| Part OneStudy of health-related quality of life and the influence factors in patients with acquired aplastic anemiaBackgroundAplastic anemia is a set of bone marrow hematopoietic function exhaustion syndrome caused by a variety of causes,which is characterized by reduced bone marrow hematopoietic cell proliferation and peripheral blood cells.Anemia,bleeding and infection are primary performance of clinic[1].However,the exact cause is not clear,it may be related to chemical drugs,radiation,viral infections and genetics.Many studies found that the pathogenesis of aplastic anemia is related to immunological anomaly,hemotopoitic micro-environment defective,number and/or functional defects of hematopoietic stem/progenitor cell and genetic level anomaly.The disease is mainly found in young adults and there are two peak periods,15-25 years old and above 60 years old.Studies also found the male has a higher potential to be involved than the.There are two groups of aplastic anemia,one group caused by congenital factor which is rare occurred and the other group is acquired after birth which is commonly occurred in clinic.According to the severity of illness,there are severe type,extreme type and non-severe type.Its treatment includes supportive treatment and targeted treatment.[2].This paper aims at the study of acquired aplastic anemia.As a disease of chronic,the treatment of acquired aplastic anemia depends on and long-term use of drug which threats human health and causes high cost for patients,thus affects the quality of personal and family life.The disease itself is characterized by various clinical manifestations and adverse reactions,thus not only has a certain effect on the patient’s physiology,moreover,it is also a negative stimulus to the patient’s psychology,life style and social role.It raises a lot of social problems,thus,the overall quality of life of patients decreased to large extent.With the development of pathogenesis research,drug exploitation,reinforcement of supportive treatment and coverage of health insurance,more and more patients can be actively treated,make the patients in the condition of long-term surviva,for this kind of patients,the purpose of treatment is not merely to prolong the life or raise the cure rate,it’s about quality of life,the physical,psychological and social rehabilitation of the patient is equally important.As the medical model is transformed from the traditional biomedical model to the biological-psycho-social medical model,treatment endpoint is no longer traditional indicators such as cure rate,survival rate and survival time,the quality of life has become an important index for the survival of patients,at the same time,the quality of life assessment is also a major factor affecting the treatment and intervention decisions[3]..In the medical field,the quality of life scale has been widely used in the selection of clinical treatment program,screening of new drugs and rehabilitation medicine.Especially in chronic diseases,the quality of life of patients is also a key predictor of the outcome of the disease.Evaluation of the efficacy of the disease and prognosis analysis,the changes of laboratory indices and molecular studies are as usual the key point of clinical research.We are also actively exploring.For example,we did a study on the prognostic value of mir-638 in acute myeloid leukemia.We found the plasma mir-638 level was reduced in patients with acute myeloid leukemia,the level of mir-638 was elevated in patients with complete remission,and the total survival rate of patients with low expression of mir-638 was significantly reduced.In addition to molecular studies and assessment of the efficacy of the disease,we also investigated the quality of life of patients,including non-malignant hematopoietic disease such as aplastic anemia.In recent years,the research of quality of life has become an international hot spot,also in blood system disease[4].Such as Adriani Kanellopoulos have been found,patients with leukemia was significantly lower than that of the healthy control group in terms of the physical function of the quality of life influence of the role,overall health self-assessment,vitality 3 dimensions and physical health score,the scores of each dimension of the patient’s physiology were higher than those in the psychological faeld.[5].Studies mainly focus on malignant hematopoietic disease such as acute leukemia,multiple myeloma,myelodysplastic syndrome,and so on.However,few studies were conducted on non-malignant hematopoietic diseases,especially acquired aplastic anemia.This study was the first study in China to study the quality of life of patients with aplastic anemia by SF-36 scale.We summarized the general demographic data,clinical features and related laboratory indices of patients.We also discussed the.factors that affect the quality of life.SPSS software(version 21.0)was used for single factor analysis and multiple-factor analysis.Not only for the eight dimensions of the scale,moreover,the total score of quality of life,mental health score and physiological health score were added as dependent variables to discuss the factors that affect the quality of life,make the results more novel and persuasive.The SSRS scale was also used to investigate the social support of patients.The correlation analysis between social support and quality of life was highlighted in this study.This study can provide a scientific reference for improving the quality of life,formulating a best strategy and setting up a good family support system.Research ObjectiveThe purpose of this study was to investigate the quality of life of patients withaplastic anemia with the quality of life scale(sf-36),to summarize the general demographic data,clinical features and laboratory inspection of patients,and to analyze the influencing factors of quality of life,provide a scientific reference for improving the quality of life,formulating the best strategy.Research method1.Cross-sectional case control study was applied in this study.The patient group with acquired aplastic anemia was collected from August 2012 to September 2017 in the department of hematology in Shandong University of Qilu hospital.The control group was healthy people with the same age and gender as patient group.Each people in these two groups answered a questionnaire with the same content.The contents of the questionnaire included the general information of the patient,the laboratory inspection and the life quality scale.2.The life quality of patients was assessed using the most commonly used quality of life assessment scale(sf-36).The scores of each dimension,total physical health,mental health and quality of life were obtained by coding,scoring and conversion.3.SPSS 21.0 analysis software was used for descriptive analysis,single factor analysis and multiple-factor analysis.Take P<0.05 for the statistic difference.The measurement data is expressed in terms of(x±s).Enumeration data use percentages or frequencies.Independent sample t was used to test the two groups.A single factor variance analysis was used for comparison between groups,if the variance analysis is different,least-significant difference method were used to make the mean multiple comparisons between different groups.4.The research results were summarized and analyzed.Research results1.Compared with the control group,except for general health self-assessment(The patients scored slightly higher than the healthy control group),the scores of the other seven dimensions in patient group were lower,among them,the scores of physical function,the effect of body function on the role,life vigor and social function were significantly lower than those in the control group(P<0.05 or P<0.01).2.The quality of life in patients with hemoglobin greater than 90g/L and platelet count was greater than 30×109/L。There was no statistical difference between case group and the normal control group,except the indices of the somatic role and social function(the case group was still significantly lower than the control group).Physical health(PCS),mental health(MCS)and quality of life of patient group showed the same level as the control group.3.Patients Significant differences on overall scores in physical function,the effect of body function on the role,emotional impact on the role,vigour of life,social function,PCS,MCS and life quality(P<0.05 or P<0.01)were found among patients with light,medium and heavy/extremely severe anemia.Patients with severe or extremely severe anemia had the most significant decline in quality of life(P<0.05 or P<0.01).The difference of platelet count between patients decreases on overall score in physical function,the effect of body function on the role,vigour of life,social function,PCS,MCS with(P<0.05 or P<0.01).The less platelet count,the lower the quality of life.The quality of life of patients dependent on blood transfusion was significantly lower than that of non-dependent transfusion patients(P<0.05 or P<0.01).4.Fatigue has a significant effect on quality of life.patients with fatigue showed significantly lower scores in 5 dimensions such as physical function,the effect of body function on the role,social function,vigour of life and general health self-assessment compared to less fatigued patients(P<0.05 or P<0.01 or P<0.001).5.There was no significant difference in the quality of life of different sexes.Data showed somatic function was influenced significantly by age(P<0.01).6.The score of quality of life in patients with ATG/ALG/hematopoietic stem cell transplantation was higher than that in the cyclosporine treatment group.7.The quality of life of patients in urban groups was slightly higher than those in rural areas,the quality of life of the farmers is less than that of the city patients,patients with high monthly incomes scored higher on quality of life than those with lower incomes,but the difference was not statistically significant.There was no significantly difference in the quality of life of different degrees of culture,different course of disease and different reimbursement rate.8.The multiple linear stepwise regression analysis showed that fatigue and quality of life were most closely related.Except of physical pain,mental health,and emotional impact on the role,linear regressions were found in all other dimensions(P<0.05 or P<0.01).The factors associated with mental health are age and occupation.The factors associated with somatic function were age,clinical typing,and anemia.Conclusions1.The quality of life of patients with aplastic anemia was significantly lower than normal person.2.The quality of life of AA patients with ahemoglobin greater than 90g/L and a platelet count greater than 30×109/L did not show significantly different frol that of normal people.3.The main factors affecting the quality of life of AA patients are the degree of anemia,the degree of thrombocytopenia,fatigue,ages,treatment methods,monthly income and living environment.Part TwoResearch of correlation analysis between social support and quality of life in patients with Aplastic anemiaBackgroundSocial support refers to getting assurances,information,and comfort through formal or informal contact with groups or other people,but the definition of social support is not yet unified[6].Social support plays a very important role in the quality of life and is closely related to the various fields of quality of life.The more support people who gain,the better their subjective feeling and life quality evaluation are[7].Yang yanjie5s studies have shown that the more social support cancer patients receive,the higher their quality of life is.By further analysis,liu xiaqin discovers that the subjective will of patients has important influence on the relationship between social support and quality of life and passive acceptance of social support does not improve patients’quality of life[8].herefore,we should strengthen the patient’s psychological care and improve the utilization of social support to improve the quality of life of the patients.Ma Ying-chun found that patients with leukemia were positively correlated to social support and quality of life through survey of 50 patients with leukermia,and perfect social support system can promote the recovery of the patient’s body and mind[9]..Savard J said that good social support can satisfy the needs of patients’ families,alleviate their anxiety state,improve their self-control and decision-making ability,and laintain a good physical and mental state[10].Social support can relieve stress and promote mental health effect,can also play a positive role on the cardiovascular,endocrine system and immune function,It can also alleviate the physical and mental disease,and have a positive impact on the quality of life.Studies have shown that,social support as a stress cushions factors,can alleviate the negative emotion of patients,increase the degree of patients with treatment and follow the medical compliance and affect the quality of life[10].Social support is very important,especially for patients with aplastic anemia.Diagnosis of aplastic anemia,the uncertainty of curative effect,the difficulty of the treatment process,the relapse of the disease,the high cost and the long treatment cycle are a strong blow to the patient and a huge change for the family,and work and life were forced.Work and life are forced to suffer,the patient is in urgent need to improve the quality of life.Research ObjectiveUsing social support rating scale(SSRS)to investigate acquired aplastic anemia patients’ situation of getting social support.Analyzing the influencing factors of social support,and through the relevant research,this paper discusses the relationship between social support and quality of life.Methods1.Cross-sectional case control study was applied in this study.The patient group with acquired aplastic anemia was collected from August 2012 to September 2017 in the department of hematology in Shandong University of Qilu hospital.The control group was healthy people with the same age and gender as patient group.Each people in these two groups answered a questionnaire with the same content.The contents of the questionnaire included the general information of the patient and social support evaluation.2.SSRS was used to evaluate the patients’ objective support,subjective support,support rate and to score each dimension and the overall status.3.SPSS software(version 21.0)was used for descriptive and single factor analysis.Take P<0.05 for the statistic difference.4.The correlation of social support and life quality of acquired aplastic anemia patients was analyzed by Person correlation analysis.5.The research results were summarized and analyzed.Results1.Compared to normal control group,the patient group showed significantly higher scores in all objective support,subjective support and support rate.The difference was statistically significant(P<0.05).2.Single factor analysis found that men scored lower than women in objective support and social support utilization,and the difference was statistically significant(P<0.05).Married people scored significantly higher in subjective support,objective support and social support than unmarried(P<0.01 or P<0.001).There was a significant difference between people of different ages in the subjective support dimension and the social support total score,the difference was statistically significant(P<0.01 or P<0.001).All the dimensions of social support scores and social support total points of middle-aged people were significantly higher than that of senior citizens,youth and adolescents,the difference was statistically significant(P<0.01 or P<0.001).The score of higher income group is higher than lower group in subjective support,objective support,support and social support,and the difference was not significant.3.There was no prominent difference in the impact on social support between different cultural degrees,occupations,living in rural or urban areas.4.The results of multiple linear stepwise regression analysis showed that marriage and age were main factors of the total score of social support.Marriage and monthly income were factors of subjective support and marriage and cultural degree influence objective support.Gender was the dominant factor who influence support rate(P<0.05 or P<0.01 or P<0.001).5.The data also found the usage of social support was closely associated with the quality of life by affecting self-evaluation of health quality of life in the overall dimension and life quality,life,body pain score,and the psychological score.Conclusion1.Patients with aplastic anemia obtained much more social support than normal people(P<0.05).2.Factors that affect social support include gender,age,income,marriage,and degree of culture.3.The use efficiency of social support strong correlated to life quality of patients.4.Men have less social support than women.Married people have more social support than unmarried people.Middle-aged people have more social support than older people,youth and teenagers.Higher earners can get more social support. |
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