CAJ | 학술논문

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11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年肘间段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性丙型肝炎肝硬化患者的生存质量.
목적 평개비절제술후항병독치료대병형간염간경화반비공능항진환자5년생존질량(QOL)적영향. 방법 수집장기수방자료완정적만성병형간염간경화반비공능항진환자자료납입회고성통계분석.의조불동치료방식분위량조:비절제술조(A조28례)화보비치료조(B조,비수술상규치료,30례),각조환자중,재분위급여취을이순간우소α-2a급리파위림치료(A1조15례,B1조19례)혹불진행임하항병독치료(A2조13례,B2조11례).분별재치료5년후대각조환자진행만성간병생존질량문권(CLDQ)、간병특유증상(SS)문권、생존질량종합평정문권(WHOQOL-BREF)측정,비교각조환자5년주간단QOL적차이.계량자료용t검험혹Mann-Whitney검험,계수자료채용x2검험,P＜ 0.05표시차이구유통계학의의.결과 종환자자신건강상황적주관감각、생리상황、심리상태、사회생활관계등사방면진행비교,발현비절제술조여보비치료조환자술후5년생존질량차이불구유통계학의의;단순행비절제술조5년생존질량교보비항병독치료조차,이비절제술조연합술후항병독치료능구유효지제고환자술후5년적생존질량,차차이균구유통계학의의(건강평분3.69±0.75대비2.15±0.98,P=0.0003).결론 비절제병연합술후항병독치료능구현저개선만성병형간염간경화환자적생존질량.
Objective To evaluate the effect of antiviral 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:splenectomy (group A,28 cases) and conservative/non-operative (group B,30 cases).Sub-grouping was carried out according to the CHC treatment:interferon-α-2a and ribavirin (15 cases in the A1 group,and 19 cases in the B1 group) and nonantiviral (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 ± 0.75 vs 2.15 ± 0.98,P =0.0003).Conclusion Splenectomy followed by antiviral therapy may improve the QOL of patients with CHC-related cirrhosis and hypersplenism.