【摘要】：背景年齡相關(guān)性黃斑變性(AMD)是一種慢性、大部分難以治愈的眼底疾病,分為干性及濕性AMD兩種類型。濕性AMD一般進展迅速,會導致嚴重視力損傷,從而嚴重影響患者生活質(zhì)量,并帶來巨大經(jīng)濟負擔。使用標準化視覺相關(guān)生活質(zhì)量量表評估患者視功能成為逐漸普及的方式。國際上應(yīng)用于AMD患者的生活質(zhì)量問卷較多,某一特定問卷的推廣應(yīng)用需經(jīng)過嚴格的語言、文化及心理測量學的驗證。中國大陸尚沒有經(jīng)過驗證的特異性針對AMD患者的生活質(zhì)量問卷。AMD患者因需要長期治療、治療藥物昂貴,從而產(chǎn)生沉重經(jīng)濟負擔。國際上關(guān)于AMD患者經(jīng)濟負擔、醫(yī)療資源利用情況的研究較多,然而中國大陸尚沒有AMD患者經(jīng)濟負擔的定量數(shù)據(jù)。目的對視功能指數(shù)量表VF-14中文版本在中國大陸AMD患者人群中進行修訂及信度效度驗證。獲得中國大陸AMD患者經(jīng)濟負擔定量數(shù)據(jù)。方法1.嚴格按照心理測量學原則,對視功能指數(shù)量表VF-14中文版本在中國大陸AMD患者人群中進行修訂及信度效度驗證。2.通過橫斷面調(diào)查的方式,對患者進行面對面問卷訪問,得到AMD患者部分直接醫(yī)療花費及全部直接非醫(yī)療花費定量數(shù)據(jù)。通過回顧性隊列研究的方式,查閱北京協(xié)和醫(yī)院電子病歷系統(tǒng),得到AMD患者部分直接醫(yī)療花費定量數(shù)據(jù)。3.使用Kruskal-Wallis秩和檢驗分析方法,分析AMD患者經(jīng)濟負擔與視力水平之問的相關(guān)性。結(jié)果137位AMD患者完成了VF-14中文版問卷調(diào)查及經(jīng)濟負擔調(diào)查。根據(jù)統(tǒng)計分析及臨床專家建議,修改VF-14問卷并去掉Q9、Q13及Q14,得到修訂版VF-11R。VF-11R具有較高的內(nèi)部信度,Cronbach's a為0.930；較高的重測信度,Cronbach's a為0.945,組內(nèi)相關(guān)系數(shù)為0.933；較高的分半信度,兩部分的Cronbach's a分別為0.840、0.895。所有信度檢驗p0.01。VF-11R具有較高的結(jié)構(gòu)效度,因子分析提取了2個主成分因子,對總方差的累積解釋72.555%；較高的效標效度,三個全面視覺自我評估問卷中,題目“視力下降帶來的麻煩”,與VF-11R問卷得分是普通負相關(guān)性,題目“對視力滿意度”與VF-11R問卷得分是普通正相關(guān)性,題目“視力總體質(zhì)量”與VF-11R問卷得分是顯著正相關(guān)性。所有效度檢驗p0.01。每個患者年均直接醫(yī)療花費為(44556.37±99208.04)元。其中,年均藥費、檢查費、治療費及掛號費分別占89.47%、5.22%、4.00%及1.31%。每個患者年均直接非醫(yī)療花費為(456.78±10210.73)元。其中,年均路費、食宿費分別占72.45%、27.55%。每個患者年均總體就醫(yī)花費為(49013.15±102082.97)元�；颊咭蛟\治AMD產(chǎn)生的費用,已超出其個人收入,AMD患者平均年花費與年收入的比值為1.33±2.57。不同小數(shù)視力組(雙眼0.5,一眼0.5、一眼≤0.5,雙眼≤0.5)患者之間的直接醫(yī)療花費、直接非醫(yī)療花費、總體花費均無統(tǒng)計學顯著性差異。不同加權(quán)平均視力(weight average logMAR, WMAR; WMAR=0.75×logMAR較佳視力眼視力+0.25×logMAR較差視力眼視力)(0-0.31、-0.32--0.55、-0.56--0.99及-1.00--1.80)患者之間的直接醫(yī)療花費、直接非醫(yī)療花費、總體花費均無統(tǒng)計學顯著性差異。結(jié)論1.首次在中國大陸年齡相關(guān)性黃斑變性(AMD)患者人群中對VF-14中文版進行了修正版的研制,得到VF-11R。VF-11R在中國大陸AMD患者中具有較高的信度和效度；2.首次獲得中國大陸AMD患者經(jīng)濟負擔數(shù)據(jù)。中國AMD患者因疾病治療產(chǎn)生沉重經(jīng)濟負擔,尤以藥費為著。
[Abstract]:Background Age-related macular degeneration (AMD) is a chronic, most difficult-to-cure fundus disease, divided into two types of dry and wet AMD. The rapid progress of wet AMD can lead to severe visual impairment, which seriously affects the quality of life of the patient and has a great economic burden. The standardized vision-related quality of life scale was used to assess the patient's visual function as a way of becoming more popular. The quality of life questionnaire applied to AMD patients is much higher in the world. The application of a particular questionnaire needs to be verified by strict language, culture and psychometrics. The mainland of China does not have a validated quality of life questionnaire for AMD patients. AMD patients are expensive to treat due to the need for long-term treatment, resulting in a heavy economic burden. There are more studies on the economic burden of AMD patients and the utilization of medical resources. However, there is no quantitative data on the economic burden of AMD patients in China. Objective To verify the revision and reliability of the visual function finger number table VF-14 Chinese version in the Chinese mainland AMD patients. To obtain the quantitative data on the economic burden of AMD patients in mainland China. Method 1. In strict accordance with the psychometric principle, the revision and the reliability-effect verification of the visual function finger number table VF-14 Chinese version in the Chinese mainland AMD patient population are carried out. Through a cross-sectional survey, a face-to-face questionnaire was conducted to the patient to obtain part of the direct medical expense and all of the direct non-medical expense quantitative data for AMD patients. Through a retrospective cohort study, the electronic medical record system of Peking Union and Hospital was reviewed to obtain the quantitative data for partial direct medical treatment of AMD patients. The relationship between the economic burden of AMD and the level of vision was analyzed by using the Kruskal-Wallis rank and the test method. Results The VF-14 Chinese version of the questionnaire and the economic burden investigation were completed in 137 patients with AMD. According to the statistical analysis and the clinical expert's suggestion, the VF-14 questionnaire was revised and Q9, Q13 and Q14 were removed to obtain the revised VF-11R.VF-11R with a high internal reliability. The Cronbach's a of the two parts were 0.840, and 0.895, respectively. All the reliability test p0.01. VF-11R had a higher structural efficiency, the factor analysis extracted two principal component factors, the cumulative explanation of the total variance was 72.555%, the higher effect degree, the three comprehensive visual self-assessment questionnaire, the subject 鈥淎 problem with a drop in vision.鈥，

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