老年皮肤瘙痒症患者生活质量及其影响因素.pdf

临床研究老年皮肤瘙痒症患者生活质量及其影响因素唐荣新,黄永青,吴婷(澄迈县人民医院医共体总院皮肤科,海南 澄迈 571900)【摘 要】目的 研究老年皮肤瘙痒症患者生活质量及其相关影响因素。方法将澄迈县人民医院医共体总院 2021 年6 月至 2022 年 6 月收治的 140 例老年皮肤瘙痒症患者纳为研究对象,采用皮肤病生活质量指数(DLQI)进行评估,并采用二元logistic 回归模型分析影响患者生活质量的相关因素。采用 SPSS 19.0 软件进行数据分析。组间比较采用2检验。结果 老年皮肤瘙痒症患者 DLQI 量表中症状感受维度均分最高(1.510.36)分,其次是工作学习(1.370.21)分,量表总得分为(10.272.38)分,疾病对15.71%(22/140)的患者的生活造成了轻度影响,对 62.86%(88/140)的患者的生活造成了中度影响,对14.29%(20/140)的患者的生活造成较大与极大影响。行二元 logistic 回归分析提示,老年皮肤瘙痒症症病程(OR=2.201,95%CI 1.7432.779)、单次瘙痒持续时间(OR=1.756,95%CI 1.1612.655)、伴随症状(OR=3.404,95%CI 1.15210.063)、瘙痒部位(OR=4.716,95%CI 1.88111.825)、皮损面积(OR=1.744,95%CI 1.1442.658)、瘙痒程度(OR=2.199,95%CI 1.6103.003)、焦虑(OR=2.349,95%CI 1.2504.415)及睡眠障碍(OR=1.952,95%CI 1.1823.224)是影响患者生活质量的独立因素(P0.05)。结论 老年皮肤瘙痒症症会对患者生活质量产生不同程度的不良影响,而病程长、瘙痒症状严重、隐私处瘙痒、合并焦虑及睡眠障碍,是影响患者生活质量的独立因素。提示临床除了积极采取措施缓解患者瘙痒症状外,还需关注患者不良情绪及睡眠障碍问题。【关键词】老年人;皮肤瘙痒;生活质量;影响因素【中图分类号】R758.3 【文献标志码】A 【DOI】10.11915/j.issn.1671-5403.2023.10.159收稿日期:2023-04-11;接受日期:2023-05-24基金项目:海南省卫生健康行业科研项目(20A200108)通信作者:唐荣新,E-mail:tangrongxin30 Life quality and its influencing factors in elderly patients with pruritusTang Rongxin,Huang Yongqing,Wu Ting(Department of Dermatology,General Hospital of Medical Community of Chengmai People s Hospital Alliance,Chengmai 571900,Hainan Province,China)【Abstract】Objective To study the quality of life and its influencing factors in the elderly patients with pruritus.Methods A total of 140 elderly patients with pruritus admitted to the General Hospital of Medical Community of Chengmai People s Hospital from June 2021 to June 2022 were enrolled as the study subjects.The patients were evaluated using dermatology life quality index(DLQI),and the factors affecting their quality of life were analyzed by binary logistic regression model.SPSS 19.0 was used for data analysis.inter group comparison was perfomed using 2 test.Results The mean DLQI score in the elderly patients with pruritus was the highest at(1.510.36)points for symptom perception,followed by(1.370.21)points for work and study.The total DLQI score was(10.272.38)points,and the disease had a mild impact on the life of 15.71%(22/140)patients,a moderate impact on the life of 62.86%(88/140)patients and a huge or very huge impact on the life of 14.29%(20/140)patients.Binary logistic regression analysis indicated that the course of pruritus(OR=2.201,95%CI 1.743-2.779),duration of single pruritus(OR=1.756,95%CI 1.161-2.655),accompanying symptoms(OR=3.404,95%CI 1.152-10.063),pruritus site(OR=4.716,95%CI 1.881-11.825),lesion area(OR=1.744,95%CI 1.144-2.658),pruritus degree(OR=2.199,95%CI 1.610-3.003),anxiety(OR=2.349,95%CI 1.250-4.415)and sleep disorders(OR=1.952,95%CI 1.182-3.224)were independent factors affecting the patients quality of life(P7 分即存在睡眠障碍。1.2.5 医学应对方式 采用医学应对方式10进行调查,分为面对、回避、屈服等 3 个方面,得分最高的维度为患者对待疾病所倾向选择的应对方式。1.2.6 基线资料调查调查被研究者年龄、性别、居住地、病程、疾病诱因、单次瘙痒持续时间、伴随症状(灼热感、出汗、疼痛感等)、瘙痒部位(分为头面部、躯体、四肢及生殖器)、皮损面积。其中皮损面积采用九分法计算,用患者合拢手指时整个掌部的面积即相当于自身体表面积的 1%,皮损面积10%为重度。1.3 统计学处理 采用 SPSS 19.0 统计软件进行数据分析。计数资料用例数(百分率)表示,采用2检验。采用二元logistic 回归模型分析影响患者生活质量的相关因素。P0.05 为差异有统计学意义。2 结 果2.1 老年皮肤瘙痒症患者生活质量统计 老年皮肤瘙痒症患者 DLQI 量表中症状感受维度均分最高,其次是工作学习,详见表 1。疾病对 7.14%(10/140)的患者无影响,疾病对 15.71%(22/140)的患者的生活质量造成了轻度影响,对 62.86%(88/140)的患者的生活质量造成了中度影响,对 14.29%(20/140)的患者的生活造成较大与极大影响。将无影响及轻度影响者一同纳为生活质量良好组(n=32),其余患者纳为生活质量不佳组(n=108)。表 1 老年皮肤瘙痒症患者生活质量统计Table 1 Statistics of quality of life in elderly patients with pruritus(points,xs)DimensionScoreAverage score of each dimensionRankingSymptom perception3.020.351.510.361Daily life1.850.290.930.223Recreational activity1.760.220.880.195Work and study1.370.191.370.212Individual activity1.840.210.920.164Treatment situation0.430.080.430.116Total score10.272.38-:no datum.2.2 影响老年皮肤瘙痒症患者生活质量的单因素分析 分析发现,病程、单次瘙痒持续时间、伴随症状、瘙痒部位、皮损面积、瘙痒程度、焦虑及睡眠障碍是影响患者生活质量的相关因素(P0.05;表 2)。2.3 影响老年皮肤瘙痒症患者生活质量的多因素回归分析 将单因素分析有意义的指标纳入二元 logistic 回归模型作为自变量,老年皮肤瘙痒症患者生活质量作为因变量,行二元 logistic 回归分析提示,病程、单次357中华老年多器官疾病杂志 2023年10月28日 第22卷 第10期 Chin J Mult Organ Dis Elderly,Vol.22,No.10,Oct 28,2023瘙痒持续时间、伴随症状、瘙痒部位、皮损面积、瘙痒程度、焦虑及睡眠障碍是影响老年皮肤瘙痒症患者生活质量的独立因素(P75 years13(40.63)50(46.30)Gender1.2450.265 Male13(40.63)56(51.85)Female19(59.38)52(48.15)Residence0.0950.758 Urban area11(34.38)34(31.48)Rural area21(65.63)74(68.52)Course of disease12.175 0.001 1 year12(37.50)77(71.30)1 year20(62.50)31(28.70)Disease inducement0.1150.944 Primary disease8(25.00)25(23.15)Internal medicine6(18.75)23(21.30)No obvious inducement18(56.25)60(55.56)Duration of single 25.156 0.001 pruritus(min)3011(34.38)9(8.33)Accompanying symptoms4.3910.036 Yes23(71.88)55(50.93)No9(28.13)53(49.07)Pruritus site35.746 0.001 Head and face4(12.50)19(17.59)Body20(62.50)77(71.30)Limbs19(59.38)61(56.48)Genitalia16(50.00)19(17.59)Lesion area8.8040.012 10%7(21.88)7(6.48)Medical coping style4.1280.127 Facing7(21.88)32(29.63)Avoiding10(31.25)46(42.59)Yielding15(46.88)30(27.78)Pruritus degree12.9290.002 0-1 point2(6.25)42(38.89)2-3 points19(59.38)47(43.52)4-5 points11(34.38)19(17.59)Anxiety5.9650.015 Yes18(56.25)35(32.41)No14(43.75)73(67.59)Depression0.3540.552 Yes10(31.25)28(25.93)No22(68.75)80(74.07)Sleep disorders5.4010.020 Yes13(40.63)22(20.37)No19(59.38)86(79.63)3 讨 论 由于老年人皮肤生理功能退化,皮肤形态、机体免疫的改变,其各类皮肤病患病风险高于其他年龄段11。老年皮肤瘙痒症是老年人群中较为活跃的瘙痒性疾病。有学者指出,长时间的瘙痒症状将引起与疼痛相似的不适感12,故老年皮肤瘙痒症患者生活质量普遍下降。本研究调查发现,老年皮肤瘙痒症对 62.86%(88/140)的患者的生活造成了中度影响,而对 14.29%(20/140)的患者的生活造成较大与极大影响。与既往研究结论相似13。随着国民经济水平及医疗条件的不断提高,生活质量也成为新的医学背景下疾病控制效果的评估标准之一。王智斌等14研究表示,经对症治疗,减轻老年皮肤瘙痒症患者瘙痒程度、减少瘙痒持续时间及其伴随症状后,患者生活质量均得到明显提升。本研究也证实单次瘙痒持续时间、伴随症状、瘙痒程度以及皮损面积均是影响患者生活质量的相关因素,说明积极用药,有效改善瘙痒症状,是提高患者生活质量的关键。此外,生殖器瘙痒患者生活质量更低,这与隐私处瘙痒将导致患者不好意思倾诉、抓瘙甚至就医相关。故应加强健康宣教,降低患者心理负担,注意保护患者就诊时隐私,增强患者治疗安全感。老年皮肤瘙痒症具有反复发作、病情迁延等特点。本研究发现,病程超过 1 年的患者生活质量所受到的影响更大。这与病情反复发作、病程长的患者受到的折磨更多、情绪及心态更为消极、进而降低生活质量相关。故对于病程较长的老年皮肤瘙痒症患者的干预,除了积极寻找病因、减轻瘙痒症状外,还需从提供更多心理支持入手,改善其生活质量。瘙痒症长期存在还将引起焦虑、烦躁、紧张等一系列精神症状15。而各种不良情绪会进一步影响机体各器官及系统功能,降低生活质量。本研究发现,焦虑是影响患者生活质量的相关因素。故在老年皮肤瘙痒症的治疗中,还需关注其是否存在焦虑情绪,并采用科学的方法对患者不良情绪进行疏导。睡眠是保障机体修复的重要生理过程,睡眠障碍可能会导致情绪失调、免疫力下降、消化功能紊乱,进一步影响老年性瘙痒症患者生活质量。故对存在睡眠障碍的患者,除针对瘙痒的治疗外,还需对其睡眠障碍进行干预。457中华老年多器官疾病杂志 2023年10月28日 第22卷 第10期 Chin J Mult Organ Dis Elderly,Vol.22,No.10,Oct 28,2023表 3 影响老年皮肤瘙痒症患者生活质量的多因素回归分析Table 3 Multivariate regression analysis of life quality of elderly patients with pruritusFactorSEWald2ORP value95%CICourse of disease0.7890.11943.9602.2010.0011.743-2.779Duration of single pruritus0.5630.2117.1201.7560.0081.161-2.655Accompanying symptoms1.2250.5534.9073.4040.0271.152-10.063Pruritus site1.5510.46910.9364.7160.0011.881-11.825Lesion area0.5560.2156.6881.7440.0101.144-2.658Pruritus degree0.7880.15924.5622.1990.0011.610-3.003Anxiety0.8540.3227.0342.3490.0081.250-4.415Sleep 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