丙型肝炎肝硬化脾切除术后抗病毒治疗患者的生存质量分析  

Life quality analysis of hepatitis C patients with fiver cirrhosis undergoing antiviral therapy followingsplenectomy

作　　者：纪光晰 陈琳[1] 张颖[1] 何瑜[1] 马力[1] 王宇[1] 马志远[1] 成程[1] 贾战生[1] 郭永红[2] 

机构地区：[1]第四军医大学唐都医院全军感染病诊疗中心,西安710038 [2]西安交通大学第二附属医院传染科

出　　处：《中华肝脏病杂志》2014年第3期195-199,共5页Chinese Journal of Hepatology

摘　　要：目的评价脾切除术后抗病毒治疗对丙型肝炎肝硬化伴脾功能亢进患者5年生存质量（QOL）的影响。方法收集长期随访资料完整的慢性丙型肝炎肝硬化伴脾功能亢进患者资料纳入回顾性统计分析。依照不同治疗方式分为两组：脾切除术组（A组28例）和保脾治疗组（B组，非手术常规治疗，30例），各组患者中，再分为给予聚乙二醇干扰素α-2a及利巴韦林治疗（A1组15例，B1组19例）或不进行任何抗病毒治疗（A2组13例，B2组ll例）。分别在治疗5年后对各组患者进行慢性肝病生存质量问卷（CLDQ）、肝病特有症状（ss）问卷、生存质量综合评定问卷（WHOQOL-BREF）测定，比较各组患者5年时间段QOL的差异。计量资料用t检验或Mann-Whitney检验，计数资料采用x2检验，P〈0．05表示差异具有统计学意义。结果从患者自身健康状况的主观感觉、生理状况、心理状态、社会生活关系等四方面进行比较，发现脾切除术组与保脾治疗组患者术后5年生存质量差异不具有统计学意义;单纯行脾切除术组5年生存质量较保脾抗病毒治疗组差，而脾切除术组联合术后抗病毒治疗能够有效地提高患者术后5年的生存质量，且差异均具有统计学意义（健康评分3．69±0．75对比2．15±0．98，P=0．0003）。结论脾切除并联合术后抗病毒治疗能够显著改善慢陛丙型肝炎肝硬化患者的生存质量。Objective To evaluate the effect of anfiviral therapy on the quality of life （QOL） of patients with chronic hepatitis C （CHC） and cirrhosis during the 5-year period following splenectomy to treat hypersplenism. Methods Data of patients with CHC and cirrhosis who had undergone treatment for hypersplenism were retrospectively selected from the hospital database of medical records. The patients were first grouped according to the hypersplenism treatment： splaneetomy （group A, 28 cases） and conservative/non-operative （group B, 30 cases）. Sub-grouping was carded out according to the CHC treatment： intefferon-ct-2a and ribavirin （15 cases in theA1 group, and 19 cases in the B1 group） and non- antiviral （13 cases in the A2 group, and 11 cases in the B2 group）. To determine the intergroup differences in QOL during the 5-year period following the hypersplenism treatment, the QOL was assessed by chronic liver disease questionnaire （CLDQ）, listing of specific symptoms （SS）, and the World Health Organization QOL scale （WHOQOL-BREF）. Results Between-group statistical comparison of the subjective feeling, physiological status, mental state, and social life relationship of the patients showed no significant differences among the patients who received splenectomy compared to those who received the conservative treatment.However, the QOL of splenectomy-treated patients who received non-antiviral CHC treatment was worse than that of the patients who were given conservative treatment for the hypersplenism and antiviral therapy for the CHC. The patients who received splenectomy and antiviral therapy had better QOL than the other patient group（3.69 α 0.75 vs 2.15 α 0.98,P = 0.0003）. Conclusion Splenectomy followed by antiviral therapy may improve the QOL of patients with CHC-related cirrhosis and hvoersolenism.

关 键 词：肝炎 丙型 慢性 生存质量 脾切除术 治疗 抗病毒 

分 类 号：R512.63[医药卫生—内科学]