摘要
目的分析核苷和核苷酸类药物治疗对慢性乙型肝炎(CHB)患者生活质量的影响,并探讨相应护理措施。方法选取2010年3月-2014年7月于南方医科大学南方医院感染内科临床研究的102例CHB患者,分为持续治疗组(n=54)与停药组(n=48),以SF-36表测量生活质量。治疗组于治疗前与治疗96周接受评估,停药组于停药点与停药48周接受评估。计量资料组间比较采用t检验,组内比较采用配对t检验;计数资料组间比较采用χ2检验。单因素及多因素分析采用Logistics回归分析。结果与抗病毒前比较,持续治疗组患者抗病毒治疗96周后,其生理功能、生理职能、躯体疼痛、总体健康均明显升高(94.91±7.11 vs 92.13±10.58,81.94±24.96 vs 71.76±34.01,87.72±8.64 vs 82.85±12.88,59.63±14.59 vs 53.52±16.79,t=-3.786^-2.623,P值均<0.05)。但心理质量除精神健康由67.30±18.94提高至75.56±15.53(t=-3.883,P<0.001)外,其余维度均无明显改善。停药组在停药后48周生理职能、总体健康与精神健康均有显著提高(84.20±18.97 vs 72.49±24.38,69.28±22.94 vs 56.41±18.27,75.02±16.03 vs 68.94±14.07,t=-3.206^-2.078,P值均<0.05)。多因素相关分析提示婚姻状况与抗病毒治疗后生存质量改善相关(比值比=11.61,95%可信区间:2.28~59.00,P=0.003)。未婚患者生活质量改善优于已婚患者,尤其是生理功能(t=-2.176,P=0.034)、生理职能(t=-2.173,P=0.034)与情感职能(t=-2.811,P=0.007)。结论抗病毒治疗能改善CHB患者的生理质量及精神健康,有效的心理干预对CHB患者尤其是已婚患者非常必要。
Objective To investigate the impact of treatment with nucleos（ t） ide analogues on quality of life（ Qo L） in patients with chronic hepatitis B（ CHB）,as well as proper nursing measures. Methods A total of 102 CHB patients who were treated in Department of Infectious Diseases,Nanfang Hospital,Southern Medical University from March 2010 to July 2014 were enrolled and divided into continuous treatment group（ 54 patients） and drug withdrawal group（ 48 patients）. The 36- item short- form health survey（ SF- 36） was used to measure Qo L. The patients in the treatment group were evaluated before treatment and at 96 weeks of treatment,and those in the drug withdrawal group were evaluated at the time of drug withdrawal and at 48 weeks after drug withdrawal. The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. The logistic regression analysis was performed for univariate and multivariate analyses. Results Compared with before treatment,the continuous treatment group had significant increases in the scores on the domains of physiological function,role physical,bodily pain,and general health after 96 weeks of antiviral therapy（ physiological function： 94. 91 ± 7. 11 vs 92. 13 ± 10. 58,t =- 2. 924,P〈0. 05; role physical： 81. 94 ± 24. 96 vs71. 76 ± 34. 01,t =- 2. 623,P〈0. 05; bodily pain： 87. 72 ± 8. 64 vs 82. 85 ± 12. 88,t =- 3. 576,P〈0. 05; general health： 59. 63 ±14. 59 vs 53. 52 ± 16. 79,t =- 3. 786,P〈0. 05）. As for psychological quality,the continuous treatment group had a significant increase in the subscale of mental health（ 67. 30 ± 18. 94 vs 75. 56 ± 15. 53,t =- 3. 883,P〈0. 001）,while there were no significant improvements in other subscales. At 48 weeks after drug withdrawal,the drug withdrawal group had significant increases in role physical（ 84. 20 ± 18. 97 vs72. 49 ± 24. 38,t =- 2. 768,P〈0. 05）,general health（ 69. 28 ± 22. 94 vs 56. 41 ± 18. 27,t =- 3. 206,P〈0. 05）,and mental health（ 75. 02 ± 16. 03 vs68. 94 ± 14. 07,t =- 2. 078,P〈0. 05）. The multivariate analysis showed that marital status was associated with the improvement in QoL after antiviral therapy（ odds ratio = 11. 61,95% CI： 2. 28- 59. 00,P = 0. 003）; the unmarried patients had better improvements in Qo L compared with the married ones,especially physiological function（ t =- 2. 176,P = 0. 034）,role physical（ t =- 2. 173,P = 0. 034）,and role emotional（ t =- 2. 811,P = 0. 007）. Conclusion Antiviral therapy can improve the Qo L and mental health of CHB patients. Effective psychological intervention is necessary for CHB patients,especially married CHB patients.
出处
《临床肝胆病杂志》
CAS
2016年第11期2080-2083,共4页
Journal of Clinical Hepatology
基金
广东省医学科学技术研究基金(A2014413)
