中医特色慢病管理在社区慢性乙型肝炎患者中的效果评价
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摘要
目的观察中医特色慢病管理方案干预社区慢性乙型肝炎(CHB)患者的疗效。方法采用非随机病例对照的研究方法,选取2014年-2016年在广州天河社区就诊的84例CHB患者为研究对象,将其分成中医慢病管理组和对照组,每组42例。中医慢病管理组给予恩替卡韦片(0.5 mg,1次/d,口服)治疗和中医慢病管理;对照组给予恩替卡韦片治疗和常规疾病基础知识教育及服药指导。治疗48周后比较两组患者ALT复常率、HBeAg血清学转换率、HBV DNA阴转率、中医症状积分、生存质量积分等的差异。符合正态分布的计量资料组间比较采用两独立样本t检验,治疗前后的比较采用配对t检验;非正态分布的计量资料采用相对应的非参数检验方法进行分析。计数资料两组间比较采用χ~2检验或Fisher确切概率法。结果治疗48周后,中医慢病管理组的临床证候积分明显低于对照组(3.66±1.92 vs 6.42±2.48,t=5.563,P<0.001),且生存质量总分明显高于对照组(550.75±54.24 vs 491.08±54.21,t=-4.888,P<0.001)。中医慢病管理组的48周ALT复常率(80.00%vs 72.22%,χ~2=0.590,P=0.443)、HBV DNA阴转率(73.17%vs 68.42%,P>0.05)、HBeAg血清学转换率(29.27%vs 18.42%,P>0.05)均稍高于对照组,但差异均无统计学意义。结论中医特色慢病管理能够改善社区慢性乙型肝炎患者临床症状,提高患者生存质量,同时,对于提高患者抗病毒疗效有一定意义,值得在社区进一步推广应用。
Objective To investigate the clinical effect of chronic disease management with traditional Chinese medicine( TCM) characteristics in community patients with chronic hepatitis B( CHB). Methods A non-randomized case-control study was performed for 84 CHB patients who visited Tianhe Community in Guangzhou from 2014 to 2016. These patients were divided into TCM chronic disease management group and control group,with 42 patients in each group. The patients in the TCM chronic disease management group were given oral entecavir tablets( 0. 5 mg,once a day) combined with TCM chronic disease management,and those in the control group were given entecavir tablets,education on disease knowledge,and instructions on medication. The two groups were compared in terms of alanine aminotransferase( ALT) normalization rate,HBeAg seroconversion rate,HBV DNA clearance rate,TCM symptom score,and quality-of-life score after 48 weeks of treatment. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups,and the paired t-test was used for comparison before and after treatment; the non-parametric test was used for comparison of non-normally distributed continuous data between groups. The chi-square test was used for comparison of categorical data between groups,and the Fisher's exact test was used when more than 20% of the cells have an expected frequency of less than 5. Results After 48 weeks of treatment,the TCM chronic disease management group had a significantly lower clinical syndrome score and a significantly higher overall quality-of-life score than the control group( clinical syndrome score: 3. 66 ± 1. 92 vs 6. 42 ± 2. 48,t = 5. 563,P < 0. 001; overall quality-of-life score: 550. 75 ± 54. 24 vs 491. 08 ± 54. 21,t =-4. 888,P < 0. 001). Compared with the control group,the TCM chronic disease management group had slightly higher 48-week ALT normalization rate( 80. 00% vs 72. 22%,χ~2= 0. 590,P = 0. 443),HBV DNA clearance rate( 73. 17% vs 68. 42%,P > 0. 05),and HBeAg seroconversion rate( 29. 27% vs 18. 42%,P > 0. 05). Conclusion In community patients with CHB,chronic disease management with TCM characteristics can improve their clinical symptoms,quality of life,and antiviral outcome and thus holds promise for clinical application in community.
Objective To investigate the clinical effect of chronic disease management with traditional Chinese medicine( TCM) characteristics in community patients with chronic hepatitis B( CHB). Methods A non-randomized case-control study was performed for 84 CHB patients who visited Tianhe Community in Guangzhou from 2014 to 2016. These patients were divided into TCM chronic disease management group and control group,with 42 patients in each group. The patients in the TCM chronic disease management group were given oral entecavir tablets( 0. 5 mg,once a day) combined with TCM chronic disease management,and those in the control group were given entecavir tablets,education on disease knowledge,and instructions on medication. The two groups were compared in terms of alanine aminotransferase( ALT) normalization rate,HBeAg seroconversion rate,HBV DNA clearance rate,TCM symptom score,and quality-of-life score after 48 weeks of treatment. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups,and the paired t-test was used for comparison before and after treatment; the non-parametric test was used for comparison of non-normally distributed continuous data between groups. The chi-square test was used for comparison of categorical data between groups,and the Fisher's exact test was used when more than 20% of the cells have an expected frequency of less than 5. Results After 48 weeks of treatment,the TCM chronic disease management group had a significantly lower clinical syndrome score and a significantly higher overall quality-of-life score than the control group( clinical syndrome score: 3. 66 ± 1. 92 vs 6. 42 ± 2. 48,t = 5. 563,P < 0. 001; overall quality-of-life score: 550. 75 ± 54. 24 vs 491. 08 ± 54. 21,t =-4. 888,P < 0. 001). Compared with the control group,the TCM chronic disease management group had slightly higher 48-week ALT normalization rate( 80. 00% vs 72. 22%,χ~2= 0. 590,P = 0. 443),HBV DNA clearance rate( 73. 17% vs 68. 42%,P > 0. 05),and HBeAg seroconversion rate( 29. 27% vs 18. 42%,P > 0. 05). Conclusion In community patients with CHB,chronic disease management with TCM characteristics can improve their clinical symptoms,quality of life,and antiviral outcome and thus holds promise for clinical application in community.
引文
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[14]CHI XL,JIANG WQ,XIAO HM,et al.Effect of health education in chronic disease management in patients with chronic hepatitis B[C]//China Society of Integrated Traditional Chinese and Western Medicine.Collected Papers from the Second International Academic Conference on Integrated Traditional Chinese and Western Medicine Therapy for Liver Diseases.Shanghai:China Society of Integrated Traditional Chinese and Western Medicine,2010:3.(in Chinese)池晓玲,江伟强,萧焕明,等.健康教育对慢性乙型肝炎患者慢病管理中的成效分析[C]//中国中西医结合学会.第二届国际中西医结合肝病学术会议论文汇编.上海:中国中西医结合学会,2010:3.
[15]CHI XL,XIAO HM.Traditional Chinese medicine prevention and treatment of liver fibrosis under the new situation of prevention and treatment of viral hepatitis[J].J Clin Hepatol,2018,34(4):694-697.(in Chinese)池晓玲,萧焕明.病毒性肝炎防治新形势下对中医药防治肝纤维化的思考[J].临床肝胆病杂志,2018,34(4):694-697.
[2]LI YR,FAN XL,DUAN XF,et al.Operation status of the twoway referral system between specialized hospital and community health center for patients with chronic hepatitits B virus infection[J].Chin Gen Pract,2015,18(19):2261-2264,2268.(in Chinese)李蕴铷,范小玲,段雪飞,等.慢性乙型肝炎病毒感染者专科医院和社区卫生服务中心双向转诊运行情况研究[J].中国全科医学,2015,18(19):2261-2264,2268.
[3]Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J].J Clin Hepatol,2015,31(12):1941-1960.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.
[4]BEDOSSA P,POYNARD T.An algorithm for the grading of activity in chronic hepatitis C.The METAVIR Cooperative Study Group[J].Hepatology,1996,24(2):289-293.
[5]THUMBOO J,FONG KY,MACHIN D,et al.Quality of life in an urban Asian population:The impact of ethnicity and socio-economic status[J].Soc Sci Med,2003,56(8):1761-1772.
[6]World Health Organization.Global hepatitis report 2017[R].Geneva:WHO,2017:VIII.
[7]LI PL,JIN WH,MENG DQ.A survey of HBs Ag carrying condition and cure knowledge of different populations[J/CD].Chin J Fron Med Sci:Electronic Version,2017,9(4):105-108.(in Chinese)李平路,金文华,孟德芹.不同住院人群乙型肝炎表面抗原携带状况及认知水平研究[J/CD].中国医学前沿杂志:电子版,2017,9(4):105-108.
[8]TAO JX,LI XD,WAN CX,et al.Investigation on the medication compliance of patients with chronic hepatitis B receiving free entecavir[J].China Med Herald,2017,14(35):37-40.(in Chinese)陶军秀,李晓东,万长秀,等.慢性乙型肝炎患者免费恩替卡韦服药依从性水平调查[J].中国医药导报,2017,14(35):37-40.
[9]ZHANG X,WANG WN.Compliance analysis of chronic hepatitis B patients receiving antiviral therapy[J].China Modern Doctor,2016,54(10):92-95.(in Chinese)张栩,汪维娜.慢性乙型肝炎患者抗病毒治疗的依从性分析[J].中国现代医生,2016,54(10):92-95.
[10]GE WH,XIE H.Status of chronic disease management[J].Pharm Clin Res,2012,20(6):479-484.(in Chinese)葛卫红,谢菡.慢病管理现状[J].药学与临床研究,2012,20(6):479-484.
[11]ZHU ZY,MENG H,ZHANG TT,et al.Effect of We Chat-based follow-up on chronic hepatitis B patients taking oiral antiretroviral[J].J Nurs,2017,24(10):71-75.(in Chinese)朱正云,孟卉,张婷婷,等.口服抗病毒药物慢性病毒性乙型肝炎患者微信随访效果观察[J].护理学报,2017,24(10):71-75.
[12]XU L.Evaluation of chronic disease management on chronic hepatitits b treatment[J].Med J West China,2012,24(6):1137-1138,1140.(in Chinese)许玲.慢病管理对慢性乙型肝炎治疗效果的评价[J].西部医学,2012,24(6):1137-1138,1140.
[13]ZHANG CZ,XIAO HM,SHI MJ,et al.A preliminary study of traditional Chinese medicine chronic disease management mode for chronic hepatitis B[J].Chin J Integr Tradit West Med Liver Dis,2016,26(3):181-183.(in Chinese)张朝臻,萧焕明,施梅姐,等.慢性乙型肝炎慢病管理中医模式初探[J].中西医结合肝病杂志,2016,26(3):181-183.
[14]CHI XL,JIANG WQ,XIAO HM,et al.Effect of health education in chronic disease management in patients with chronic hepatitis B[C]//China Society of Integrated Traditional Chinese and Western Medicine.Collected Papers from the Second International Academic Conference on Integrated Traditional Chinese and Western Medicine Therapy for Liver Diseases.Shanghai:China Society of Integrated Traditional Chinese and Western Medicine,2010:3.(in Chinese)池晓玲,江伟强,萧焕明,等.健康教育对慢性乙型肝炎患者慢病管理中的成效分析[C]//中国中西医结合学会.第二届国际中西医结合肝病学术会议论文汇编.上海:中国中西医结合学会,2010:3.
[15]CHI XL,XIAO HM.Traditional Chinese medicine prevention and treatment of liver fibrosis under the new situation of prevention and treatment of viral hepatitis[J].J Clin Hepatol,2018,34(4):694-697.(in Chinese)池晓玲,萧焕明.病毒性肝炎防治新形势下对中医药防治肝纤维化的思考[J].临床肝胆病杂志,2018,34(4):694-697.