慢性肝病患者健康相关生存质量的影响因素研究  

Influencing factors for health-related quality of life in patients with chronic liver disease

作　　者：高峰[1,2] 高茹[3] 李光[3] 王宇[1] 郝建宇[3] 贾继东[1] 

机构地区：[1]首都医科大学附属北京友谊医院肝病中心,100050 [2]北京朝阳医院消化内科 [3]首都医科大学附属北京朝阳医院消化内科

出　　处：《中华全科医师杂志》2013年第6期438-442,共5页Chinese Journal of General Practitioners

摘　　要：目的研究慢性肝病患者健康相关生存质量的影响因素。方法对2009年12月至2011年5月在北京友谊医院肝病中心和北京朝阳医院消化内科治疗的所有慢性肝病患者进行简明量表SF-36中文版（第2版）测定，计算出生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、精神健康共8个维度以及躯体健康总评和精神健康总评评分。同时登记所有受试者的一般资料和临床资料。结果392例慢性肝病患者、91名健康对照者参与调查。健康对照组和慢性肝病患者躯体健康总评评分分别为54．6±5．5和47．8±8．8（t=9．343，P〈0．01），精神健康总评评分分别为56．4±8．1和51．7±7．4（t=5．302，P〈0．01）。慢性肝病患者随着Child—Turcotte—Pugh分级的加重依次分为无肝硬化组、A级组、B级组、C级组，躯体健康总评评分分别为53．1±5．9，48．7±6．6，42．4±7．1，37．2±8．9（F=93．353，P〈0．01）；精神健康总评评分分别为53．2±4．8，52．7±6．5，51．8±7．5，46．8±7．5（F=11．325，P〈0．01）。逐步法线性回归分析显示，疾病严重程度、年龄、出现腹水、出现静脉曲张及凝血酶原时间对躯体健康有影响（F=100．893，P〈0．010）；疾病严重程度、性别、出现静脉曲张、总胆红素水平、凝血酶原时间及血红蛋白水平对精神健康有影响（F=19．237，P〈0．010）。结论慢性肝病患者的健康相关生存质量明显低于健康人，且随疾病严重程度的加重而明显下降。疾病严重程度加重、腹水、静脉曲张、高胆红素水平和凝血酶原时间延长是降低慢性肝病患者健康相关生存质量的重要因素。Objective To investigate the factors affecting health-related quality of life （HRQOL） in patients with chronic liver disease （CLD）. Methods HRQOL was measured with SF-36v2 Chinese version. All patients with CLD diagnosed between December 2009 and May 2011 in Liver Research Center, Beijing Friendship Hospital and Digestive Department, Beijing Chaoyang Hospital were enrolled in this study. Patients with CLD were divided into 4 groups according to their Child-Turcotte-Pugh scores： no cirrhosis, Child＇s classes A, B, and C. Demographic and clinical data were collected in each group. Results A total of 392 patients with CLD and 91 healthy controls were included. HRQOL in patients with CLD was lower than that in healthy controls. Physical component score （PCS） in healthy controls was 54.6±5.5, and in CLD was 47.8 ±8.8 （t =9.343, P〈0.01）. Mental component score （MCS） in healthy controls was 56. 4 ± 8.1, and in CLD was 51.7 ± 7.4 （t = 5. 302, P 〈 0.01 ）. Increasing severity of CLD from no cirrhosis to advanced cirrhosis was associated with a decrease on HRQOL, PCS scores were 53.1±5.9,48.7±6.6,42.4±7.1 and 37.2±8.9 （F=93.353, P〈0.01）;MCS scores were 53.2± 4.8, 52.7 ± 6. 5, 51.8 ± 7.5, and 46.8 ± 7.5 （ F = 11. 325, P 〈 0.01 ）, for no patients with cirrhosis, Child＇s classes A, B and C respectively. Stepwise linear regression analysis showed that severity of disease, age, present ascites, present varices, and prothrombin time had significant effects on physical health area （F = 100. 893, P 〈 0.010）. Severity of disease, female gender, present varices, total bilirubin, prothrombin time and hemoglobin had significant effects on mental health area （ F = 19. 237, P 〈 0. 010 ）. Conclusions Patients with CLD have reduced HRQOL. Increasing severity of CLD is associated with adecreasing HRQOL. Old age, female gender, advanced stage of CLD, present ascites, hyperbilirubinemia and prolonging prothrombin time are risk factors for reducing HRQOL.

关 键 词：肝疾病 生活质量 疾病影响状态调查 

分 类 号：R575[医药卫生—消化系统]