摘要
目的：当前大多数对亚健康的研究都是以某项或某些症状达到一定严重程度为标准直接判断,缺乏对总体健康状态的评估以及对这些症状的临床评估。我们的前期研究应用改良Delphi法得出了包括9项在健康状态受损时最常受到影响的一级指标(胃肠道功能、睡眠、性功能、疲劳感、疼痛、情绪、焦虑敏感、社交焦虑、社会关系)的亚健康评估工具。本研究的目的就是在对照亚健康定义、通过访谈综合判断研究对象总体健康状态(健康、亚健康、疾病)基础上,初步验证这一工具的评估功能。
方法：向在协和医院门诊候诊区域及健康体检中心经过的人员以及获知研究信息前来的各界人士发放亚健康评估量表。对完成问卷、了解本研究内容并自愿接受临床评估的18岁以上研究对象,按其问卷评分分别纳入高分组和低分组；排除已确诊明确疾病可解释当前不适者。任意一项一级指标均分≥3分(0-4分)即归入高分组,否则为低分组,两组纳入大致相同人数。在我科评估室对所有的研究对象进行开放访谈及CIDI访谈,通过量表和访谈获得全面的躯体检查资料和精神心理及社会学资料。由我科专科医师依据这些资料对研究对象的“不适状态”作出临床判断。判断标准为：a)疾病：研究对象当前的“不适”导致其心理、生理、或社会功能受损,并且该“不适”严重程度符合相关疾病诊断；b)亚健康：研究对象当前的“不适”导致其生理、心理、社会功能受损,但不符合疾病诊断,也未发现可以明确解释“不适”的疾病；c)健康：研究对象呈现的“不适”未导致其生理、心理、社会功能出现下降。精神心理诊断参照ICD-10标准。
结果：共纳入60名研究对象,男性17名(28.3%),女性43名(71.7%),平均年龄35.6±11.4岁,均无重大躯体疾病或严重的慢性躯体疾病,呈现的“不适”主要为疲劳、情绪、睡眠、家庭社会关系、工作学习压力等(57/60)；经判断结果为：健康者15名,亚健康者22名,疾病者23名；高分组满足疾病诊断者占60.7%(17/28),低分组满足疾病诊断者占18.8%(6/32)(p=0.0003)；除了性功能、疼痛量表外,其余一级指标与健康状态之间均存在统计学显著性关系,与健康状态的线性相关性由强至弱分别为：情绪(Pearson系数0.75,p<0.0001)、疲劳(0.59,p<0.0001)、睡眠(0.56,p<0.0001)、社会关系(0.53,p<0.0001)、社交焦虑(0.38,p=0.0025)、焦虑敏感(0.35,p=0.0058)、胃肠道功能(0.33,p=0.0082)；各维度评分及总分与健康状态之间存在统计学显著性关系,生理维度、心理维度、社会功能维度与健康状态之间的线性相关系数分别为0.63(p<0.0001)、0.51(p<0.0001)、0.53(p<0.0001)。
结论：1.本研究人群中高分组满足疾病诊断者达60.7%,另外,健康-亚健康-疾病之间在健康各维度功能受损方面是有重叠的,这两点均提示当前亚健康描述性研究中设定某一严重标准即判断“亚健康”而不经临床评估的研究方法是欠合理的。2.本研究使用的评估量表有良好的健康评估功能；性功能评分与健康状态无关；在健康状态受损时,不同个体中受到影响的具体一级指标或者维度也各异,从三个维度整体出发评估个体的健康状态更为合理。
Purpose:In most descriptive studies of subhealth, subjects were ruled as in "subhealth state" without clinical evaluation, if their "unfitness" symptom had lasted for a certain time and met certain severity criteria. In our preceding study, a subhealth evaluation inventory was designed with collective wisdom of professionals from various health specialties. It includes9first-degree indices which are easily disturbed when general health condition is compromised:gastrointestinal function, sleep, sexual function, fatigue, pain, emotion, anxiety sensitivity social anxiety and social relation. Purpose of this study was to explore the health evaluation power of our inventory on the basis of clinical evaluation.
Methods:A mean score of≥3(0-4points) in any first degree index would be grouped as high score, otherwise low score. The evaluation inventory was given out in the out clinic building and health examination center of Peking Union hospital. Study population included passersby and individuals who learned about this study through various ways. All subjects must be more than18years old. Those who were willing to participate after they were informed of the procedure and purpose of this study were excluded. Those whose "unfitness" could be explained by an already diagnosed disease were excluded. An open interview and CIDI interview was done with all enrolled subjects. A judgment of subject's health state was made by clinical doctors based on the physical, psychological and social information acquired. Classification standards:a) disease: subject's unfitness caused a decrease in his/her physiological, psychological, or social function, and a relevant disease could be diagnosed; b) subhealth:subject's unfitness caused a decrease in his/her physiological, psychological, and social function, but no relevant diagnose could be made or found; c) health:this "unfitness" didn't cause function loss. Psychiatric diagnoses were made by psychiatrists according to ICD-10criteria.
Results:Seventeen males and43females with a mean age of35.6±11.4years (range,18to61) were enrolled. None of them had grave physical diseases or severe chronic diseases. Their main "unfitness" complaints were mostly common problems such as fatigue, sleeping problems, emotional stress, work and social stress, etc(57/60). Evaluation results of the subjects'unfitness are as follows:15"health",22"subhealth",23"disease". In high score group,60.7%(17/28) subjects were diagnosed with a disease/disorder;18.8%(6/32) in the low score group. Except for sexual function and pain scores, other first degree indices were all statistically related to health status. These indices were also linearly correlated with health state (coefficient from high to low): emotion (Pearson coefficient0.75, p<0.0001), fatigue(0.59, p<0.0001), sleep(0.56, p <0.0001), social relation(0.53, p<0.0001),social anxiety(0.38,p=0.0025), anxiety sensitivity(0.35,p=0.0058),gastrointestinal function(0.33,p=0.0082). The linear relevance coefficients of physiological, psychological and social function dimension with health state are0.63(0.59, p<0.0001),0.51(0.59, p<0.0001) and0.53(0.59, p<0.0001) separately.
Conclusions:1. In our subjects,60.7%in the high score group were diagnosed with a disease. Also, our study showed a great overlapping of function impairment between different health states. These two facts strongly indicate that it is inappropriate to make subhealth conclusion merely on certain symptom's severity and duration while lacking clinical evaluation.2. The inventory used in this study is a good evaluation tool of individual's general health; sexual function score is not relevant to health state; as individuals may be very different as to which dimension or which index comes first to sacrifice when general health is imperiled, an integrated bio-psycho-social approach should be taken in health evaluation.
引文
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