The Evaluation To The Quality Of Life Of The Patients With Chronic Rhinositis And Nasal Polyps And Analysis Of Influential Factors

The end point of development of medical technology is to heighten the level of diagnosis and treatment of disease and consequently achieve to improve the people's quality of life(QOL).It is very important introducing the assessment of QOL into chronic rhinositis with nasal polyps(CRSwNP)as one of the most important guide,which is now accepted and assented abroad.As for our country,it still is a blank zone that the patient's with CRSwNP are assessed by QOL.The existing evaluation is only limited in the non-end-point guide line of endoscopy or computed tomography(CT).In this research,we introduced the mature scale's such as visual analog scale(VAS),QOL scale of the Medical Outcomes Study Short Form-36(SF-36),Lund-Makcay staging systems of sinus's computed tomography(CT)and Lanza-Kennedy staging systems of sinus's endoscopy, and put up a subjective and objective assessment system for CRSwNP and at the same time all kinds of factors such as gender,age,setting of city-country,household income,academic qualifications,WAS scores, surgical history of sinus,case history,nasal endoscopic scores,CT scores and clinical classification are all explored the correlation to the outcomes of CRSwNP for the aim of heightening diagnosis and treatment of disease and consequently improving the involved patients'QOL status.ObjectiveTo investigate the influences of CRSwNP on QOL status of involved patients and the effects of ESS and establish a subjective and objective assessment system of quantificational outcomes;to explore all kinds of clinical and social factors related to QOL effects so that to improve the diagnosis and treatment of CRSwNP;and to evaluate the applying of Chinese version of the SF-36 questionnaire in the patient the CRSwNP.Material and Methods148 patients with CRSwNP and 150 individuals passing health examination were studied and tested by using SF-36 questionnaire.At the same time,we introduce VAS,Lund-Makcay staging systems of sinus' s computed tomography and Lanza-Kennedy staging systems of sinus's endoscopy to the CRSwNP.All parts of the assessment system was statistically analyzed the correlations each other by SPSS for Windows Version 13.0.The relation was statistically tested by bivariate correlation analysis and multiple-factor linear regression between the QOL effects and data of clinical and social factors including gender,age,setting of city-country,household income,academic qualifications,VAS scores, surgical history of sinus,case history,nasal endoscopic scores,CT scores and clinical classification.Then a multiple-factor linear stepwise regression was analyzed to detect the prominent factors.Result1.By the assessment of VAS instrument,the severity score is 1.21-4.05, while the total severity score and global severity scores are 23.5 and 3.58.Respectively the top 6 symptoms were nasal obstruction,nasal drainage:anterior,decreased sense of smell,nasal drainage:posterior, headache and fatigue.QOL scores,nasal endoscopic scores and CT scores were correlated to VAS scores.2.The psychometric properties of SF-36 Chinese version such as feasibility,reliability,validity and responsibility all passed the test.Analysis of internal consistencies for all SF-36 domains showed a Cronbach's a value higher than 0.7(varied from 0.75 to 0.89)except for role emotional.3.By the assessment of SF-36 instrument,the patients' physical functioning,bodily pain,mental health,vitality,social functioning and general health were less than that of the individuals passing health examination(P＜0.05)excluding role physical and role emotional.4.Between CRSwNP patients and healthy people,gender,age and setting of city-country had similar influences on quality of life,while household income and academic qualifications had significant different influences.Furthermore,household income and academic qualifications had more significant influences on CRSwNP patients than healthy people. All of the clinical measures of the disease,including VAS scores,case history,surgical history of sinus,nasal endoscopic scores,CT scores and clinical classification were significantly negatively associated with the QOL.Clinical classification,nasal endoscopic scores and CT scores were correlated with the physiological health,but not correlated with the emotional health.5.By multiple-factor linear stepwise regression,three equations was achieved and the top 6 factors affecting QOLwere gender,age,VAS scores, surgical history of sinus,and household income.Conclusions1.Chinese version of SF-36 is a valid outcome measure for patients with chronic rhinositis and nasal polyps.2.Respectively the top 6 symptoms were nasal obstruction,nasal drainage:anterior,decreased sense of smell,nasal drainage:Posterior, headache and fatigue.3.CRSwNp has a negative effect on involved patients' QOL status seriously and prevalently.4.Household income and academic qualifications had more significant influences on CRSwNP patients' QOL than healthy people's.All of the clinical measures of the disease,were significantly negatively associated with the QOL.Clinical classification,nasal endoscopic scores and CT scores were correlated with the physiological health,but not correlated with the emotional health.5.The top factors affecting QOL status are gender,age,VAS scores, surgical history of sinus,and household income.