Quality of life among pulmonary tuberculosis patients under treatment in Eastern Taiwan

台灣東部肺結核病患治療期間生活品質的變化

Objectives: We evaluate the quality of life (QOL) among tuberculosis (TB) patients during different treatment periods. Methods: We conducted a population based cohort study in Eastern Taiwan. The short version of the World Health Organization quality of life (WHOQOL) question­naire was administered to TB patients under treatment at 3 periods: during an initial treatment period, at a 2-month treatment period, and after a 6-month treatment period. Results: 140 TB patients were interviewed after approval by institutional review boards and interviewee informed consents. The average age of the patients was 48.9 years (SD=18.9 years) and more than half of them were men. Physical domain scores decreased significantly from the initial treatment to the 2-month anti-TB treatment (12.517 ± 2.832, 11.667 ± 3.179, p<.001), and then increased after a 6-month treatment (12.691 ± 2.903). Social domain scores also significantly decreased from the initial treatment to the 2-month anti-TB treatment (13.618 ± 2.685, 12.899 ± 2.953, p<.05), and then increased after 6 months of treatment (13.900 ± 2.552).While controlling probable factors af­fecting the 4 domain scores related to QOL, drugs related hepatitis reduced physical (β = 2.3700, p < .001), psychological (β = 2.633, p < .001), social (β = 4.135, p < .001), and environmental do­main scores (β = 3.449, p < .001) and blurred vision significantly reduced physical (β = 2.290, p < .001), psychological (β = 2.127, p < .001), social (β = 1.075, p < .05), and environmental domain scores (β = 1.587, p < .01). Physical domain scores significantly decreased as age increased per 10-year (β = 0.39, p < .01). The patients employed exhibited significantly higher scores of physi­cal, social, and environmental domains compared than those who were unemployed (β = 0.959, p < .05, β = 0.815, p < .05, and β = 0.852, p < .05 respectively). The patients with a higher income showed fewer scores of psychological domain (β = 2.029, p < .01) compared than those who having a lower income. Conclusions: TB affected individual health and QOL, although patients underwent effective treatment. Healthcare workers should be concerned regarding the adverse re­actions of anti-TB drugs.

目標：評估肺結核病患在不同治療時期的生活品質。方法：本研究以台灣東部民眾為基礎的世代研究。採用世界衛生組織健康相關生活品質簡明版問卷，針對台灣東部地區初診斷的肺結核病患進行研究，研究分三階段追蹤研究，第一階段是開始治療時，第二階段是治療二個月治療時，及第三階段是治療六個月時，分別進行面對面問卷調查。結果：本研究經人體試驗委員會通過，並取得病人知情同意後進行。共有140位肺結核病患，男性為多，平均年齡為48±18.9歲。整體生理範疇從第一階段開始治療時至第二階段下降到最低（12.517±2.832分，11.667±3.179分，p＜.001），到第三階段治療六個月時才回升（12.691±2.903分）。社會範疇也是從第一階段開始治療時至第二階段下降到最低（13.618±2.685分，12.899±2.953分，p＜.05），到第三階段治療六個月時才回升（13.900±2.552分）。當控制可能干擾變項，病患因藥物引起的肝炎比起沒有肝炎者顯著降低生理範疇（β=2.370，p＜.001）、心理範疇（β=2.633，p＜.001）、社會範疇（β=4.135，p＜.001）及環境範疇（β=3.449，p＜.001）。病患因藥物引起的視力模糊比起沒有視力模糊者顯著降低生理範疇（β=2.290，p＜.001）、心理範疇（β=2.127，p＜.001）、社會範疇（β=1.075，p＜.05）及環境範疇（β=1.587，p＜.01）。生理範疇隨著年齡每增加10歲顯著下降0.39分（β=0.39，p＜.01）。有工作的病人比起沒有工作的病人有顯著較高的生理範疇、社會範疇及環境範疇（分別為β=0.959，p＜.05，β=0.815，p＜.05，β=0.852，p＜.05）。每月高收入的病患比起收入低的病患有比較低的心理範疇分數（β=2.029，p＜.01）。結論：肺結核病不僅影響個人健康，而且影響生活品質。健康照護者除了關心病患服藥的順從性，更應謹慎注意及處理藥物的副作用。