原发性胆汁性胆管炎患者生活质量与治疗情况的调查分析

An investigation of quality of life and treatment of patients with primary biliary cholangitis

目的通过PBC-40量表对原发性胆汁性胆管炎患者生活质量及治疗情况进行评估。方法对37例于2017年1月-2018年12月在空军军医大学第一附属医院消化内科确诊并持续治疗的原发性胆汁性胆管炎患者进行PBC-40量表调查,并结合患者基线生化指标及病理分期等,对量表“症状”“瘙痒”“乏力”“认知”“社会”“情感”六大模块的得分进行分析。符合正态分布的计量资料两组间比较采用两独立样本t检验,多组间比较采用方差分析;非正态分布的计量资料两组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis H检验。瘙痒得分治疗前后比较采用配对样本的Wilcoxon符号秩和检验,乏力得分治疗前后比较采用配对样本t检验。相关性分析采用Spearman分析。结果PBC-40量表中症状得分(16.5±4.3)分,瘙痒(5.2±3.3)分,乏力(26.4±8.3)分,认知功能(15.3±5.1)分,社会功能(25.4±8.4)分,情感(8.1±2.7)分。以50岁和60岁为节点进行分层分析,发现瘙痒得分在不同年龄组中差异有统计学意义(χ^2=8.290,P=0.016)。BMI≥24 kg/m2的PBC患者症状得分和认知得分较BMI<24 kg/m2显著降低,差异均有统计学意义(Z=-2.222,P=0.025;t=2.255,P=0.030)。抗着丝点抗体阳性PBC患者乏力程度显著升高(t=3.453,P=0.001)。“瘙痒”模块得分与ALP(R2=0.325,P=0.049)和GGT(R2=0.402,P=0.014)呈正相关。结论PBC-40量表可用于我国原发性胆汁性胆管炎患者的生活质量评估。高ALP和GGT水平可能预示较差的生活质量。

Objective To evaluate the quality of life and treatment of patients with primary biliary cholangitis(PBC)using the PBC-40 scale.Methods The PBC-40 scale was used to perform an investigation of 37 patients who were diagnosed with PBC and received continuous treatment in Department of Gastroenterology,The First Affiliated Hospital of Air Force Medical University,from January 2017 to December 2018.With reference to patients’baseline biochemical parameters and pathological staging,the scores of the six domains of the PBC-40 scale,i.e.,“symptom”,“pruritus”,“weakness”,“cognitive function”,“social function”,and“emotional function”,were analyzed.The two-independent-samples t test was used for comparison of normally distributed continuous data between two groups,and an analysis of variance was used for comparison between multiple groups;the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups,and the Kruskal-Wallis H test was used for comparison between multiple groups.The paired-samples Wilcoxon signed rank sum test was used for comparison of pruritus score before and after treatment,and the paired samples t-test was used for comparison of weakness score before and after treatment.A Spearman analysis was used to investigate correlation.Results In the PBC-40 scale,the scores of symptom,pruritus,weakness,cognitive function,social function,and emotional function were 16.5±4.3,5.2±3.3,26.4±8.3,15.3±5.1,25.4±8.4,and 8.1±2.7,respectively.A stratified analysis was performed for the patients aged<50 years,50-60 years,and>60 years,and the results showed that there was a significant difference in the score of pruritus between the different age groups(χ^2=8.290,P=0.016).The PBC patients with a body mass index of≥24 kg/m2 had significantly lower scores of symptom and cognitive function than those with a body mass index of<24 kg/m2(symptom:Z=-2.222,P=0.025;cognitive function:t=2.255,P=0.030).The patients with positive anticentromere antibody had a significantly higher score of weakness than those with negative anticentromere antibody(t=3.453,P=0.001).The score of pruritus was positively correlated with alkaline phosphatase(ALP)(R2=0.325,P=0.049)and gamma-glutamyl transpeptidase(GGT)(R2=0.402,P=0.014).Conclusion The PBC-40 scale can be used to evaluate the quality of life of Chinese patients with PBC.High levels of ALP and GGT may predict low quality of life.