Evaluation of health-related quality of life and influencing factors in patients with Crohn disease

ObjectiveWe assessed levels of anxiety and depression in patients with Crohn disease (CD) to identify predictors of health-related quality of life (HRQOL).MethodsIn this case-control study, we enrolled 50 adult patients with CD and 50 matched, healthy controls. All participants completed self-administered questionnaires including the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Short Form-36 Health Survey (SF-36), and Short Inflammatory Bowel Disease Questionnaire (IBDQ, patients only). We analyzed the relationship between HRQOL and influencing factors.ResultsMean total scores on the SAS, SDS, and SF-36 were significantly different between patients and controls. IBDQ scores among patients in the active phase of CD were significantly lower than those in remission phase. SF-36 scores were significantly lower in patients with CD compared with healthy controls. SF-36 scores among patients with active CD were significantly lower than scores among those in remission, and SF-36 scores in patients without complications were significantly higher than in those with complications. SF-36 scores in patients with good nutritional status were also significantly higher than scores in malnourished patients with CD.ConclusionsDepression, anxiety, disease activity, complications, and nutritional status were predictive factors of decreased HRQOL in patients with CD.     

系统性红斑狼疮患者健康相关生存质量分析

目的：评价系统性红斑狼疮患者健康相关生存质量（HRQOL）,筛选SLE患者健康相关生存质量的影响因素。方法：采用中文版36条目简明量表（Medical Outcomes Study,Short Form 36,SF-36）测量107例SLE患者,结果与中国健康居民常模比较,SLE患者进行系统性红斑狼疮疾病活动度评分（SLEDAI）,不同疾病活动度之间进行比较。结果：SLE患者与常模比较,差异有统计学意义。根据SLEDAI,不同疾病活动度比较,差异有统计学意义。Logistic回归分析显示：SLEDAI、病程、年龄、收入、学历与系统红斑狼疮患者健康相关生存质量相关。结论：SLE患者健康相关生存质量较健康人群差,SLEDAI、病程、年龄、收入、学历是SLE患者HRQOL的影响因素,应采取积极有效的护理干预,提高患者生活质量。     

Quality of life and social-economic characteristics of greek male patients on long-term oxygen therapy

BACKGROUND: Chronic obstructive pulmonary disease (COPD) profoundly impacts patients' functional status, especially in the advanced stages, when long-term oxygen therapy (LTOT) is implemented. OBJECTIVE: To determine the health-related quality of life (HRQOL) in patients with COPD and using LTOT, and assess the relationship of socioeconomic characteristics and pulmonary function test results to HRQOL scores. METHODS: We studied a group of 85 patients with COPD and hypoxemia who were on LTOT, and a control group of 48 patients with stable COPD but without hypoxemia. All subjects were asked to rate their dyspnea on the Modified Medical Research Council dyspnea scale, and to take the Medical Outcomes Study Short Form (SF-36), the General Health Questionnaire (30 questions), and a questionnaire (which we developed for this study) to measure their independence in activities of daily living (ADL). We also conducted pulmonary function tests and arterial blood gas analyses, and recorded socioeconomic characteristics. RESULTS: The subjects' socioeconomic status was moderate to low. HRQOL was impaired in patients on LTOT, especially in the physical function domain, and most of the examined dimensions correlated with the severity of dyspnea and psychological status. There was a significant association between ADL score and SF-36 score in the vitality and physical domains, but there was no significant association between HRQOL score and spirometry or blood gas values. CONCLUSIONS: HRQOL in patients with COPD and on LTOT is low and is influenced by dyspnea, mental status, and incapacity, rather than by physiological variables. We recommend a multidimensional therapeutic approach that targets symptom-control and ADL support to improve the patient's overall HRQOL.     

Gender- and age-related benefit of renal replacement therapy on health-related quality of life

Objectives:  The aim of this study was to compare the health-related quality of life (HRQOL) of end-stage renal disease patients on renal replacement therapy with that of subjects of the same gender and similar age from the general population, in an attempt to determine patient subgroup that benefits more from the treatment.
Methods:  A cross-sectional study involving haemodialysis, peritoneal dialysis and renal transplant patients (n = 874) was conducted with subjects providing socio-demographic and disease-related data, and completing the validated Greek Short Form-36 (SF-36) Health Survey. Patient-specific z -scores were calculated using mean SF-36 scores and SD of age- and gender-matched subgroups from the Greek norms.
Results:  Males and younger patients generally reported better HRQOL. However, z -scores in these groups generally showed a larger health deficit, i.e. an increased divergence from the HRQOL of their age- and gender-matched counterparts of the general population, compared with the health deficit observed in female and younger patients.
Conclusions:  Health-related quality of life studies involving disease groups may sometimes be inconclusive if results are not compared with population norms, and particularly with subgroups matched for important demographic variables. Otherwise, as this study has shown, it is possible that important information may remain unrevealed.     

Effects of olanzapine alone and olanzapine/fluoxetine combination on health-related quality of life in patients with bipolar depression: secondary analyses of a double-blind, placebo-controlled, randomized clinical trial

BACKGROUND: Improving patients' health-related quality of life (HRQOL) could be a treatment goal for bipolar depression. OBJECTIVES: The objectives of these secondary analyses of a previous report were to determine the benefits of olanzapine alone and olanzapine-fluoxetine combination (OFC) for improving HRQOL in patients with bipolar depression using both a generic and a depression-specific HRQOL instrument, and to examine the association between the 2 HRQOL instruments and the construct validity of the depression-specific HRQOL instrument. METHODS: This was a double-blind, placebo-controlled, 83-site, international, randomized trial. Adults with bipolar I disorder, most recent episode depressed (according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), were randomly assigned to receive olanzapine (6-20 mg/d), OFC (6/25, 12/25, or 12/50 mg/d), or placebo for 8 weeks. HRQOL improvement was calculated as last-observation-carried-forward changes in dimension and component summary scores on Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and total score on the Quality of Life in Depression Scale (QLDS). Results: Patients were assigned to receive olanzapine (n = 370), [corrected] OFC (n = 86), or placebo (n = 377) [corrected] for 8 weeks. Of 833 enrolled patients, 454 discontinued (olanzapine, 191/370 [51.6%] [corrected]OFC, 31/86 [36.0%]; and placebo, 232/377 [61.6%]) [corrected] Compared with placebo, olanzapine-treated patients exhibited greater improvements on SF-36 mental component summary (MCS) score ( P=0.002) and 3 of 8 SF-36 dimension scores (mental health [P=0.015], role-emotional [P=0.046], and social functioning [P=0.006). OFC-treated patients exhibited greater improvements on MCS score ( P<0.001) vs both placebo and olanzapine), 5 SF-36 dimension scores (general health perception (P<0.001) vs placebo; (P<0.001) vs olanzapinel, mental health [ P=0.001] vs both placebo and olanzapine], role-emotional [ P<0.001] vs placebo; [P=0.007] vs olanzapine], social functioning [ P=0.001] vs placebo; [P=0.032] vs olanzapine], and vitality [P=0.002] vs placebo; [P=0.011] vs olanzapine]), and QLDS total score ( P<0.001] vs both placebo and olanzapine). Changes in SF-36 scores of mental health, social functioning, role-emotional, and vitality were highly correlated to changes in the QLDS total score (all p < -0.5). CONCLUSIONS: Based on these analyses, patients with bipolar depression receiving olanzapine or OFC for 8 weeks had greater improvement in HRQOL than those receiving placebo. OFC treatment was associated with greater improvement in HRQOL than olanzapine alone. The correlation results support the construct validity of the QLDS.     

Serum hepatitis C virus (HCV) RNA: a reliable tool for evaluating HCV- related liver disease in anti-HCV-positive blood donors with persistently normal alanine aminotransferase values

BACKGROUND: The significance of hepatitis C virus (HCV) antibodies in blood donors with persistently normal alanine aminotransferase (ALT) levels requires evaluation. STUDY DESIGN AND METHODS: The serum and the liver were assayed for HCV RNA. Liver histology was analyzed in 14 HCV- positive subjects who had repeatedly normal ALT values over a follow-up period of at least 3 months. RESULTS: HCV RNA was not detected in liver and serum, and liver histology showed minimal changes in more than one- half of the subjects (8/14), even if third-generation recombinant immunoblot assay was positive; this demonstrated that HCV can be eradicated spontaneously. Moderately histopathological liver lesions were usually found in HCV RNA-positive subjects (6/14), but one subject had active disease that required interferon therapy; this shows that chronic hepatitis may be present in HCV-positive individuals despite repeatedly normal transaminase values. HCV genotypes other than 1b (II) were usually identified, and the presence or absence of serum and liver HCV RNA correlated completely in all 14 patients. CONCLUSION: Serum HCV RNA should be assayed in those HCV-positive donors having repeatedly normal transaminase activity; if it is positive, indicating an ongoing HCV infection, a liver biopsy should be performed to measure the degree of the liver disease and determine the appropriate antiviral therapy.     

Health-related quality of life in long term-survivors of thoracoabdominal aortic aneurysm repair.

The purpose was to assess health-related quality of life (HRQOL) in long-term survivors of thoracoabdominal aneurysm repair. Between 1983 and 2001, 43 patients underwent thoracoabdominal aneurysm repair. Long-term survivors (13) were investigated. Two were lost to follow-up. The mean follow-up period was 6.2 years. HRQOL was measured by Short Form (SF)-36, constructed of 36 items grouped into eight scales measuring physical functioning, role limitations caused by physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations caused by emotional problems, and mental health. Additional questions specific for vascular disease were ascribed. The patients' relatives received corresponding questions, responding on behalf of the patients. Patient data scores were compared with a selection of individuals from the general population. The patients' SF-36 scores were generally poorer than that of the healthy population in both physical and mental dimensions. Patients who had a complicated postoperative course generally scored lowest in physical dimensions. Comparing patients' scores with relatives scoring on behalf of the patients showed no statistical differences. According to disease-specific questions, impotence and pain were reported as major long-term postoperative problems. Patients with uncomplicated postoperative courses all reported improved health status (six) compared with the preoperative status, whereas five patients with complicated postoperative courses reported poorer health status. Nine of 11 patients experienced the same or improved HRQOL, and two patients reported reduced HRQOL after surgery. Ten of 11 patients evaluated the operation as successful. Although the sample size in this study is small, those who had postoperative complications or reported a decreased physical function in the years after surgery generally had low scores in almost all dimensions of the SF-36. When disease-specific questions were related to thoracoabdominal aneurysm surgery, most patients reported an acceptable HRQOL.     

The effect of testosterone on health-related quality of life in elderly males - a pilot study

OBJECTIVE: To assess the effect of short-term testosterone supplementation on health-related quality of life in elderly males. METHOD: As part of a double-blind, placebo-controlled study, healthy males > or = 65-year-old were randomised to receive a total of four doses of 200 mg testosterone enanthanate (n = 14) or placebo (n = 8) intramuscularly every 2 weeks. Health-related quality of life (HRQOL) was assessed using the Short Form 36-item (SF-36) and Psychological General Well-Being (PGWB) scales, at baseline, week 8 and during therapy withdrawal, 6 weeks after the last dose. RESULTS: The baseline SF-36 scores were similar between the groups in seven domains; only vitality was significantly lower in the placebo group (T: 80.4, P: 65.6; P = 0.007). After the 8-week treatment period and withdrawal phase, SF-36 scores were not significantly different between the groups. The PGWB scores at baseline, on treatment and off treatment were not significantly different between the groups. Moreover, the SF-36 and PGWB scores within each group did not change significantly over time. CONCLUSION: This pilot study suggests that intramuscular testosterone, administered at a dose of 200 mg every 2 weeks, does not affect the HRQOL of elderly males.     

Role of screening for hepatitis C virus in children with malignant disease and who undergo bone marrow transplantation

BACKGROUND: Children with malignant disease who received multiple blood transfusions before the clinical definition of hepatitis C virus (HCV) require evaluation for HCV infection. STUDY DESIGN AND METHODS: The role of HCV infection in 54 children with primary malignant disease was evaluated in terms of the following aspects: prevalence of HCV infection, distribution of HCV subtype, the benefit of screening of blood donors, and the presence of chronic liver disease. The benefit of screening for HCV in a subset of patients who underwent bone marrow transplantation (BMT) was also evaluated. RESULTS: Seventeen patients (31.4%) of 54 tested were seropositive in a second-generation HCV antibody test. Thirteen patients (24.0%) were also positive for circulating HCV RNA. HCV subtype 1b and HCV subtype 2b were found in six and two patients, respectively. Multiple HCV genotypes were present in two patients. One of these two patients had relatively progressive liver disease. Before the introduction of blood screening with a second- generation HCV antibody test, 15 of 35 patients seroconverted, whereas none of 7 patients seroconverted after the screening was used (p = 0.032). For patients who underwent BMT, the screening drastically decreased the seroconversion rate, from 7 of 11 patients to 0 of 6 (p = 0.016). CONCLUSION: A considerable number of children with primary malignant disease who received multiple blood transfusions became infected by HCV before HCV screening was used. Patients who underwent BMT were at high risk for HCV infection. Screening with a second- generation HCV antibody test has proven to be remarkably beneficial in preventing HCV infection in these children.     

对丙型肝炎病毒感染的10名献血者的追踪研究

目的：了解感染丙型肝炎病毒（ Ｈ Ｃ Ｖ）献血者的预后。方法：选择刚发生 Ｈ Ｃ Ｖ 感染的３０ 名献血者,进行定期多项指标的动态追踪观察,对其中１０ 名自愿者作了肝组织病理检查。结果：１０ 名 Ｈ Ｃ Ｖ 感染者４ 年的１０３ 份系列血清检测及肝组织检查获得以下结果：①血清各种 Ｈ Ｃ Ｖ 抗体大多持续存在,１０ 人中无 Ｈ Ｃ Ｖ 抗体完全转阴者;②１０ 名感染者中 ９ 名血清 Ｈ Ｃ Ｖ Ｒ Ｎ Ａ 持续阳性或间断阳性,仅 １ 名在感染后１ 年转阴;③血清 Ａ Ｌ Ｔ 水平常有波动,１０ 名感染者１０３ 份血清 Ａ Ｌ Ｔ水平异常者占 ３０％ ;④１０ 名 Ｈ Ｃ Ｖ 感染者肝活检均表现为轻度慢性肝炎,７ 人的肝组织中有６ 人查到 Ｈ Ｃ Ｖ Ｒ Ｎ Ａ。结论：发生 Ｈ Ｃ Ｖ 感染的献血者大多有向慢性肝炎发展的趋势,因此对 Ｈ Ｃ Ｖ 感染的献血者应当积极采取适当治疗措施,以控制其向慢性肝炎发展。     

不同年龄维持性血液透析患者健康相关生活质量分析

目的了解不同年龄维持性血液透析（maintenance hemodialysis,MHD）患者的健康相关生活质量（fiealthrelated quality of life,HRQOL）,为采取有效措施提供依据,帮助提高其生活质量。方法采用SF-36量表对62例MHD患者进行调查,用描述性研究的方法分析不同年龄MHD患者HRQOL水平。结果62例MHD患者SF-36各个维度得分均显著低于一般人群,其中总体健康（general health,GH）得分最低,其次为生理职能（physical role,RP）,而心理健康（mental health,MH）得分相对较高。SF-36得分随着MHD患者年龄的增加而降低。结论在治疗护理过程中更应重视患者的生活质量,尤其是65岁以上的老年患者。     

The impact of severe acute respiratory syndrome on the physical profile and quality of life

OBJECTIVE: To investigate the impact of severe acute respiratory syndrome (SARS) on the physical fitness and health-related quality of life (HRQOL) among SARS survivors. DESIGN: A cohort study. SETTING: An outpatient physiotherapy department in a major hospital in Hong Kong. PARTICIPANTS: SARS patients (N=171) discharged from the hospital. Their mean age was 37.36+/-12.65 years, and the average number of days of hospitalization was 21.79+/-9.93 days. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects cardiorespiratory (6-minute walk test [6MWT], Chester step test for predicting maximal oxygen uptake [Vo 2 max]), musculoskeletal (proximal/distal muscle strength and endurance test), and HRQOL status (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]) were measured and compared with the normative data matched for age and sex. RESULTS: Seventy-eight (45.61%) patients continued to require prednisolone (< 0.5mg.kg -1 .d -1 ) for residual lung opacities when data were collected. The values of 6MWT distance, predicted Vo 2 max, proximal and distal muscle strength, and the scores from all SF-36 domains, particularly perceived role-physical, were significantly lower than the normative data ( P <.05). CONCLUSIONS: SARS survivors had deficits in cardiorespiratory and musculoskeletal performance, and their HRQOL appeared to be significantly impaired.     

Survivors of acute respiratory distress syndrome: relationship between pulmonary dysfunction and long-term health-related quality of life

BACKGROUND: Patients who survive acute respiratory distress syndrome (ARDS) often report decreased general health-related quality of life (HRQOL) following hospital discharge. The extent to which this impairment is due to pulmonary or nonpulmonary causes is unclear. We describe the pattern of recovery of patients surviving ARDS to illuminate any relationships between lung spirometry values, pulmonary symptoms, and overall HRQOL. METHODS: Seventy-three survivors of ARDS were enrolled in a 12-month follow-up study as part of a phase III randomized, multicenter trial. Patients were contacted at 3, 6, and 12 months after enrollment to complete generic and disease-specific HRQOL questionnaires and have lung spirometry tests performed. RESULTS: For all domains of the Medical Outcomes Study Short Form-36 (SF-36) and the St. George's Respiratory Questionnaire (SGRQ) at all time intervals, survivors of ARDS had significantly lower scores than age- and sex-matched population values. Over the 12-month follow-up period, we observed significant improvements to the overall Physical Component Score, but the Mental Component Score of the SF-36 and the SGRQ scores were not statistically different. Physical performance measures suggested that by 12 months, 57% had not returned to "normal activity." At 12 months, lung spirometry tests demonstrated mild abnormalities that were stable over time (64% and 49% had <80% predicted forced expiratory volume in 1 sec [Fev1] and forced vital capacity [Fvc], respectively). At 12 months, the forced expiratory volume in 1 sec correlated strongly with the physical function domain of the SF-36 (correlation coefficient = 0.601; p < .01) and moderately with all domains of the SGRQ (correlation coefficient = -0.36, -50; p < .01 in all cases). In addition, there were several strong to moderate correlations between the various domains of the SF-36 and SGRQ. CONCLUSIONS: Survivors of ARDS have considerable respiratory symptoms and reduced HRQOL that is still prevalent at 12 mos following onset of injury. There are significant correlations between lung spirometry, pulmonary symptoms, and overall HRQOL, thus suggesting the acute lung injury/ARDS is causally contributing to the observed long-term outcome.     

Estimation of utilities for the effects of depression from the SF-12

BACKGROUND: Utilities for health conditions, including major depressive disorder, have a theoretical relationship to health-related quality of life (HRQOL). Because of the complexity of utility measurement and the existence of large numbers of completed studies with HRQOL data but not utility data, it would be desirable to be able to estimate utilities from measurements of HRQOL. OBJECTIVE: The objective of this study was to estimate utility for remission in major depression by use of information on associated variation in Short Form 12 (SF-12) scores. DESIGN: A mapping function for SF-12 scores (based on a 6-health-state model with patient-weighted preferences) was applied to longitudinal data from a large naturalistic study to estimate changes in utilities. SUBJECTS: Preference ratings for states were performed in a convenience sample of depressed primary care patients (n = 140). Outcomes were evaluated in patients in the Course of Depression Study (n = 295) with a DSM III diagnosis of depression at the onset of the study. MEASURES: From clinical interview data, differences in utilities and global physical and mental health-related quality of life at 1- and 2-year follow-up were compared for patients who did and did not experience remission as determined by the Course of Depression Interview. RESULTS: Remission of depression resulted in health status improvement, as measured by the SF-12, equivalent to a gain of 0.11 quality-adjusted life-years over 2 years. CONCLUSIONS: Utilities for changes in health status, associated with a clinical change in depression, can be modeled from the SF-12 scales, which results in utilities within the range of estimates described in the literature.     

Functional status and health-related quality of life during inpatient stroke rehabilitation

OBJECTIVE: To examine changes in functional status and health-related quality of life (HRQOL) during inpatient stroke rehabilitation to examine the associations between changes in the two measures. DESIGN: Two independently collected databases were combined for a retrospective analysis. One contained the objectively assessed FIM score; the other contained the subjectively assessed Medical Outcomes Study 36-item short form (SF-36). Admission and discharge scores were compared using paired-samples t tests. Associations between the FIM outcomes and the SF-36 outcomes were assessed by means of Pearson's product-moment correlations. RESULTS: One hundred sixteen patients were represented in both databases. Mean age was 71.4 yrs; 59 (51.1%) were female. All FIM scores, four of eight SF-36 domains, and one summary component score showed statistically significant improvement during the course of rehabilitation. Changes in SF-36 were not strongly associated with changes in FIM score, with only 6 of 90 correlations attaining statistical significance. CONCLUSIONS: Functional status and HRQOL improved considerably over the course of rehabilitation. However, there was poor association between the two outcomes. Both instruments offer insights into outcomes of inpatient rehabilitation, but they are complementary rather than overlapping.     

The discriminative ability of the 12-item short form health survey (SF-12) in a sample of persons infected with HIV

BACKGROUND: Self-reported health-related quality of life (HRQOL) assesses constructs that transcend laboratory-based clinical parameters. Corroboration of the hypothesized relationships between the 2 types of health indicators (ie, clinical and HRQOL) could provide evidence of the validity of an HRQOL measurement tool. OBJECTIVE: The purpose of this study was to evaluate the ability of scores on the mental component summary (MCS-12) and physical component summary (PCS-12) of the 12-Item Short Form Health Survey (SF-12) to discriminate between HIV-infected persons in predefined disease-severity groups based on surrogate markers. METHODS: This cross-sectional study involved the collection of clinical data (ie, CD4 cell count, viral load [HIV-1 RNA copies/mL]) from patients' medical records and HRQOL data from the SF-12 at 2 HIV specialty clinics. The ability of SF-12 summary scores to discriminate between patients stratified by disease severity (ie, CD4 cell count <200 vs > or = 200/mm3; HIV-1 RNA >55,000 vs < or = 55,000 copies/mL) was assessed by receiver operating characteristic curve analysis. RESULTS: Data were collected from 478 patients. The scores from the PCS-12 were able to discriminate between groups of patients stratified by disease severity based on CD4 cell count (P < 0.001) and HIV-1 RNA copies/mL (P < 0.01). MCS-12 scores did not discriminate between disease-severity groups. CONCLUSIONS: Although the SF-12 is a brief generic measure of HRQOL, these findings provide further evidence of the validity of the SF-12 and suggest that it may be a practical way to monitor health status from the perspective of the HIV-infected patient.     

Successful pulmonary vein isolation using transvenous catheter cryoablation improves quality-of-life in patients with atrial fibrillation

BACKGROUND: Recent studies have demonstrated that transvenous catheter cryoablation is a safe and effective technique for creating pulmonary veins (PVs) electrical isolation for the treatment of atrial fibrillation (AF). However, the impacts of this procedure on quality-of-life (QoL) have not been evaluated. METHODS AND RESULTS: We studied the effects of PV isolation using transvenous catheter cryoablation on QoL in 46 patients (34 men, mean age: 50 +/- 12 years) with drug-refractory AF. QoL was assessed by Medical Outcomes Study Short Form-36 (SF-36) and Symptom Checklist at baseline and 3-month after cryoablation, and compared with those in a sex-age matched normal control. At 3-month follow-up, 24 of 46 patients (52%) had no recurrence of AF, including 11 patients who were not taking antiarrhythmic drugs. At baseline, patients with AF had significantly lower QoL scores in overall and in 5/8 subscales of SF-36 than the sex-age matched control group (P < 0.05). In patients with successful outcome after cryoablation showed a significant improvement in overall and in 5/8 subscales of SF-36 QoL scores have significantly increased as compared with the baseline (P < 0.05). Furthermore, their QoL scores in overall and in 6/8 subscales of SF-36 were similar to the sex-age matched control group (P > 0.05). The Symptom Checklist also showed significant reduction in both the symptoms frequency scores and symptoms severity scores at 3-month follow-up as compared with baseline (P < 0.05). CONCLUSIONS: Successful PV isolation using transvenous catheter cryoablation is associated with significant reduction in the frequency and severity of AF symptoms and improvement in the general QoL, reaching the levels of normal controls.     

丙型肝炎病毒感染的献血者10年追踪观察

目的　追踪观察发生HCV感染的献血者的疾病进程和健康状况。方法　从 1993年 10月～ 2 0 0 4年 2月 ,对 30名HCV感染的献血者定期抽取血液标本 ,观察所得到的 4 4 2份系列标本的血清ALT、抗 HCV和HCV RNA的动态变化 ,并进行HCV分型测定 ,重点分析了其中 10名自愿者肝组织的病理检查结果和血清ALT、抗 HCV与HCV RNA的动态变化。结果　① 30名HCV感染者系列标本中 ,ALT异常率 37.6 % (16 6 / 4 4 2 ) ;抗 HCV阳性率97.1% (42 9/ 4 4 2 ,ELISA法 ) ;HCV RNA阳性率 74 .9% (331/ 4 4 2 )。② 10名HCV感染的献血者 10年系列血清中抗 HCV大多数持续存在 (94 4 % ,15 1/ 16 0 ) ,其HCV RNA时有间隙性阴性 ,阳性率 6 7 5 % (10 8/ 16 0 )其血清ALT水平异常率 33 6 % (5 0 / 14 9)。③HCV分型测定 :HCVⅡ / 1b型占 85 % (2 2 / 2 6 ) ,Ⅲ / 2a型占 15 % (4/ 2 6 )。④ 10名HCV感染者肝组织检查显示均为轻度慢性肝炎。结论　肝组织的病理变化同血清抗 HCV、HCV RNA和ALT的异常有明显相关性。虽然HCV感染后 10年的疾病进程大多是缓慢的 ,但应采取适当治疗措施以控制慢性肝炎的发展。     

Virological pattern in plasma, peripheral blood mononuclear cells and liver tissue and clinical outcome in chronic hepatitis B and C virus coinfection

BackgrounD: We aim to evaluate in chronic hepatitis B virus-hepatitis C virus (HBV-HCV) coinfection the interplay of these viruses in liver tissue, peripheral blood mononuclear cells (PBMC), and plasma and to analyze the effect on disease course and response to treatment. METHODS: We enrolled 19 patients with chronic HBV-HCV coinfection, 20 with chronic HCV and 20 with chronic HBV infection at their first liver biopsy, all were naive for antiviral therapy. The patients' plasma, PBMC and liver biopsy samples were tested for HBV DNA and/or HCV RNA by real-time PCR, according to the presence/absence of hepatitis B surface antigen and antibodies against HCV in the serum. RESULTS: Contemporary presence of HBV DNA and HCV RNA was rare in plasma (5.3% of cases) and PBMC (10.6%), but frequent in liver tissue (52.6%). Of 10 cases circulating only HCV RNA and treated with pegylated interferon (PEG-IFN) plus ribavirin for 12 months, two showed a sustained response, and eight cleared HCV RNA but became HBV-DNA-positive in plasma; these eight had detectable HBV DNA in liver at baseline. One patient, who was plasma HBV-DNA-positive/HCV-RNA-negative at baseline, showed a sustained response after 18 months of PEG-IFN treatment; another, who was plasma HBV-DNA/HCV-RNA-positive at baseline, cleared only HCV RNA during 12 months of PEG-IFN plus ribavirin treatment. Seven cases remained untreated. CONCLUSION: Despite a reciprocal inhibition in plasma, HBV and HCV frequently coexist in liver tissue, a condition to be taken into consideration when deciding therapy.     

酒精性肝病患者健康相关生存质量研究

目的研究酒精性肝病患者健康相关生存质量及其与疾病严重程度的关系以及对比酒精性肝病与慢性乙型肝炎患者健康相关生存质量的差别。方法 2010年12月至2011年10月收治的70例男性酒精性肝病患者(非肝硬化组45例,肝硬化组25例),56例男性慢性乙型肝炎患者(非肝硬化组24例,肝硬化组32例)以及42例男性健康对照组受试者参与试验。所有受试者回答SF-36V2(中文版)量表,通过SF-36V2软件计算出:生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、精神健康共8个维度,以及躯体健康总评和精神健康总评。使用协方差分析对比健康对照组,酒精性肝病非肝硬化组,以及酒精性肝病肝硬化组健康相关生存质量;对比酒精性肝病与慢性乙型肝炎患者健康相关生存质量。结果和健康对照组相比,酒精性肝病患者随着疾病的加重,SF-36V2各维度评分明显降低(P<0.05)。酒精性肝病非肝硬化组患者较慢性乙型肝炎非肝硬化组患者仅生理功能、生理职能、活力、躯体健康总评四项评分轻度受损(P<0.05)。酒精性肝病肝硬化组与慢性乙型肝炎肝硬化组患者SF-36V2各维度评分相似(P>0.05)。结论酒精性肝病患者健康相关生存质量降低,且病情越重,健康相关生存质量越差。酒精性肝病患者健康相关生存质量与慢性乙型肝炎患者相似。