非酒精性脂肪性肝病患者生活质量调查

摘要/Abstract

摘要： 目的探讨非酒精性脂肪性肝病(NAFLD)患者健康相关生活质量(HRQoL)的变化。方法对319例健康体检成人以及64例除NAFLD以外的其他肝病患者(57例为慢性乙型肝炎)进行肝脏受控衰减参数(CAP)、肝硬度(LSM)及血清转氨酶测定,用简明健康测量量表(SF-36)评估研究对象的HRQoL。结果无肝病组、NAFLD组和其他肝病组SF-36量表中生理机能分别为(90.22±12.83)、(84.90±14.34)、(82.58±19.07)、生理职能(84.41±28.05)、(75.63±34.20)、(56.64±43.47)、一般健康状况(65.67±19.75)、(55.02±18.73)、(52.06±19.42)、精力项(75.00±15.69)、(69.82±15.32)、(66.02±19.80),NAFLD组与无肝病组比较,差异均有统计学意义(均P<0.05),与其他肝病组之间差异均无统计学意义(均P>0.05)。生理机能(90.22±12.83对83.41±15.25对86.10±13.51)、一般健康状况(65.67±19.75对55.03±20.60对55.00±17.16)、精力项(75.00±15.69对69.77±14.84对69.86±15.76)评分随CAP值的增高在无肝病组、轻度脂肪肝组和中重度脂肪肝组之间呈显著降低趋势(P<0.05)。生理机能(87.33±13.84对86.40±15.58对77.73±12.51)、生理职能(79.27±32.18对76.75±35.94对60.23±37.53)、躯体疼痛(80.31±20.01对76.61±20.07对66.59±25.01)、一般健康状况(59.63±19.78对55.61±20.40对47.82±20.72)、精力项(72.77±15.16对70.96±15.60对63.86±19.27)评分,随LSM值的增高在无肝纤维化组、肝纤维化组和肝硬化组之间呈显著降低趋势(P<0.05)。在NALFD患者中,与非肥胖组相比,肥胖组精力(73.06±14.69对68.33±15.42)和健康变化项(47.58±17.94对41.11±20.59)评分显著降低,差异均有统计学意义(均P<0.05)。与血清转氨酶正常组相比,健康体检成人转氨酶增高组一般健康状况(59.82±20.72对52.84±18.59)及精力项(73.18±16.26对68.36±14.59)评分显著降低,差异均有统计学意义(均P<0.05)。结论与以CHB为主的其他肝病患者相似,NAFLD患者生活质量严重受损。

关键词: 非酒精性脂肪性肝病, 健康相关生活质量, 慢性乙型肝炎

Abstract: Objective To discuss the association between nonalcoholic fatty liver disease (NAFLD) and health-related quality of life (HRQoL). Methods Three hundred and nineteen adults who had physical examinations and sixty-four patients with liver diseases except NAFLD (89.1% were chronic hepatitis B, CHB) were enrolled. Measurements of controlled attenuation parameter (CAP), liver stiffness measurement (LSM), and serum transaminase were performed for NAFLD screening. HRQoL were assessed by short form health survey (SF-36). Results In NALFD group, scores of physical function (PF) (90.22±12.83), role-physical (RP) (84.41±28.05), general health (GH) (65.67±19.75) and vitality (VT) (75.00±15.69) were significantly lower than those in healthy control group (84.90±14.34, 75.63±34.20, 55.02±18.73 and 69.82±15.32, all P<0.05), but not obviously different from those in non-NALFD liver disease group (82.58±19.07, 56.64±43.47, 52.06±19.42 and 66.02±19.80, all P>0.05). There was a statistically significant decreasing tendency in PF (90.22±12.83 vs 83.41±15.25 vs 86.10±13.51), GH (65.67±19.75 vs 55.03±20.60 vs 55.00±17.16) and VT scores (75.00±15.69 vs 69.77±14.84 vs 69.86±15.76) from healthy control group to mild hepatic steatosis group, to moderate and severe hepatic steatosis group (all P<0.05). Additionally, PF (87.33±13.84 vs 86.40±15.58 vs 77.73±12.51), RP (79.27±32.18 vs 76.75±35.94 vs 60.23±37.53), body pain (BP) (80.31±20.01 vs 76.61±20.07 vs 66.59±25.01), GH (59.63±19.78 vs 55.61±20.40 vs 47.82±20.72) and VT scores (72.77±15.16 vs 70.96±15.60 vs 63.86±19.27) showed significantly downward trends from fibrosis-free group to fibrosis group, and to cirrhosis group (all P<0.05). In NAFLD patients, obesity group had significantly lower scores in VT (73.06±14.69 vs 68.33±15.42) and health transition (HT) (47.58±17.94 vs 41.11±20.59) than non-obesity group (P<0.05). Compared with normal aminotransferase group, elevated aminotransferase group had significantly lower scores in GH and VT (59.82±20.72 vs 52.84±18.59, 73.18±16.26 vs 68.36±14.59, all P<0.05). Conclusion Similar to non-NAFLD liver disease patients that mainly composed of CHB, NAFLD patients showed a severe impairment in HRQoL.

Key words: Nonalcoholic fatty liver disease, Health-related quality of life, Chronic hepatitis B

陶叶婷, 颜士岩, 陈光榆, 潘勤, 陈源文, 范建高. 非酒精性脂肪性肝病患者生活质量调查[J]. 肝脏, 2016, 21(12): 1017-1022.

TAO Ye-ting, YAN Shi-yan, CHEN Guang-yu, PAN Qin, CHEN Yuan-wen, FAN Jian-gao. Research on life quality in patients with nonalcoholic fatty liver diseases[J]. Chinese Hepatolgy, 2016, 21(12): 1017-1022.

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