Kvalitet života kod bolesnika sa sarkoidozom koji imaju promene na očima

Abstract

Sarkoidoza je multisistemska bolest nepoznate etiologije koja se karakteriše prisustvom nekazeifikujućih granuloma u tkivima i organima. Složena patogentska osnova sarkoidoze i često nepredvidiv tok bolesti, uzrokuje značajan poremećaj kvaliteta života obolelih. Posebnu grupu u tom smislu predstavljaju oboleli od sarkoidoze sa promenama na očima, koje uzrokuju značajan pad opšteg i organ specifičnog (vezanog za vid) kvaliteta života. Materijal i metode: Opservacijsko (deskriptivno) kliničko istraživanje (studija preseka) obavljeno je u Klinici za pulmologiju Kliničkog centra Srbije i Domu zdravlja Voždovac. Prospektivnom analizom je obuhvaćen uzorak od 80 bolesnika sa dokazanom sarkoidozom. Svim bolesnicima je uzeta detaljna anamneza sa procenom kliničkih simptoma, kao i kompletan oftalmološki pregled. U odabranoj grupi od 20 bolesnika učinjena je paracenteza i analiza aktivnosti angiotenzin konvertujućeg enzima (ACE) u očnoj vodici. Svi bolesnici su podeljeni u dve grupe (sa i bez očnih promena) i popunjavali su upitnike za procenu kvaliteta života. Dobijeni rezultati su kodirani, uneti u bazu podataka i analizirana je statistička veza podataka dobijenih ispitivanjem. Ciljevi ispitivanja su bili: utvrditi razliku u kvalitetu života bolesnika sa sistemskom sarkoidozom kod kojih postoje i promene na očima u odnosu na one bolesnike bez očnih promena, ispitati korelaciju demografskih i kliničkih faktora na kvalitet života bolesnika sa sistemskom sarkoidozom i sa očnim promenama, ispitati uticaj aktivnosti ACE u očnoj vodici na očne manifestacije sarkoidoze. Rezultati: Bilo je više muškaraca (56,25%) nego žena (43,75%) u obe grupe zajedno. Odnos polova iznosio je 1,28 u korist muškaraca. Žene oboljevaju od očne sarkoidoze češće od muškaraca i ta razlika je statistički značajna. U odnosu na sva pitanja iz upitnika NEI 25 (National Eye Institute- Nacionalni institut za oči) statistički je visoko značajna razlika između odgovora bolesnika sa i bez očnih promena u smislu lošijeg kvaliteta života kod onih sa očnim promenama. U odnosu na sva pitanja iz upitnika KSQ (King’s Sarcoidosis Questionairre- Upitnik Kraljevskog koledža za sarkoidozu) uočena je visoko statistički značajna razlika u kvalitetu života vezanom za vid ali i u opštem kvalitetu života po svim pitanjima između dve grupe ispitanika s tim što su pacijenti s očnim promenama imali značajno niže skorove. Bolesnici sa očnom sarkoidozom su imali povišene vrednosti ACE u očnoj vodici...

Sarcoidosis is a multisystemic disease of unknown aetiology characterized by the presence of non-caseating granulomas in tissues and organs. The complex pathogenic basis of sarcoidosis and the often unpredictable course of the disease causes a significant disorder of the quality of life of thepatients. A particular group are patients with sarcoidosis with changes in the eyes, which cause a significant decrease in the general and organ specific (related to vision) quality of life. Material and Methods: Observational (descriptive) clinical research (cross-section study) was carried out at the Clinic for pulmonology of the Clinical Center of Serbia and the Health Center Vozdovac. A prospective analysis included a sample of 80 patients with proven sarcoidosis. In all patients a detailed history was taken, with assessment of clinical symptoms, as well as a complete ophthalmological examination. In a specially selectedgroup of 20 patients, paracentesis and analysis of ACE activity in aqueous humor was performed. All patients were divided into two groups (with and without eye changes) and filled out questionnaires for the assessment of quality of life. The obtained results are encoded, entered into the database, and the statistical analysis performed. The objectives of the study were: to determine the difference in the quality of life of patients with systemic sarcoidosis in whom there are changes in eyes compared to those patients without eye changes, to examine the correlation of demographic and clinical factors to the quality of life of patients with systemic sarcoidosis and eye changes, examine the effect angiotensin-converting enzyme activity (ACE) in the aqueous humor on eye manifestations of sarcoidosis. Results: There were more men (56.25%) than women (43.75%) in both groups together. The gender ratio was 1.28 for men. Women suffer from ocular sarcoidosis more often than men, and this difference is statistically significant. Regarding all the questions from the NEI 25 questionnaire, a statistically significant difference was observed between the patients with and without ocular changes in terms of poor quality of life in those with eye changes. Regarding all the questions from the King's Sarcoidosis Questionairre questionnaire (KSQ), a highly statistically significant difference in the quality of life related to vision and overall quality of life was observed on all issues between the two groups of patients and patients with ocular sarcoidosis had significantly lower scores. Patients with eye sarcoidosis had elevated ACE levels in the aquous humor...