Research On Quality Of Life Based On Assessment Of Clinical Curative Effect Of Renal Transplantation Patients Taking Immunosuppressant

Research objectiveTo make an investigation to postoperative patients who have had a renal transplantation operation, divide patients into two groups based on which immunosuppressant they have taken—either cyclosporine or tacrolimus, apply quality of life indexes to assess clinical efficacy of cyclosporine and tacrolimus respectively, then accordingly to provide instructions for clinical rational use of medicines and obtain preferable therapeutic effect.Objects and methodsUtterly random design is applied in this experiment. All samples taken for this experiment are based on practical situation of taking medicine, to take out two groups for samples at the rate of 1:2 for patients taking cyclosporine to tacrolimus i.e. 75 take cyclosporine and 150 take tacrolimus. The on-site questionnaire has been completed from December 2007 to June 2008. All respondents are postoperative patients, who have had a renal transplantation operation in Nanfang Hospital and are in stable prognosis status. 225 questionnaires have been handed out and 192 have been taken back, with the rate 85.3%. thereinto, valid questionnaires are 186, with the rate 96.9%.Content of the adopted questionnaire involves: general information, health-ralated quality of life measurement scale—self-rated health measurement scale (SRHMS V1.0).EpiData3.02 data management software is used to manage the data in the investigation. SPSS15.0 software is used to analyze the data, and the statistics methods include: descriptive analysis,chi-square test independent sample t inspection.Result1. Comparison of self-rated health scores gained by renal transplantation patients taking two kinds of immunosuppressant—cyclosporine and tacrolimus finds the discrepancy among scores on physiological health dimension, psychological health dimension and social health dimension and scale total scores has no statistical sense. It is suggested there is no differences on survival quality among renal transplantation patients taking cyclosporine and tacrolimus, which are similar in curative effect.2. Comparison of self-rated health scores gained by respectively male or female patients taking two kinds of immunosuppressant finds the discrepancy among scores of each dimension and scales total scores has no statistical sense. It is revealed that curative effect of cyclosporine and tacrolimus are not impacted by gender.3. If dividing renal transplantation patients into three groups according to different ages, only the discrepancy of the group no more than 40 years old taking cyclosporine or tacrolimus in role activity and social adaptation dimension has statistical sense (P=0.044) , which reveals cyclosporine is superior to tacrolimus in the two factors. Perhaps physical fitness of middle-aged or young patients no more than 40 years old is good enough to repel adverse reaction brought by cyclosporine. While in the two groups over 40 years old, the effect of cyclosporine and tacrolimus to quality of life has no statistical sense.4. In the course of taking cyclosporine or tacrolimus, in terms of quality of life, renal transplantation patients applied associated therapeutic schedule has no statistical sense in curative effect. While the discrepancies of renal transplantation patients taking cyclosporine or tacrolimus exclusively in terms of scores for physical function dimension, positive emotion dimension, role activity and social adaptation dimension have statistical sense (P < 0.05) . It shows among renal transplantation patients not simultaneously taking drugs, patients taking cyclosporine are superior to patients taking tacrolimus in terms of physical function, positive, role activity and social adaptation.5. The discrepancies of Family per capita monthly income to renal transplantation patients taking cyclosporine or tacrolimus in terms of scores for self-rate health, scores for physiological, psychological and social dimensions and total scores have no statistical sense. It shows family per capita income has no effect on self-rated health index of patients taking the two kinds of drugs.6. This study shows once renal transplantation operation is successful, the discre-pancy of the two groups for renal transplantation patients less than 2 years after the operation in daily activities has no statistical sense (P=0.000). It reveals score of tacr-olimus are superior to that of cyclosporine in daily life activities. As to renal transpla-ntation patients over 7 years after the operation, the discrepancy of the two groups in social support dimension has statistical sense (P=0.022), and it reveals that social sup-port level of cyclosporine is superior to that of tacrolimus. 7. Comparison between cyclosporine and tacrolimus in terms of expenses, effect, frequency of discomfort and time and dosage finds discrepancy between the two has no statistical sense.8. The discrepancies of average monthly dosage and expenses of cyclosporine and tacrolimus have statistical sense (P<0.01) . Clinically, dosage of cyclosporine is far larger than that of tacrolimus and specifications are entirely different between the two. This study reveals although average monthly dosage of cyclosporine is nearly 32 times to that of tacrolimus, average monthly expense of cyclosporine is only 1/2 of that of tacrolimus, thus, cyclosporine has economically overwhelming superiority in price comparing with tacrolimus.9.In this study, utility index of renal transplantation patients taking immunosupp-ressant is set at the average value of the total scores of self-rated health measurement scale. Cost-effectiveness ratios are 6.70 and 12.74 respectively and the curative cost-effectiveness ratios of the two groups reveal cyclosporine group is lower than tacrolimus group. According to the conclusion in this study, there are no discrepancies in patients in the two groups in terms of scores on physiological health, psychological health, and social health and total scores, and the curative effect of the two medicines are basically the same. Based on it, it is suggested that cyclosporine has better therapeutic schedule.Conclusion1. Through this study, there is no difference in the influence of cyclosporine and tacrolimus on total scores of quality of life of renal transplantation patients of cyclosporine and tacrolimus and curative effects are basically the same. There is no difference in physiology, psychology and social health and the total scores of renal transpla- ntation patients taking other medicines simultaneously; for renal transplantation patients taking immunosuppressant, the group taking cyclosporine is superior to the other group taking tacrolimus in terms of physical activity function, positive emotion, role activity and social fitness.2. This study reveals quality of life of taking cyclosporine and tacrolimus is not influenced by sex and family per capita income and they have the same curative effect.3. This study reveals the group taking cyclosporine is superior to the other group taking tacrolimus in terms of role activity and social fitness among renal transplantation patients younger than 40.4. This study reveals among renal transplantation patients less than 2 years after the operation, the group taking cyclosporine is superior to the other group taking tacrolimus in daily life function; among renal transplantation patients more than 7 years after the operation, the group taking cyclosporine is superior to the other group taking tacrolimus in social support.5. This study reveals average monthly dosage of cyclosporine taken by renal transplantation patients is larger, while average monthly expense is 1/2 of that of tacrolimus, besides, cyclosporine is clinically effective and low in price. Thus, if renal transplantation patients have better tolerance to cyclosporine, considering both curative effect and economy, it is recommended to choose cyclosporine.6. This study reveals the cost-effectiveness ratio of the two groups shows cyclosporine group is obviously lower than tacrolimus group. Thus, on the basis of approximation in curative effect of the two medicines, cyclosporine is suggested to have better therapeutic schedule. Characteristics or innovations1. In This study, quality of life index related to health is first used in China to evaluate clinical curative effect of renal transplantation patients taking cyclosporine and tacrolimus.2. The self-rated health measurement scale used in this questionnaire is a scale related to health broadly used in China at present. It bases on the basic condition of our country and cultural background, complies with conversion of biomedical mode, takes in the updated outcome on human science and has preferable reputation, efficiency and feedback.3. In this questionnaire, the fitness level of patients to medicines and responsible index to personal feelings, namely recognition of medicines have been added in, which is an innovation.Limitation and consideration of further research1. Limited by research conditions and time, this questionnaire place an emphasis upon patients who have had the renal transplantation operation in Nanfang Hospital and have stable prognosis. Whether the research results are representative to the existing medication situation of renal transplantation patients in other cities remains to be studied and demonstrated.2. This research belongs to a transect research, thus the conclusion obtained is limited and a further experiment remains to be performed.Henceforth, research results will be more representative if we increase sample cities, expand amount of samples in the investigation, assort renal transplantation patients into different levels or different regional hospitals and launch a horizontal resea- rch. It is also recommended to have a long-term investigation by means of irregular visits to the same batch of respondents, compare quality of life of patients taking immunosuppressant periodically and go deeper into the research vertically.