아토피피부염의 중증도 변화에 따른 삶의 질 변화
Change in Quality of Life according to the Change in Atopic Dermatitis Severity
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목 적:아토피피부염 환자의 임상적 중증도와 환자 및 가족의 삶의 질의 상관관계를 평가하고, 치료에 따른 아토피피부염의 중증도 변화가 환자 혹은 가족의 삶의 질의 변화에 미치는 영향을 추적 조사하고자 하였다. 방 법:아토피피부염을 진단받은 환자를 대상으로 중증도와 삶의 질을 평가하였고 약 12개월 뒤 전향적 추적 평가를 시행하였다. 아토피피부염의 중증도는 진찰을 통해 scoring of atopic dermatitis (SCORAD)로 평가하였다. 가족의 삶의 질은 dermatitis family impact (DFI) 설문지를 이용하였으며, 환자의 삶의 질은 infants’ dermatologic quality of life index (IDQoL)과 children’s dermatology life quality index (CDLQI) 설문을 이용하였다. 첫 평가 시기에 중증도와 삶의 질의 단면적 상관관계를, 추적 평가로 중증도의 변화와 삶의 질의 변화의 상관관계를 분석하였다. 결 과:79명의 환자가 SCORAD 및 DFI 평가를 받았으며, 이중 36개월 미만인 45명이 IDQoL 설문에 참여하였으며, 36개월 이상인 13명이 CDLQI 설문에 참여하였다. 환자 연령의 중앙값은 13개월이었으며 추적 평가 시 연령의 중앙값은 29개월 이었다. 단면적 분석에서 objective SCORAD (oSCORAD)와 DFI (r=0.235, P<0.05), IDQoL (0.602, P<0.01), CDLQI (r=0.589, P<0.01)는 유의한 상관관계를 보였다. 추적 관찰에서 객관적 SCORAD의 중앙값은 17.4에서 7.8로 감소하였으며 DFI는 23.0에서 18.0으로, IDQoL은 9.0에서 6.0으로 유의하게 감소하였다(P<0.01). CDQLI는 17.0에서 13.0으로 감소하였으나 통계적 유의성은 없었다(P=0.26). IDQoL의 변화는 oSCORAD의 변화와 유의한 상관관계를 보였다(ΔIDQoL=0.294xΔoSCORAD-2.129, P<0.01). DFI의 변화는 SCORAD의 변화와 선형의 상관관계를 보이지 않았으며 SCORAD가 호전되었으나 DFI가 호전되지 않은 경우 식품 알레르기가 동반된 경우가 유의하게 많았다(60.7% vs. 27.8%, P<0.01). 결 론:아토피피부염을 적극적으로 치료하여 중증도를 낮추는 것이 삶의 질 향상에 도움이 되며 가족의 삶의 질 향상을 위해서는 식품 알레르기와 같은 동반된 악화 인자를 발견하고 적극적으로 관리하는 것이 필요하다.
Abstract
Purpose:The aim of this study was to longitudinally examine the correlation between the change of atopic dermatitis (AD) severity and the change of quality of life (QOL). Methods:We assessed AD severity and QOL of patients and their families, by a prospective followed up for at least 12 months. AD severity was assessed, using the scoring of atopic dermatitis (SCORAD) index. A questionnaire based on dermatitis family impact (DFI), infants’ dermatologic quality of life (IDQoL) and children’s dermatology life quality index (CDLQI) were used to determine QOL Results:Seventy-nine AD patients were assessed for total and objective SCORAD and DFI. Among them, 45 patients that were less than 36 months old completed IDQoL and 13 patients that were equal to or more than 36 months old completed CDLQI. Objective SCORAD (oSCORAD) were correlated with DFI (r=0.235), IDQoL (r=0.602) and CDLQI (r=0.589) (P<0.05). At the 2nd interview, median oSCORAD (from 17.4 to 7.8), DFI (from 23.0 to 18.0) and IDQoL (from 9.0 to 6.0) were significantly decreased (P<0.01). The changes of oSCORAD were linearly related with the change of IDQoL (P<0.01), but neither with DFI (P=0.356) nor with CDLQI (P=0.267). Of the 64 patients with decreased oSCORAD, food allergy was accompanied more frequently in those with an increased DFI than those with a decreased DFI (60.7% vs. 27.8%, P<0.01). Conclusion:In this longitudinal study, the improvement of AD severity is correlated with the improvement of the patient’s QOL, under the age of 3. To improve the family’s QOL, we need to find out accompanying factors, such as food allergy, and to support the family accordingly.
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