经颈静脉肝内门体分流术对门静脉高压患者心理状态、生活质量的影响

Effect of transjugular intrahepatic portosystemic shunt on mental status and quality of life in patients with portal hypertension

目的探讨经颈静脉肝内门体分流术(TIPS)对门静脉高压患者心理状态、生活质量的影响。方法收集2020年1月至2022年2月首都医科大学附属北京世纪坛医院行TIPS治疗的102例门静脉高压患者的临床资料,根据患者是否存在焦虑、抑郁状态,将其分为焦虑/抑郁组(n=69)和无焦虑/抑郁组(n=33)。采用焦虑自评量表(SAS)、抑郁自评量表(SDS)评分评估患者在TIPS治疗前后的心理状态,采用卡氏功能状态(KPS)评分评估患者的行为能力,采用世界卫生组织生活质量评定简表(WHOQOL-BREF)评分评估患者的生活质量,采用Logistic回归模型分析患者心理状态的影响因素。结果治疗后1个月,门静脉高压患者SAS、SDS评分均明显降低,而KPS评分则明显升高,WHOQOL-BREF评分中生理、心理、社会关系、环境4个维度的评分均明显升高,差异均有统计学意义(P<0.01)。单因素分析结果显示,两组患者年龄、并存疾病、病程、人际关系比较,差异均有统计学意义(P<0.05);两组患者文化程度、肝病类型、消化道出血史比较,差异均无统计学意义(P>0.05)。多因素分析结果显示,有并存疾病、人际关系差、病程≥2年均是门静脉高压患者发生焦虑或抑郁的危险因素(P<0.05)。结论有并存疾病、人际关系差、病程≥2年均是门静脉高压患者发生焦虑或抑郁的危险因素,TIPS可显著改善门静脉高压患者的焦虑、抑郁情绪,提高了患者的行为能力和生活质量。

Objective To analyze the effect of transjugular intrahepatic portosystemic shunt(TIPS)on mental state and quality of life in patients with portal hypertension.Method A total of 102 patients with portal hypertension who received TIPS treatment in Beijing Shijitan Hospital,Capital Medical University from January 2020 to February 2022 were selected,they were divided into anxiety/depression group(n=69)and no anxiety/depression group(n=33)according to whether they had anxiety and depression.The self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were used to evaluate the stress of patients.Karnofsky performance status(KPS)score was used to evaluate the patients'behavior ability,and World Health Organization quality of life-BREF(WHOQOL-BREF)score was used to evaluate the patients'quality of life.The influencing factors of patients'psychological state were analyzed by Logistic regression model.Result One month after treatment,the scores of SAS and SDS decreased significantly the scores of KPS increased significantly,the differences were statistically significant(P<0.01);the scores of physical state,psychological state,social relationship and environmental in WHOQOL-BREF increased significantly,the differences were statistically significant(P<0.01).Univariate analysis showed there were differences for age,concomitant diseases,disease duration and interpersonal relationship between two groups,the differences were statistically significant(P<0.05);there were no significant differences for the education,types of liver diseases,history of gastrointestinal bleeding,the differences were not statistically significant(P>0.05).Multivariate analysis showed concomitant disease,poor interpersonal relationship,and disease duration≥2 years were risk factors for anxiety or depression in patients with portal hypertension,the differences were statistically significant(P<0.05).Conclusion Concomitant disease,poor interpersonal relationship,and disease duration≥2 years are risk factors for anxiety or depression in patients with portal hypertension,and TIPS can improve the anxiety and depression of patients,improve their behavioral ability and quality of life.