儿童肝移植术后供体生活质量分析

Analysis of health-related quality-of-life in donors of pediatric liver transplantation

目的调查儿童活体肝移植术后供体的生活质量情况并探讨影响其生活质量的主要因素。方法采用简明健康调查问卷（SF-36），对2005年1月至2014年12月在四川大学华西医院和重庆医科大学附属儿童医院实施的86例儿童活体肝移植供体进行了生活质量调查。所有纳入供体为不带肝中静脉的左半肝或左外叶切除者，且无重大并发症，能够较好应用汉语沟通者。将调查结果与普通人群生活质量进行比较，并对可能影响生活质量的因素进行分析探讨。结果共发放符合调查要求的问卷80例，有效回收问卷71例（88．7％）。男24例，女47例，平均年龄（29．4±8．O）岁。胆道闭锁患儿供体35例，代谢性肝病患儿供体15例，原发性肝硬化患儿供体11例，肝肿瘤及其他疾病患儿供体1O例。移植供体主要为受体父母。总体上，肝移植供体术后生活质量水平在各维度与普通人群没有明显的差异（P〉0．05）；胆道闭锁患儿供体在精神健康维度得分优于非胆道闭锁患儿供体（P=0．029）；全自费医疗患儿供体在总体健康方面得分明显低于具有医疗保险患儿的供体（P=0．033）；供体手术2年后在生理功能（P=0．038）及躯体疼痛（P=0．040）维度得分较术后2年内明显增高；应用主成分分析将生活质量8个维度综合为1个维度，结果提示术后时间是影响肝移植供体术后生活质量的首要因素（P=0．037）。结论儿童肝移植供体术后生活质量状况良好，术后时间、受体原发病和受体医疗形式是影响供体生活质量的主要因素。

Objective To explore the health-related quality-of-life of pediatric liver transplant donors and examine the principal influencing factors of quality-of-life. Methods A total of 86 consecutive pediatric liver transplant donors undergoing hepatectomy were recruited from West China Hospital of Sichuan University and Children＇s Hospital, Chongqing Medical University between January 2005 and December 20T4. Health-related quality-of-life was measured with the Chinese version of Medical Outcomes Study Short Form-36 （SF-36）. All participants fulfilled the criteria of left hepatic resection without middle hepatic vein involvement or left lateral lobectomy, no severe medical complications and communicating influent Chinese. The survey results were compared with those of general population. And the influencing factors of quality-of-life were also explored. Results A total of 80 questionnaires were distributed in accordance with the selection criteria and 71 （88. 70//00） returned. There were 24 males and 47 females with an average age of 29. 4 ＋ 8. 0 years. The recipients had biliary atresia （BA,n = 35）,metabolic liver disease （n = 15）, primary hepatocirrhosis （n = 11） and hepatic tumors （n = 10）. Most donors were recipients＂ parents. In general, all dimensions of health- related quality-of-life in donors were favorable as compared with general population （P ~0. 05）.Mental health scores in donors donated to BA were better than those to non-BA （P = 0. 029）. General health scores were lower in donors without recipients＂ medical insurance than those with recipients＂ medical insurance （P = 0. 033）. Regarding physical functioning （P = 0. 038） and bodily pain （P = 0. 040）,donors ~ 2 years after surgery scored higher than those ~2 years. Based upon principal component analysis, 8 dimensions of SF-36 were integrated into one single dimension. The Results indicated that time since surgery was a principal influencing factor of donors＂ quality-of-life （P = 0. 037）. Conclusions The outcomes of health-related quality-of-life are favorable for pediatric liver transplant donors. Time since surgery, recipient＇s primary disease and medical insurance may impact the donors＂ postoperative quality-of-life significantly.