肝移植术后患者的生存质量及其影响因素研究

Quality of life following liver transplantation and its impact factors

目的探讨肝移植术后患者的生存质量及其影响因素。方法2007年5月至2010年12月，根据自愿的原则，通过便利抽样调查，在中山大学附属第一医院和中山大学附属第三医院接受肝移植术2周以上的202例患者入选本研究。采用一般情况调查表、医学结局研究简短36条目问卷（SF-36）、抑郁自评量表（SDS）、焦虑自评量表（SAS）和社会支持评定量表的方法，对肝移植术后患者的生存质量及其影响因素进行回顾性研究。所有患者术前均签署知情同意书，符合医学伦理学规定。将患者分为5组，其中术后≤6个月者42例，术后7-12个月者40例，术后13-24个月者40例，术后25-36个月者40例、术后〉3年者40例。计算各组患者SF-36中包括生理机能（PF）、生理职能（RP）、躯体疼痛（BP）、一般健康（GH）、精力（VT）、社会功能（SF）、情感职能（RE）、精神健康（MH）8个维度得分和生理健康总分（PCS）、精神健康总分（MCS）。采用Kruskal-Wallis检验比较各组生存质量的差异。分别以术后患者PCS总分和MCS总分为因变量，将客观支持分、主观支持分、支持利用度分、抑郁、焦虑、年龄、性别、婚姻状况、学历、术后时问（术后≤6个月、术后7-12个月、术后13-24个月、术后25-36个月、术后〉3年者）、家庭月收入、原发病、医疗费用支付方式等可能的影响因素作为自变量分别纳入回归方程，采用逐步筛选（stepwise）法筛选变量，分析生存质量的影响因素。结果SF-36表中除RP、GH得分外，各组患者的其余6个维度得分及PCS、NCS比较，差异均有统计学意义（均为P〈0．05）。与术后≤6个月患者比较，术后13-24个月组和术后〉3年组的PCS和MCS显著升高，比较差异有统计学意义（Z值分别为3．103、2．233和2．859、2．551，均为P〈0．05）。主观支持和术后时间为生理健康影响因素，主观支持分高和术后13-24个月及术后〉3年的患者的生理健康水平较佳（t值分别为3．518、2．771、2．402，均为P〈O．05）。术后时间、抑郁和焦虑为术后患者精神健康的影响因素。术后13-24个月及术后〉3年的患者的精神健康水平较佳（t值分别为2．385、2．479，P〈0．05），轻度抑郁、中度抑郁、中重度焦虑患者精神健康水平较差（t值分别为-2．141、-2．517、-2．071，均为P〈0．05）。结论肝移植术后13-24个月和〉3年患者的生存质量优于1年以内患者。主观支持和术后时问为患者生理健康的影响因素，术后时间、抑郁和焦虑为精神健康的影响因素。

Objective To study the quality of life and its impact factors in liver transplant recipients. Methods A total of 202 patients in the First Affiliated Hospital and the Third Affiliated Hospital of Sun Yat-sen University who had undergone liver transplantation for more than 2 weeks werevoluntarily enrolled in this retrospective study by Convenience Sampling and the questionnaire surveys including general information questionaire, Medical outcomes study of 36-item short-form health survey （SF-36）, self-rating depression scale（SDS）, self-rating anxiety scale（SAS） and social support rating scale were performed in each patient. This study was approved by local ethical committee and that the informed consent of all participating subjects was obtained. The participants were divided into 5 groups according to their postoperative period. There were 42 patients in the group of less than or equal to 6 months after transplantation and 40 patients respectively in the group of 6 to 12 months, 13 to 24 months, 25 to 36 months and more than 3 years after transplantation. The scores of 8 sub-scales in SF-36, physical function（PF）,role limitation due to physical problem（RP）, blood pain（BP）, general health（GH）,vitality（VT）, social function （SF）, role limitation due to emotional problem （RE）, mental health （MH）,and physical component summary （PCS）, mental component summary （MCS） scores were calculated and the differences among 5 groups were tested by Kruskal-Wallis test. The PCS and MCS scores were the dependent variables and the scores of objective support, subjective support, social supports and uses（sub-scales of Social Support Rating Scale）, depression, anxiety, age, gender, marital status, education, postoperative period, family income, primary disease, medical payment were included as independent varibles into subsequent multiple linear regression analysis to identify factors influencing the quality of the recipients＇ life. Results Except RP and GH scores, there were significant differences of scores in other six scales and PCS, MCS scores among 5 groups （P〈0.05）. Compared to patients in the group of less than or equal to 6 months, the scores of PCS and MCS were significantly higher among the patients in the group of 13 to 24 months after transplantation and more than 3 years after transplantation （Z=3.103, 2.233 and Z=2.859, 2.551, all in P〈0.05）. Multivariate analysis showed that subjective support and postoperative time were the influencing factors of patients＇ physical health （t=3.518,2.771,2.402, all in P〈0.05）. Higher scores of subjective support of patients in the group of 13 to 24 months after transplantation and more than 3 years after transplantation had higher physical health scores. Postoperative time, depression and anxiety were the main influencing factors for patients＇ mental health. Patients in the group of 13 to 24 months after transplantation and more than 3 years after transplantation had higher mental health scores （t=2.385, 2.479, all in P〈0.05）. Patients with mild, moderate depression, moderate and severe anxiety had lower mental health scores （t=-2.141, -2.517, -2.071, all in P〈0.05）. Conclusions The quality of life in patients who received liver transplantation for more than 1 year but less than 2 years and more than 3 years are better than those within 1 year. The subjective support and postoperative time are the factors influencing physical health, while the postoperative time, depression and anxiety are the main factors influencing mental health.