肝硬化患者肝移植术后生存质量的变化

Change of quality of life in hepatic cirrhosis patient after liver transplantation

目的调查肝硬化患者肝移植前后生存质量的变化情况。方法研究对象为在中山大学附属第三医院移植中心行首次肝移植手术的68例肝硬化患者。分别在术前,术后0～6个月、7～12个月、12个月以上对患者进行问卷调查。问卷采用健康调查简表(medical outcome study 36-item short form health survey,SF-36)与疾病专用调查表——慢性肝病问卷(chronic liver disease questionaire,CLDQ)。结果在肝移植术前,肝硬化患者的SF-36和CLDQ各维度评分均偏低。术后各时段SF-36的生理机能、躯体疼痛、一般健康、精力和CLDQ的腹部症状、乏力、全身症状、活动评分均较术前明显升高(均为P<0.05);与术前比较,术后0～6个月SF-36的生理职能、社会功能、情感职能、精神健康和CLDQ的情感功能、焦虑评分差异无统计学意义(均为P>0.05),但术后7～12个月、术后12个月以上述维度评分比较差异均有统计学意义(均为P<0.05);术后随着时间的推移,两表各维度得分逐步升高。结论肝硬化肝移植患者术后的生存质量与术前比较有明显改善,术后早期以生理功能方面改善明显,随时间的推移,生存质量其他指标如心理状态和社会功能也得到明显的改善。

Objective To investigate the change of quality of life in hepatic cirrhosis patients before and after liver transplantation. Methods Sixty-eight hepatic cirrhosis patients, who received first liver transplantation in transplantation centre of the Third affiliated hospital of Sun Yat-sen university, were selected as subjects of the study. The patients were investigated by questionnaires before operation and 0- 6 months, 7-12 months, 12 months after the operation. Medical outcomes study 36-item short form health survey （SF-36） and the chronic liver disease questionaire （CLDQ） were applied in this investigation. Results Before liver transplantation, the scores of SF-36 and CLDQ in all dimensionalities were low in hepatic cirrhosis patients. The scores of physical function, body pain, general health, vitality in SF-36 and abdominal symptoms, fatigue, systemic symptoms, activity in CLDQ at all the time after transplantation were higher than those before transplantation （ all in P 〈 0. 05 ）. Compared with those before transplantation, there was no significant differ- ence in the scores of role-physical, social function, role-emotion, metal health in SF-36 and emotional func- tion, worries in CLDQ at 0- 6 months after transplantation （ all in P 〉 0. 05 ）, but there was significant differ- ence in those at 7-12 months and over 12 months after transplantation （all in P 〈 0. 05 ）. The scores of the twotables in all dimensionalities increased gradually after transplantation as time goes by. Conclusions Compared with that before transplantation, the quality of life in hepatic cirrhosis patients improves significantly after liver transplantation. Physical function increases at early stage after transplantation. As time goes by, the other indices of quality of life such as mental state and social function improve significantly.