背景:对于2型神经纤维瘤病(NF2)患者,保持独立的生活状态很重要。本研究旨在检查社会独立性的丧失(即,使用日本国家注册中心的数据,患者可以工作和上学的状态)及其在NF2患者中的影响因素。
方法:这项纵向研究使用了一个注册数据库,其中包含有关NF2患者的信息,这些患者在2004年至2010年之间提交了最初的医疗费用补贴申请。有“雇佣”的患者,\"\"学习,“”和“家政”类别被归类为“社会独立”。“在基线时具有社会独立性的患者进行了长达9年的随访。本研究的主要结果是在随访期间失去了社会独立性,这被定义为从社会独立到社会依赖的地位的变化。首先,我们研究了基线时的人口统计学变量与神经系统症状以及社会独立性丧失之间的纵向关联.第二,我们检查了神经系统症状的发生是否与患者社会独立性的丧失有关.
结果:本研究共纳入156例患者。在后续期间,37例(23.7%)患者经历了社会独立性的丧失。在第一个分析中,多因素logistic回归模型显示,脊髓功能障碍患者的社会独立性丧失明显高于无脊髓功能障碍患者.在第二个分析中,Logistic回归分析显示,神经系统症状,包括双侧听力损失,面神经麻痹,小脑功能障碍,面部感觉下降,言语功能障碍(吞咽困难/构音障碍和失语症),双重视觉,失明,偏瘫,和癫痫发作,与社会独立性的丧失显著相关。
结论:NF2的各种神经症状的发生可以长期阻碍社会独立。医疗服务提供者需要观察患者,同时考虑风险,并提供适当的支持来解决可能限制社会独立性的神经症状,因为这将导致保持社会参与。
BACKGROUND: For patients with neurofibromatosis type 2 (NF2), maintaining an independent state of living is important. The present
study aimed to examine the loss of social independence (i.e., a status that patients can work and go to school) and its contributing factors in patients with NF2 using data from a national registry in Japan.
METHODS: This longitudinal
study used a registry database containing information on patients with NF2 who had submitted initial claims to receive medical expense subsidies between 2004 and 2010. Patients with \"employed,\" \"studying,\" and \"housekeeping\" categories were classified as \"socially independent.\" Patients who were socially independent at baseline were followed-up for up to nine years. The primary outcome of the present
study was the loss of social independence during the follow-up period, which was defined as the change in status from being socially independent to socially dependent. First, we examined longitudinal associations between demographic variables and neurological symptoms at baseline and the loss of social independence. Second, we examined whether the occurrence of neurological symptoms is associated with a loss of social independence in patients.
RESULTS: A total of 156 patients were included in the present
study. During the follow-up period, 37 (23.7%) patients experienced a loss of social independence. In the first analysis, the multivariate logistic regression model showed that the loss of social independence was significantly more frequent among patients with spinal dysfunction than among patients without. In the second analysis, logistic regression analyses showed that neurological symptoms, including bilateral hearing loss, facial nerve palsy, cerebellar dysfunction, decreased facial sensation, speech dysfunction (dysphagia/dysarthria and aphasia), double vision, blindness, hemiparesis, and seizures, were significantly associated with loss of social independence.
CONCLUSIONS: The occurrence of various neurological symptoms of NF2 can hinder social independence in the long term. Medical service providers need to observe patients while considering the risks, and provide appropriate support to address neurological symptoms that can restrict social independence, as this will lead to maintaining social engagement.