underwent ophthalmic examinations to confirm the diagnosis, and the patients met the inclusion criteria and exclusion criteria. Chinese version of the questionnaire survey. 3. The second group of 54 patients with uveitis, the same ophthalmic examination, in line with the inclusion criteria, to fill in the questionnaire survey. 4. Questionnaire survey: the general information of patients and related conditions were recorded to inform patients of the purpose of the questionnaire, all patients under the supervision of the same physician completed two scales. The VRQoL scores of patients with uveitis were analyzed by SPSS 18.0 statistical software. The total scores and the sub-items of the scale were described by mean (x s) standard deviation (x s). The general conditions of all patients were grouped and compared by independent sample t test and Pearson correlation analysis. The relationship between VRQoL score and different types of inflammation and visual impairment was analyzed, and the relationship between visual-related quality of life and mental status was analyzed by correlation analysis. The general data were grouped and analyzed. The overall health of the patients with systemic diseases was statistically significant (p = 0.000). There were significant differences in the overall visual acuity, brachytherapy, teleactivity, social activity, mental health, dependence, color perception sub-items and total scores between the patients aged 45 and over (p 0.05). Quality of life of patients with different types of diseases: there were significant differences in overall visual acuity, short-distance activity, long-distance activity, social activity, driving vehicles, color vision, peripheral visual acuity and total mean score between unilateral and binocular involvement groups (t = 2.51-3.68, p0.05). No significant difference was found in the other sub-items (t = 2.850-3.163, p0.05). No significant difference was found between the patients with visual acuity less than 0.3 and those with binocular visual acuity better than 0.3 (t = 0.67-1.64, p0.05), except for overall health and eye pain (t = 2.50-4.72, p0.05). Correlation analysis and comparison: The correlation analysis between visual impairment and VRQoL score showed that there was no correlation between overall health and eye pain (p0.05), and many other visual impairments were negatively correlated (r = - 0.45 ~ - 0.54, p0.05). Patients with eye complications had no correlation except overall health, eye pain, social activities and peripheral vision (p0.05). Age was negatively correlated with VRQoL score (r=-0.29-0.40, p0.05). Age was negatively correlated with age (r=-0.29-0.49, p0.05) except for overall health (p0.05). The other items were negatively correlated with age (r=-0.29-0.49, p0.05). (2) Comparison of anxiety and depression in patients with uveitis 1. Anxiety and depression score: the average anxiety score of all patients was 4.63 + 3.73, and depression was flat. The average score of anxiety and depression was 3.73 (+3.53). The positive rate of anxiety and depression was 17.6%. 2. Correlation analysis between anxiety and depression scores and the total average score of VRQoL showed that anxiety score was negatively correlated with the total average score, r value was - 0.587, P 0.01. Depression score was negatively correlated with the total average score, R value was - 0.617, P 0.01.Conclusion: 1. The visual-related quality of life of uveitis patients is generally low, uveitis has a more serious impact on the quality of life of patients. 2. The more serious the visual impairment of uveitis patients, the lower the score of visual-related quality of life. The older the patient is, the lower the VRQoL score is. The higher the score is in patients without eye complications. 4. The patients with uveitis have a certain degree of anxiety and depression changes, and have a negative correlation with the quality of vision-related life, indicating anxiety. The NEI-VFQ-25 questionnaire can sensitively reflect and evaluate VRQoL and its related factors in patients with uveitis. 6. According to the changes of visual-related quality of life and psychological status in patients with uveitis, we should pay attention to uveitis while treating uveitis. People's quality of life and mental state.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R773.9

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