广州市慢性丙型肝炎医保策略改变对患者生活质量的影响

effect of guangzhou healthcare insurance policy on the quality of life of patients with chronic hepatitis c

目的 研究聚乙二醇干扰素α-2a抗病毒治疗对慢性丙型肝炎患者生活质量的干预作用,并评估广州市慢性丙型肝炎医保策略对患者生活质量的影响.方法 应用生活质量评定问卷(gqoli-74),对102例慢性丙型肝炎患者生活质量进行评估,其中,42例为广州市医保缴费的聚乙二醇干扰素α-2a治疗组,30例为自费聚乙二醇干扰素α-2a治疗组,其余30例未进行干扰素治疗.三组患者均于治疗前、治疗结束时接受测评,每组治疗前后比较采用wilcoxon检验,并用kruskal-wallis检验对三组间的各维度及总分值进行比较.结果 治疗前,三组间躯体功能、心理功能、社会功能、物质生活维度及总分值比较(医保治疗组分别为55.3、58.8、61.9、60.6和58.5；自费治疗组分别为57.5、60.4、61.1、55.2和58.3；未治疗组分别为58.6、60.3、57.5、54.8和56.4),差异无统计学意义(z=-1.177、-0.846、-1.062、-0.377和-1.085,p值均＞0.05).治疗后,医保治疗组各维度(分别为67.1、76.4、68.1、70.1)及总分值(72.6)均高于未治疗组(分别为54.6、54.0、53.3、57.5和54.6,p＜0.01)；自费治疗组除物质生活维度外(56.3),其余3个维度(65.1、65.0和69.6)及总分值(64.3)均高于未治疗组(p＜0.05)；医保治疗组心理功能、物质生活维度及总分值高于自费治疗组(p＜0.05).结论聚乙二醇干扰素α-2a治疗可以提高慢性丙型肝炎患者生活质量.由广州市医保缴费的聚乙二醇干扰素α-2a治疗组患者生活质量改善水平高于自费治疗组.

objective to investigate the effect of peg-interferon α-2a therapy on the quality of life (qol) of patients with chronic hepatitis c,and to evaluate the effect of healthcare insurance policy in guangzhou city on these patients.methods totally 102 patients with chronic hepatitis c were enrolled.forty-two patients (group a) were treated with peg-interferon α-2a plus ribavirin whose medical expenses were covered by medical insurance; 30 patients (group b ) received the same therapy but at their own expenses ; and the other 30 patients ( group c) were not treated with peg-interferon α-2a.qol of patients in three groups were investigated using the general quality of life inventory questionnaire (gqoli-74) before and after peg-interferon α-2a treatment.wilcoxon test was used to compare on all scales and total scores before and after treatment in each group,and kruskal-wallis test was performed to compare on all scales and total scores among three groups.results before treatment,the physical function,psychological function,social function,material life and total score of group a were 55.3,58.8,61.9,60.6 and 58.5 ; those of group b were 57.5,60.4,61.1,55.2 and 58.3; those of group c were 58.6,60.3,57.5,54.8 and 56.4.there was no statistic difference on all scales and total scores among three groups (z =- 1.177,- 0.846,- 1.062,-0.377 and - 1.085,p ＞ 0.05).after treatment,group a had higher qol on all scales (67.1,76.4,68.1,70.1) and total score (72.6) than group c (54.6,54.0,53.3,57.5 and 54.6,p ＜0.01) ; group b had higher qol (p ＜0.05) on three scales (65.1,65.0 and 69.6) and total score ( 64.3 ) except material life ( 56.3 ) than group c ; group a had higher qol on psychological function,material life and total score than group b ( p ＜ 0.05 ).conclusions qols of chronic hepatitis c patients treated with peg-interferon α-2a are higher than those without peg-interferon α-2a treatment.patients whose medical expenses are covered by medical insurance may have higher qols than those at their own expenses.