PACG患者视觉生活质量和心理状况的临床研究

Vision related quality of life and emotional impact in primary angle-closure glaucoma patients

摘要:

目的:评估原发性闭角型青光眼（primary angle-closure glaucoma，PACG）患者的心理和视觉健康相关生存质量状况,分析青光眼小梁切除手术对其影响。 方法:采用前瞻性随机临床对照的方法, 对42例PACG患者分别采用国家眼科研究视功能问卷（25-item national eye institute visual functioning questionnaire, NEI-VFQ-25）和综合医院焦虑抑郁量表（hospital anxiety and depression scale, HADS）中文版评定患者最近1mo的视觉生活质量和焦虑、抑郁评分，术后1mo再次患者评定焦虑、抑郁情况及视觉生活质量，42例健康自愿者作为对照，分析其心理和视觉健康相关生存质量变化情况。 结果:PACG患者焦虑、抑郁及共患患者发生率分别为23.8%,23.8%和 16.7%。NEI-VFQ-25评分显示患者在视觉健康相关生存质量部分亚功能（10/12）如一般健康、总体视觉、社会功能、心理问题、周边视野和依赖性等均有不同程度的损害(P<0.05)。通过小梁切除手术干预，患者焦虑、抑郁评分明显好转(P<0.05)，视觉健康相关生存质量的样本中位数差值\[41.6(一般健康)、34.5 (眼痛)、32.6 (社会功能)、21.2(心理问题)、24.8(社会活动)、21.8（依赖性）\]，均较手术前明显改善\[10.4(一般健康)、6.4 (眼痛)、10.6(社会功能)、8.3(心理问题)、7.3(社会活动)、6.9（依赖性）；均为P<0.05\]。 结论: PACG患者焦虑、抑郁状况加重，视觉健康相关生存质量明显降低。小梁切除术有助于患者视觉生活质量和心理康复。

Abstract:

AIM: To evaluate the vision related quality of life (VRQOL) and anxiety and depression symptoms and investigate its changes in primary angle-closure glaucoma (PACG) by trabeculectomy interventions. METHODS: The present study included 42 PACG patients.A healthy control group(n=42)sociodemografically matched to the group was established. The VRQOL and anxiety and depression symptoms were evaluated and analyzed on the pre-operative and post-operative month 1 by using two instruments. Instruments applied included the NEI-VFQ-25 and Hospital Anxiety and Depression Scale (HADS). RESULTS: The incidence of anxiety, depression, anxiety combined depression in comitant constant esotropia patients was 23.8%, 23.8%, 16.7%, respectively. Compared with control subjects, PACG patients showed significantly impaired disease-specific VRQOL in 10 out of 12 subscales, including ‘General Health’, ‘General Vision’ , ‘Ophthalmological pain’, ‘Social Functioning’, ‘Distance vision’, ‘Mental Problems’ , ‘Peripheral Vision’, ‘Near vision’ , ‘ Social role’ and ‘Dependency’ (P<0.05)．Compared with pre-operative values, significant improvements were noted after surgery in NEI-VFQ summary score, anxiety and depression scores (P<0.05). The VRQOL of PACG patients improved at 1 month after second surgery compared with those of pre- surgery：MD=41.6(General Health), 34.5(Ophthalmological pain), 32.6(Society Functioning), 21.2(Mental Problems), 24.8 (Social Activities), 21.8(Dependency) \[F=10.4(General Health), 6.4 (Ophthalmological pain), 10.6 (Society Functioning), 8.3 (Mental Problems), 7.3 (Social Activities), 6.9(Dependency)；P<0.05\]. CONCLUSION: PACG patients were affected in mentation and VRQOL while surgery interventions can improve VRQOL, anxiety and depression in strabismus patients.