非酒精性脂肪肝与非酒精性脂肪肝炎患者健康相关生活质量调查比较
|
摘要
目的通过慢性肝病调查问卷,比较非酒精性脂肪肝与非酒精性脂肪肝炎对患者健康相关生活质量的影响,为后续治疗提供依据与指导。方法选择2014年11月至2015年12月成都市第六人民医院门诊非酒精性肝病患者63例,按非酒精性脂肪肝病临床类型分组,其中非酒精性脂肪肝患者44例,非酒精性脂肪肝炎患者19例,采用慢性肝病问卷量表进行健康相关生活质量调查。比较两组患者评分负担总体情况和在腹部症状、疲劳、全身症状、活动、情感功能、焦虑6个维度的分布。在组内分别评估性别、病程时间、肥胖、代谢性疾病等对患者慢性肝病问卷评分的影响。结果 63例非酒精性脂肪肝病患者问卷评分在各个维度综合评分为(5.66±0.50)分。非酒精性脂肪肝炎患者评分低于非酒精性脂肪肝患者,差异有统计学意义(P=0.0004),以焦虑(P=0.0081)、活动(P=0.0275)、情感功能(P=0.0243)维度最为突出。在非酒精性脂肪肝组,肥胖(P=0.0135)与慢性代谢性疾病(P=0.0162)患者问卷评分更低;但在非酒精性脂肪肝炎组,病程>6个月患者评分低于对照组,差异有统计学意义(P=0.0020)。结论非酒精性脂肪肝炎对患者健康相关生活质量影响高于非酒精性脂肪肝,其差异主要体现在活动、情感和焦虑纬度。可以对不同临床特点患者在相应维度进行针对性干预。
Objective To compare the impact of non-alcoholic fatty 1iver( NAFL) and non-alcoholic steatohepatitis( NASH) on health-related quality of life( HRQL) through chronic liver disease questionnaire( CLDQ) so as to provide basis and guidance for the subsequent treatment. Methods The survey was conducted in 63 patients with non-alcoholic fatty 1iver( NAFLD) from Nov. 2014 to Dec.2015 in the Sixth People's Hospital of Chengdu. Patients were divided into two groups by clinical type of NAFLD. The comprehensive score and the distribution in subscales of abdominal symptoms( AS),fatigue( FA),systemic symptoms( SS),activity( AC),emotional functioning( EF),worry( WO) were calculated in patients with NAFL( n = 44) or NASH( n = 19). The influence of different clinical features such as sex,duration of disease,obesity or metabolic disease on the outcomes of CLDQ within two groups was evaluated. Results The outcomes from63 patients with NAFLD showed that all subscales of CLDQ were impaired with a comprehensive score of 5. 66 ± 0. 50,which decreased more significantly in patients of non-alcoholic steatohepatitis( NASH) than in those with non-alcoholic fatty 1iver( NAFL)( P = 0. 0004). The most prominent change was in subscale of anxiety( P = 0. 0081),activity( P = 0. 0275),emotional functioning( P = 0. 0243). Patients of NAFL with obesity( P = 0. 0135) or chronic metabolic disease( P = 0. 0162) got a lower score than others. The outcomes of CLDQ in patients of NASH were related to the duration time of the disease( P = 0. 020). Conclusion HRQL in patients of NASH is more significantly influenced than that of NAFL,especially in subscales of AC,EF and WO. Targeted intervention should be offered for patients with various clinical types in various subscales.
Objective To compare the impact of non-alcoholic fatty 1iver( NAFL) and non-alcoholic steatohepatitis( NASH) on health-related quality of life( HRQL) through chronic liver disease questionnaire( CLDQ) so as to provide basis and guidance for the subsequent treatment. Methods The survey was conducted in 63 patients with non-alcoholic fatty 1iver( NAFLD) from Nov. 2014 to Dec.2015 in the Sixth People's Hospital of Chengdu. Patients were divided into two groups by clinical type of NAFLD. The comprehensive score and the distribution in subscales of abdominal symptoms( AS),fatigue( FA),systemic symptoms( SS),activity( AC),emotional functioning( EF),worry( WO) were calculated in patients with NAFL( n = 44) or NASH( n = 19). The influence of different clinical features such as sex,duration of disease,obesity or metabolic disease on the outcomes of CLDQ within two groups was evaluated. Results The outcomes from63 patients with NAFLD showed that all subscales of CLDQ were impaired with a comprehensive score of 5. 66 ± 0. 50,which decreased more significantly in patients of non-alcoholic steatohepatitis( NASH) than in those with non-alcoholic fatty 1iver( NAFL)( P = 0. 0004). The most prominent change was in subscale of anxiety( P = 0. 0081),activity( P = 0. 0275),emotional functioning( P = 0. 0243). Patients of NAFL with obesity( P = 0. 0135) or chronic metabolic disease( P = 0. 0162) got a lower score than others. The outcomes of CLDQ in patients of NASH were related to the duration time of the disease( P = 0. 020). Conclusion HRQL in patients of NASH is more significantly influenced than that of NAFL,especially in subscales of AC,EF and WO. Targeted intervention should be offered for patients with various clinical types in various subscales.
引文
[1]中华医学会感染病学分会,肝脏炎症及其防治专家共识专家委员会.肝脏炎症及其防治专家共识[J].中华肝脏病杂志,2014,22(2):94-103.
[2]European Association for the Study of the Liver(EASL),European Association for the Study of Diabetes(EASD),European Association for the Study of Obesity(EASO).EASLEASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease[J].Obes Facts,2016,9(2):65-90.
[3]DAVID K,KOWDLEY K V,UNALP A,et al.Quality of life in adults with nonalcoholic fatty liver disease:baseline data from the nonalcoholic steatohepatitis clinical research network[J].Hepatology,2009,49(6):1904-1912.
[4]LES I,DOVAL E,FLAVIA M,et al.Quality of life in cirrhosis is related to potentially treatable factors[J].Eur J Gastroenterol Hepatol,2010,22(2):221-227.
[5]YOUNOSSI Z M,GUYATT G,KIWI M,et al.Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease[J].Gut,1999,45(2):295-300.
[6]ALT Y,GRIMM A,SCHLEGEL L,et al.The impact of liver cell injury on health related quality of life in patients with chronic liver disease[J].PLo S One,2016,11(3):e0151200.
[7]中华医学会肝病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南[J].中华肝脏病杂志,2010,18(3):163-166.
[8]常彬霞,邹正升,李保森,等.2015年日本胃肠病学会非酒精性脂肪肝病/非酒精性脂肪性肝炎的循证医学临床治疗指南[J].临床肝胆病杂志,2015,31(7):1027-1030.
[9]SCHULZ K H,KROENCKE S,EWERS H.The factorial structure of the Chronic Liver Disease Questionnaire(CLDQ)[J].Qual Life Res,2008,17(4):575-584.
[10]CHAWLA K S,TALWALKAR J A,KEACH J C.Reliability and validity of the Chronic Liver Disease Questionnaire(CLDQ)in adults with non-alcoholicsteatohepatitis(NASH)[J].BMJ Open Gastroenterol,2016,3(1):e000069.
[11]JARA M,BEDNARSCH J,MALINOWSKI M,et al.Predictors of quality of life in patients evaluated for liver transplantation[J].Clin Transplant,2014,28(12):1331-1338.
[12]FRITH J,DAY C P,ROBINSON L,et al.Potential strategies to improve uptake of exercise interventions in non-alcoholic fatty liver disease[J].J Hepatol,2010,52:112-116.
[13]MOHAMED J,NAZRATUN NAFIZAH A H,ZARIYANTEY AH,et al.Mechanisms of diabetes-induced liver damage:the role of oxidative stress and inflammation[J].Sultan Qaboos Univ Med J,2016,16(2):e132-e141.
[2]European Association for the Study of the Liver(EASL),European Association for the Study of Diabetes(EASD),European Association for the Study of Obesity(EASO).EASLEASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease[J].Obes Facts,2016,9(2):65-90.
[3]DAVID K,KOWDLEY K V,UNALP A,et al.Quality of life in adults with nonalcoholic fatty liver disease:baseline data from the nonalcoholic steatohepatitis clinical research network[J].Hepatology,2009,49(6):1904-1912.
[4]LES I,DOVAL E,FLAVIA M,et al.Quality of life in cirrhosis is related to potentially treatable factors[J].Eur J Gastroenterol Hepatol,2010,22(2):221-227.
[5]YOUNOSSI Z M,GUYATT G,KIWI M,et al.Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease[J].Gut,1999,45(2):295-300.
[6]ALT Y,GRIMM A,SCHLEGEL L,et al.The impact of liver cell injury on health related quality of life in patients with chronic liver disease[J].PLo S One,2016,11(3):e0151200.
[7]中华医学会肝病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南[J].中华肝脏病杂志,2010,18(3):163-166.
[8]常彬霞,邹正升,李保森,等.2015年日本胃肠病学会非酒精性脂肪肝病/非酒精性脂肪性肝炎的循证医学临床治疗指南[J].临床肝胆病杂志,2015,31(7):1027-1030.
[9]SCHULZ K H,KROENCKE S,EWERS H.The factorial structure of the Chronic Liver Disease Questionnaire(CLDQ)[J].Qual Life Res,2008,17(4):575-584.
[10]CHAWLA K S,TALWALKAR J A,KEACH J C.Reliability and validity of the Chronic Liver Disease Questionnaire(CLDQ)in adults with non-alcoholicsteatohepatitis(NASH)[J].BMJ Open Gastroenterol,2016,3(1):e000069.
[11]JARA M,BEDNARSCH J,MALINOWSKI M,et al.Predictors of quality of life in patients evaluated for liver transplantation[J].Clin Transplant,2014,28(12):1331-1338.
[12]FRITH J,DAY C P,ROBINSON L,et al.Potential strategies to improve uptake of exercise interventions in non-alcoholic fatty liver disease[J].J Hepatol,2010,52:112-116.
[13]MOHAMED J,NAZRATUN NAFIZAH A H,ZARIYANTEY AH,et al.Mechanisms of diabetes-induced liver damage:the role of oxidative stress and inflammation[J].Sultan Qaboos Univ Med J,2016,16(2):e132-e141.