13C-苯丙氨酸呼气试验测量肝脏储备功能的临床研究

目的用^13C-苯丙氨酸呼气试验评估慢性乙型肝炎、肝硬化患者和健康人的肝功能情况。方法肝硬化患者80例、慢性乙型肝炎患者20例和20名健康志愿者进入研究。检测三组的各项血清学指标，对肝硬化患者进行Child-Pugh和轻微肝性脑病（MHE）评分。在口服L-[1^-13C]苯丙氨酸100mg后，收集检测计算并比较各组在0、10、20、30、45、60、90、120 min 8个时间点呼出气体中的^13CO2呼出速率（^13CO2ER）和^13C累计排除率（^13Ccum）。结果除1例肝硬化患者因呼气试验失败而剔除，其余患者的Child-Pugh分级为A级23例、B级44例、C级12例；MHE28例，非MHE51例。健康对照组及Child-Pugh A、B、C组中^13CO2ER在20、30 min时的差异最明显，20min时分别为15．8±2．0、9．2±1．9、6．2±1．2和3．8±0．7；30 min时分别为14．2±2、1、7．04±1．2、5、1±0．8和4．4±0．5。60、120 min的^13Ccum则依次下降，60 min时分别为11．1±0．9、6．7±0．8、5．0±0．6和3．7±0．4；120 min时分别为13．0±1．2、8．2±1．0、6．2±0．9和4．8±0．6，各组间差异有统计学意义（P〈0．01）。MHE组和非MHE组比较结果相似，20 min时^13CO2ER为7．4±2．3比5．6±1．5，30 min时为5．8±1．4比5．0±1．0．60 min时^13Ccum为5．6±1．2比4．8±0．9，120 min时为6．8±1．6比6．0±1．1，差异有统计学意义（P〈0．05）。结论^13C-苯丙氨酸呼气试验可有效评估肝硬化以及肝硬化MHE患者的肝功能，呼气后20 min和30 min时^13CO2ER的测定值以及60 min时的^13Ceum有可能成为检测的关键时间点。     

肝癌患者乙型肝炎病毒基因变异的检测

目的了解肝癌患者HBV基因变异、机体免疫功能异常及肿瘤抑制基因P16蛋白失活的情况。方法运用基因芯片和核苷酸序列分析技术，对114份我院住院患者血清中HBVDNA（前C区1814、1896、BCP区1762、1764位）进行分析，流式细胞荧光染色检测患者外周血WBC中P16蛋白，流式细胞仪检测T淋巴细胞亚群，ELISA法检测IFN-γ、IL-4水平。结果慢性乙型肝炎组（41份）、乙型肝炎肝硬化组（37份）、肝癌组（36份）血清中的HBV总突变率为58．5％、75．6％和88．8％，肝组织中肝硬化、肝癌分别为75．0％和100％；慢性乙型肝炎、乙型肝炎肝硬化、肝癌组患者外周血WBC中P16蛋白阳性率分别为（43．09±8．08）％、（30．54±10．61）％和（16．29±6．86）％，正常人为（76．57±6．07）％；肝癌患者CD3^＋、CD4^＋、CD8^＋T淋巴细胞绝对数均明显低于健康对照组（t＇1=8．83、t＇2=6．59、t＇3=9．84，P〈0．05）；肝癌患者IFN-γ、IL-4水平明显低于健康者（t＇1=6．67、t＇2=3．82，P〈0．05）。结论肝癌患者中HBV基因变异普遍存在，机体免疫功能低下，外周血WBC中P16蛋白表达明显低。     

慢性乙型肝炎患者外周血单核细胞Toll样受体2和4的变化

目的探讨慢性乙型肝炎和慢性重型乙型肝炎患者外周血单核细胞Toll样受体2 （TLR2）和Toll样受体4（TLR4）的变化情况及其意义。方法用流式细胞仪检测正常对照、慢性乙型肝炎患者和慢性重型乙型肝炎患者外周血单核细胞表面TLR2和TLR4的表达,ELISA法检测上述患者血清TNFα的水平。Student-t检验比较3组间TLR2、TLR4和TNFα表达的差异;3组病例TLR2、TLR4的表达水平间及它们与血清TNFα水平间的相关性分析采用线性相关分析。结果正常对照组（30例）、慢性乙型肝炎组（31例）和慢性重型乙型肝炎组（30例）外周血单核细胞TLR2和TLR4的平均免疫荧光强度（MFI）分别为21．5±2．7、39．0±4．1．47．7±21．4和2．3±1．1、3．7±2．3、6．9±4．1;外周血清TNFα（ng／L）水平分别为53．8±38．1、164．3±89．9、359．8±1 40．0,自正常对照组到慢性乙型肝炎组及慢性重型乙型肝炎组外周血单核细胞TLR2、TLR4表达强度和外周血清TNFα水平均依次显著升高;经线性相关分析研究发现,外周血单核细胞TLR2、TLR4表达水平和血清TNFα表达水平间均呈现显著的正相关性。结论TLR2和TLR4可能与慢性乙型肝炎及慢性重型乙型肝炎的发病有关。     

肝硬化患者腹水中细菌DNA的检测及临床意义

目的 利用PCR测序方法检测肝硬化患者腹水中的细菌DNA，探讨肝硬化患者发生细菌移位的高危因素及其后果。方法 在细菌16SrRNA基因保守区设计一对通用引物，对37份肝硬化患者腹水标本进行扩增，腹水中细菌DNA阳性者纯化后经核苷酸测序鉴别细菌种类；同时对患者的临床症状及实验室检查结果进行统计分析。结果 37份腹水标本中有9份获得530bp细菌DNA片段，占24．3％。测序共检测出4种细菌，其中大肠埃希菌6例，表皮葡萄球菌、溶血性链球菌、阴沟肠杆菌各1例；统计分析表明，腹水中细菌DNA阳性和阴性两组肝硬化患者在Child-Pugh积分（12．3±0．8，10．9±1．2）、上消化道出血的发生率（3例，1例）、血清TBil水平[（395．5±216．6）μmol／L，（192．7±206．3）μmol／L]、凝血酶原活动度[（31．3±9．7）％，（50．4±15．1）％]、腹水总蛋白浓度[（4．1±2．8）g／L，（7．9±5．2）g／L]、外周血WBC总数[（12．3±7．5）×10^9／L，（5．3±4．1）×10^9／L]等方面比较，差异有统计学意义（P〈0．05）。结论 PCR测序方法可应用于肝硬化患者腹水中细菌DNA的检测及细菌移位的研究；肝功能损害、腹水调理活性低下和上消化道出血是肝硬化患者发生细菌移位的高危因素和后果。     

Assessment of health-related quality of life in Chinese patients with minimal hepatic encephalopathy

AIM:To evaluate the health-related quality of life (HRQOL) based on the Chinese version of SF-36 and Chronic Liver Disease Questionnaire (CLDQ) in subjects with chronic hepatitis B,liver cirrhosis,including patients with minimal hepatic encephalopathy (MHE). METHODS:The SF-36 and CLDQ were administered to 160 healthy volunteers,20 subjects with chronic hepatitis B and 106 patients with cirrhosis (33 cases exhibited MHE). HRQOL scores were compared among the different study groups. The SF-36 includes eight health concepts:physical functioning,role-physical,body pain,general health,vitality,social functioning,role-emotion,and mental health. Six domains of CLDQ were assessed:abdominal symptoms,fatigue,systemic symptoms,activity,emotional function and worry. RESULTS:Compared with healthy controls (96.9 ± 4.5,86.6 ± 18.4,90.1 ± 12.5,89.0 ± 5.7,87.5 ± 4.3,95.8 ± 7.1,88.5 ± 15.9,88.7 ± 5.2 in SF-36 and 6.7 ± 0.5,6.1 ± 0.6,6.3 ± 0.6,6.5 ± 0.5,6.3 ± 0.5,6.8 ± 0.4 in CLDQ),patients with chronic hepatitis B (86.3 ± 11.0,68.8 ± 21.3,78.9 ± 14.4,60.8 ± 10.5,70.8 ± 8.6,76.1 ± 12.6,50.0 ± 22.9,72.2 ± 10.6 and 5.5 ± 1.0,4.5 ± 1.0,5.2 ± 1.1,5.3 ± 0.9,4.8 ± 0.9,4.9 ± 1.0) and cirrhosis (52.8 ± 17.4,32.8 ± 27.9,61.6 ± 18.9,30.2 ± 18.3,47.9 ± 20.1,54.0 ± 19.2,28.9 ± 26.1,51.1 ± 17.8 and 4.7 ± 1.2,3.9 ± 1.2,4.7 ± 1.2,4.7 ± 1.3,4.7 ± 1.0,4.4 ± 1.1) had lower HRQOL on all scales of the SF-36 and CLDQ (P < 0.01 for all). Increasing severity of liver cirrhosis (based on the Child-Pugh score/presence or absence of MHE) was associated with a decrease in most components of SF-36 and CLDQ,especially SF-36.CONCLUSION:The Chinese version of SF-36 along with CLDQ is a valid and reliable method for testing MHE in patients with liver cirrhosis. Cirrhosis and MHE are associated with decreased HRQOL.     

乙型肝炎肝硬化患者生存质量研究

慢性HBV感染是严重影响我国人民健康的传染病,容易发展为肝硬化、肝细胞癌等终末期肝病。国外研究显示,乙型肝炎肝硬化不仅严重影响患者的寿命,也给患者生活质量带来很大的影响。我们使用SF-36（36-item short form health survey）简明健康情况调查表（中文版）,对乙型肝炎肝硬化患者健康相关生存质量进行研究，分析其影响因素，并与慢性乙型肝炎患者和正常人群生存质量情况进行了比较。     

不同水平呼气末正压通气对肺内外源性急性呼吸窘迫综合征患者的影响

目的 观察不同水平呼气末正压（PEEP）通气对肺内、外源性急性呼吸窘迫综合征（ARDS）患者的影响。方法 以16例早期肺内源性ARDS（A组）和12例早期肺外源性ARDS（B组）患者为研究对象,调整PEEP水平,分别监测在PEEP通气前和PEEP为5、10、15cmH2O通气后30min时的氧合、呼吸力学和血流动力学的变化。结果 PEEP5cmH2O时与PEEP通气前比较,A、B两组患者的动脉血氧分压（PaO2）／吸入气氧浓度（FiO2）、气道峰压（Ppeak）、气道平台压（Pplat）、平均动脉压（MAP）以及B组患者的呼吸系统顺应性（Crs）差异均无统计学意义（P均〉0．05）;A组患者的Crs[PEEP5cmH2O时、PEEP通气前分别为（0．027±0．004）、（0．022±0．005）L／cmH2O]差异有统计学意义（P〈0．05）。PEEP10cmH2O时与PEEP通气前比较,A、B两组患者的PaO2／Fioz[PEEP10cmH2O时、PEEP通气前A组分别为（130．Off=30．6）、（81．6±26．7）,B组分别为（137．3±28．9）、（73．6±30．8）]、Crs[PEEP10cmH2O时、PEEP通气前A组分别为（0．032±0．005）、（0．022±0．005）L／cmH2O,B组分别为（0．033±0．005）、（0．022±0．004）L／cmH2O]、MAP[PEEP10cmH2O时、PEEP通气前A组分别为（68．9±8．4）、（79．3±9．2）mEHg,B组分别为（69．0±6．2）、（77．5±8．7）mEHg]以及A组患者的Ppeak[PEEP10cmH2O时、PEEP通气前分别为（33．0±6．O）、（25．0±5．8）mEHg]和PplatFPEEP10cmH20时、PEEP通气前分别为（30．5±5．6）、（22．1±4．8）mEHg]差异均有统计学意义（P〈0．05或P〈0．01）,其中B组患者PaO2／FiO2升高幅度、Crs增大幅度均较A组患者更显著（P均G0．05）。PEEP15cmHzO时与PEEP通气前比较,A、B两组患者的PaO2／FiO2[EEP15cmH2O时、PEEP通气前A组分别为（139．8±34．8）、（81．6±26．7）,B组分别为（178．7±35．4）、（73．6±30．8）]、Crs[PEEP15cmH2O时、PEEP通气前A组分别为（0．030±0．005）、（0．022±0．005）L／cmH20,B组分别为（0．036±0．007）、（0．022±0．004）L／cmH201、MAP[PEEP15cmH2O时、PEEP通气前A组分别为（66．9±9．1）、（79．3±9．2）mEHg,B组分别为（66．3±5．2）、（77．5±8．7）mEHg]、Ppeak[PEEP15cmH2O时、PEEP通气前A组分别为（40．3±6．7）、（25．0±5．8）cmH2O,B组分别为（35．7±8．5）、（22．2±7．8）cmH2O]和Pplat[PEEP15cmH2O时、PEEP通气前A组分别为（36．9±5．6）、（22．1±4．8）cmH2O,B组分别为（29．2±6．8）、（18．7±5．6）cmH2O]差异均有统计学意义（P均〈0．01）,其中B组患者PaO2／FiO2升高幅度、Crs增大幅度均较A组患者更显著（P均〈0．01）,A组患者Pplat增高幅度较B组患者更显著（P〈0．01）。A、B两组患者MAP下降幅度比较差异无统计学意义（P〉0．05）。机械通气24h后A组2例出现轻度纵隔气肿。结论 PEEP通气能改善部分ARDS患者的氧合和呼吸系统顺应性,而且对肺外源性ARDS患者的改善可能要优于肺内源性ARDS患者。但高PEEP可能使Ppeak和Pplat显著增高,而且肺内源性ARDS患者Pplat的增高幅度可能要更显著于肺外源性ARDS患者。     

家庭无创正压机械通气对稳定期重度慢性阻塞性肺疾病患者的疗效和安全性观察

目的探索与评估家庭无创正压机械通气（HNPPV）长期治疗重度慢性阻塞性肺疾病（COPD）稳定期患者的疗效和安全性。方法将40例经住院治疗处于稳定期的重度COPD患者[动脉血二氧化碳分压（PaCO2）≥55mmHg（1mmHg=0．133kPa）]分为常规治疗＋HNPPV组（治疗组）20例和常规治疗组（对照组）20例。分别记录观察前（治疗前）、观察2年后的呼吸困难分级评分、辅助呼吸肌评分、心理情绪评分、肺功能、动脉血气、6分钟行走距离（6MWD）；采用超声心动图测定肺动脉平均压（mPAP）、病死率及每年住院次数等指标。结果治疗组与对照组的年龄、性别、身高、体重、呼吸困难分级评分、辅助呼吸肌评分、焦虑评分、抑郁评分、动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、用力肺活量（FVC）、第一秒用力呼气容积（FEV1）、6MWD、mPAP、每年住院次数均具有可比性（t值分别为1．08、1．15、1．20、1．09、0．86、0．54、0．00、0．00、0．43、0．96、0．76、0．38、0．26、0．24、0．87，P均〉0．05）。2年后治疗组死亡3例（3／20），对照组死亡8例（8／20），两组比较差异无统计学意义（χ^2=3．27，P〉0．05）。2年后治疗组呼吸困难分级评分、辅助呼吸肌评分、焦虑评分、抑郁评分、PaCO2、PaO2、6MWD、mPAP、每年住院次数分别为（2.4±0．5）分、（2．6±0.6）分、（6．9±2．1）分、（6．1±1．6）分、（49．5±2．2）mmHg、（60．8±4．7）mmHg、（213±45）m、（30．3±2．2）mmHg、（1．4±0．4）次／年，与对照组[（3．9±0．3）分、（4．8±0．4）分、（11．2±2．6）分、（11．6±2．1）分、（61．5±2．3）mmHg、（52．8±2．4）mmHg、（127±23）m、（36．4±2．3）mmHg、（3．9±0．3）次／年]比较差异均有统计学意义（t值分别为9．53、10．83、4．92、7．83、14．07、5．41、6．07、4．81、10．22，P均〈0．01）。结论长期家庭无创正压机械通气对有选择性稳定期重度COPD患者疗效较为肯定。     

冠状动脉内应用山莨菪碱对急性心肌梗死介入治疗后无再流及心室功能和收缩同步性的影响

目的探讨冠状动脉内应用山莨菪碱对急性心肌梗死介入治疗（AMI-PCI）后无再流患者的逆转作用并评价其对患者局部、整体心室功能和收缩同步性的影响。方法自2003年1月至2006年2月首发急性前壁心肌梗死并于12h内行急诊PCI的患者136例,根据心肌灌注分级方法（myocardial blush grade,MBG）确认无再流患者（MBG0-1级）47例（男36例,女11例）,平均年龄（63．23±11．24）岁,随机分为两组：A组（山莨菪碱组,24例）和B组（对照组23例）,A组于PCI后即刻由指引导管冠状动脉内注射山莨菪碱1000斗g／次,余治疗同B组。于PCI后即行左心室造影,测定心室容积、压力参数和室壁运动积分（wall motion score,WMS）;AMI后1周时行平衡法核素心室造影,测定左室整体和局部收缩功能、舒张功能和收缩同步性参数;AMI后6个月随访时重复行心室造影和核素心室造影检查测定上述参数,同时随访并记录术后6个月内主要不良心脏事件（MACE）的发生率。结果（I）A组患者在冠状动脉内应用山莨菪碱1000μg／次,平均（2．53±0．34）次后MBG由（0．74±0．32）级增加到用药后的（2．33±0．28）级。（2）AMI-PCI后6个月随访时,A组左室收缩末容积指数、左心室舒张末期容积指数、WMS和左室舒张末期压均较B组明显降低[（40．53±8．12）mL／m^2比（50．32±8．26）mL／m^2,（80．13±9．74）ml／m^2比（87．17±10．25）mL／m^2,（8．24±1．31）比（10．23±1．82）,（13．36±4．21）mmHg（1mmHg=0．133kPa）比（16．38±3．21）mmHg,P均〈0．05];核素心室造影参数比较,A组左室射血分数、峰射血率和峰充盈率等参数均较B组明显增加I（44．02±5．86）％比（38．52±5．18）％,（1．86±0．09）EDV／s比（1.61±0．09）EDV／s,（2．19±0．32）EDV／s比（1.78±0．17）EDV／s,P均〈0．05]。（3）A组AMI-PCI后6个月左室局部射血分数（LrEF）2-LrEF8均分别较B组增加13．96％、25．02％、30．36％、22．86％、27．67％、22．07％和18．71％（P均〈0．05）.（4）相位分析示A组左室收缩同步性参数相角程、半高宽和峰相位标准差亦均低于B组[（46．04±8．93）°比（53．19±16．62）°,P〈0．05;（23．02±6．27）°比（25．02±5．31）°,P〉0．05;（7．92±4．12）°比（11．76±4．11）°,P〈0．05]。（5）在6个月随访期内,A组MACE发生率明显低于B组。结论冠状动脉内注射山莨菪碱可明显逆转AMI-PCI后无再流现象,改善无再流患者的心室功能和收缩同步性,降低MACE发生率。     

甘舒霖强化治疗初诊2型糖尿病37例研究

75例初诊T2DM患者，按单、双日随机分为两组，对照组瑞格列奈1～3mg及二甲双胍0．25～0．5，每日各三次口服；强化组给予甘舒霖R（三餐前30分钟），甘舒霖N（睡前）皮下注射。4周后观察治疗前后空腹血糖（FBG）、餐后2小时血糖（2HBG）、糖化血红蛋白A1c（HbA1c）、胰岛β细胞功能指数（HOMA—β）、胰岛素抵抗指数（HOMA—IR）、血糖达标时间等。结果：两组病人治疗后，上述指标均有明显下降，强化组下降更明显分别为（15．8±3．2）mmol／Lvs（5．9±0．5）mmol／L，（20．2±3．8）mmol／L（7．5±0．5）mmool／L，（10．4±1．36）％vs（6．96±0．74）％。均P〈0．01，（3．49±0．82）vs（5．32±2．20），（2．20±0．81）vs（1．02±0．41），均P〈0．05。结论：甘舒霖强化治疗初诊T2DM，能明显增强胰岛β细胞的功能，减轻胰岛素抵抗，使患者血糖良好控制。     

Determinants of health-related quality of life in patients with chronic liver diseases.

BACKGROUND AND AIMS: The study aims to assess influence of the liver disease, active medical and psychiatric comorbidities, and sociodemographic variables in the determination of health-related quality of life (HRQOL) measured by a generic and a liver-specific instrument in unselected patients with chronic liver disease. METHODS: Two hundred four of 255 consecutive patients (80%) with all stages of various liver diseases attending a tertiary-care center completed the following self-report questionnaires: sociodemographic questionnaire of the Competence Network Bowel Disease, morbidity list of the German Pain Questionnaire, the German version of the Hospital Anxiety and Depression Scale (HADS-D), and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) as generic instruments; and the German version of the Chronic Liver Disease Questionnaire (CLDQ) as a disease-specific HRQOL-instrument. RESULTS: Stepwise multiple regression showed that cause of liver disease, severity of disease (cirrhosis vs. no cirrhosis, Child-Pugh score), sex, age, and social class had no effect on HRQOL. Anxiety resp. depression scores >/= 11 in the German version of the HADS, indicating a probable psychiatric disorder, contributed independently to the impaired HRQOL in the total score of the CLDQ and the Physical and Mental Summary Scores of the SF-36 (P < 0.0001). Number of active medical comorbidities contributed independently to the reduced HRQOL in the total score of the CLDQ and the Physical Summary Score of the SF-36 (P < 0.0001). Furthermore, the SF-36 Mental Summary Score was influenced negatively by active cardiovascular comorbidity (P < 0.003). CONCLUSIONS: Psychiatric comorbidity and active medical comorbidity, and not severity of the liver disease according to Child-Pugh score, determine reduced HRQOL in patients with chronic liver diseases.     

Physical and psychosocial contributors to quality of life in veterans with hepatitis C not on antiviral therapy

BACKGROUND AND AIMS: Treatment-naive hepatitis C virus (HCV)-infected patients report impaired health-related quality of life (HRQOL), although causes are unclear. Psychosocial factors may be major determinants of HRQOL. METHODS: We administered a general (Short Form-36; SF-36) and a liver-specific (Chronic Liver Disease Questionnaire; CLDQ) HRQOL measure to 62 HCV-infected veterans being considered for antiviral therapy. Psychosocial assessment included the Structured Clinical Interview for DSM-IV Axis I Disorders/Non-Patient (SCID-I/NP), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Abbreviated Cook-Medley (ACM) anger measure, and Medical Outcomes Study Social Support Measure (SSM). We examined the potential determinants of HRQOL, including psychosocial measures, demographic measures (age, sex, race/ethnicity), clinical measures (presence of cirrhosis, comorbid medical conditions), and viral data (quantitative PCR). RESULTS: SF-36 scores were significantly lower in HCV-infected patients than published U.S. population norms but similar to those reported by previous studies of HCV-infected samples. CLDQ scores were very similar to those reported by previous studies. Demographic, clinical, and viral indicators were not statistically associated with HRQOL, and neither was the presence of a substance abuse or psychotic disorder. Lower BDI-II and BAI scores were associated with better general and disease-specific HRQOL. Lower SSM scores were associated with lower scores on SF-36 but not CLDQ; however, this effect did not persist in multiple linear regression analyses. In these, BDI-II was the strongest independent predictor of both SF-36 and CLDQ. CONCLUSIONS: Psychosocial factors, especially depression, are strong indicators of impaired HRQOL for HCV-infected veterans not receiving antiviral therapy. Screening and treatment of psychosocial factors is recommended.     

Health-related quality of life in patients with chronic hepatitis B.

Although chronic hepatitis C (CH-C) has consistently been shown to impair patients' health-related quality of life (HRQL), the impact of chronic hepatitis B (CH-B) on HRQL has not been fully explored. AIM: Compare HRQL between patients with CH-B, CH-C, primary biliary cirrhosis (PBC) and healthy controls. Design: Three HRQL questionnaires [Chronic Liver Disease Questionnaire (CLDQ), Short Form 36 (SF-36) and the Health Utility Index (HUI Mark-2 and Mark-3)] were administered prospectively. Additional clinical and laboratory data and normative data for healthy individuals, were available. ANALYSIS: Scores were compared using analysis of variance and multiple regression. RESULTS: One hundred and forty-six patients with CH-B, CH-C and PBC were included [mean age 47.1 years (+/-11.6), 41% female, 33% cirrhosis]. CH-C and PBC patients scored the lowest on all CLDQ, SF-36 and HUI domains compared with CH-B patients and healthy controls. CH-B patients had scores similar to the healthy population, measured by most CLDQ and SF-36 scales. However, the HUI scores for CH-B patients showed more impairment than population norms. Having CH-B and not having cirrhosis were predictive of utility and HRQL scores in multivariate models. CONCLUSIONS: CH-B patients have better HRQL than CH-C, PBC and population norms. CH-B patients' overall utility scores are lower than population norms.     

Chronic liver disease questionnaire： Translation and validation in Thais

AIM: Quality of life (QOL) is a concept that incorporates many aspects of life beyond “health“ The chronic liver disease questionnaire (CLDQ) was developed to evaluate the impact of chronic liver diseases (CLD) on QOL. The objectives of this study were to translate and validate a liver specific questionnaire, the CLDQ.METHODS: The CLDQ was formally translated from the original version to Thai language with permission. The translation process included forward translation, back translation, cross-cultural adaptation and a pretest. Reliability and validity of the translated version was examined in CLD patients. Enrolled subjects included CLD and normal subjects with age- and sex-matched. Collected data were demography,physical findings and biochemical tests. All subjects were asked to complete the translated versions of CLDQ and SF36, which was previously validated. Cronbach‘s alpha and test-retest were performed for reliability analysis. One-way Anova or non-parametric method was used to determine discriminant validity. Spearman‘s rank correlation was used to assess convergent validity. P-value &lt;0.05 was considered statistically significant.RESULTS: A total of 200 subjects were recruited into the study, with 150 CLD and 50 normal subjects. Mean ages(SD) were 47.3(11.7) and 49.1(8.5) years, respectively. The number of chronic hepatitis: cirrhosis was 76:74, and the ratio of cirrhotic patients classified as Child A:B:C was 37(50%): 26(35%): 11(15%). Cronbach‘s alpha of the overall CLDQ scores was 0.96 and of all domains were higher than 0.93. Item-total correlation was&gt;0.45. Test-retest reliability done at 1 to 4 wk apart was 0.88 for the average CLDQ score and from 0.68 to 0.90 for domain scores. The CLDQ was found to have discriminant validity. The highest scores of CLDQ domains were in the normal group, scores were lower in the compensated group and lowest in the decompensated group. The significant correlation between domains of the CLDQ and SF-36 was found. The average CLDQ score was strongly correlated with the general health domain of SF-36. (P=0.69: P=0.01).CONCLUSION: The translated CLDQ is valid and applicable in Thais with CLD. CLDQ reveals that QOL in these patients is lower than that in normal population. QOL is more impaired in advanced stage of CLD.     

Depression, anxiety and alexithymia symptoms are major determinants of health related quality of life (HRQoL) in cirrhotic patients

HRQoL is impaired in cirrhosis. Establishing the relevance of depression, anxiety, alexithymia and cirrhosis stage on the patients’ HRQoL. Sixty cirrhotics underwent a neuropsychological assessment, including ZUNG-SDS, STAI Y1-Y2 and TAS-20. Minimal hepatic encephalopathy (MHE) was detected by PHES, HRQoL by Short-Form-36 (SF-36). Depression was detected in 34 patients (57 %, 95%CI?=?44–70 %), state-anxiety in 16 (27 %, 95%CI?=?15–38 %), trait-anxiety in 17 (28 %, 95%CI?=?17–40 %), alexithymia in 14 (31 % 95%CI?=?16–46 %) and MHE in 22 (37 %, 95%CI?=?24–49 %). Neuropsychological symptoms were unrelated to cirrhosis stage, hepatocellular carcinoma or MHE. A significant correlation was observed among psychological test scores and summary components of SF-36. At multiple linear regression analysis including Child-Pugh and MELD scores, previous-HE and the psychological test scores as possible covariates, alexithymia and depression as well as to the Child-Pugh score were significantly related to the SF-36 mental component; while trait-anxiety was the only variable significantly and independently related to the SF-36 physical component. Depression, state and trait-anxiety and alexithymia symptoms are frequent in cirrhotics and are among the major determinants of the altered HRQoL.     

Estimation of utilities for chronic hepatitis C from SF-36 scores

OBJECTIVES: Utilities are the recommended health-related quality of life (HRQOL) measure for cost-effectiveness studies. The aim of this study was to estimate utilities for chronic hepatitis C health states from published studies reporting Short Form-36 (SF-36) quality-of-life scores. METHODS: A systematic review of published studies was undertaken. Articles were eligible for review if direct HRQOL assessment using the SF-36 in a chronic hepatitis C population was reported. SF-36 data were grouped according to hepatitis C virus (HCV) treatment status at baseline, stage of liver disease, association with comorbidity, and HCV treatment response. The SF-36 scores were then transformed into utilities using three different methods. RESULTS: Using Nichol's method, the estimated SF-36 mean utilities were 0.87 for sustained virological response (SVR) to interferon-based treatment, 0.82 for untreated chronic hepatitis C, 0.81 for precirrhosis, 0.76 for compensated cirrhosis, 0.69 for decompensated cirrhosis, 0.67 for hepatocellular carcinoma (HCC), and 0.77 for liver transplant. Other methods showed differences across comparison groups (e.g., treated vs untreated) but absolute scores differed substantially by translation method. SF-36 utilities for different stages of liver disease varied considerably from expert estimates but comparable to direct patient-elicited utilities. CONCLUSIONS: Application of SF-36 translation methods facilitate use of large existing datasets to generate community-weighted utilities for cost-effectiveness analyses, an important consideration in the absence of large studies of direct patient-elicited utilities in chronic hepatitis C.     

Health-related quality of life in Egyptian patients after liver transplantation

Introduction-Aim. Health-Related Quality of Life (HRQOL) has become an important focus of patient care and clinical outcomes research with the improvement in patient and graft survival after liver transplantation (LT). The current study was designed to evaluate the post-transplant HRQOL profiles using the Liver Disease Quality of Life 1.0 (LDQOL 1.0) Questionnaire and demonstrate the possible effect of peri-transplant clinical covariates on these profiles.Material and methods. Participants included pre-transplant group (waiting-list patients n = 50) and post-transplant group (mean 5 ± 4 years after deceased or living donor LT n = 103) who were recruited from 3 specialized centers in Egypt. We applied the LDQOL 1.0 questionnaire; a 111-item containing the Short Form-36 version 2.0 (SF-36v2) as a generic component supplemented by 75 disease-specific items. The etiology of cirrhosis, co-morbidities, model for end-stage liver disease (MELD), Child-Pugh class and post-operative complications were analyzed.Results. All recipients had significant higher HRQOL scores than patients in waiting-list using both questionnaire components. Recipients with pre-LT MELD ≥ 15, Child-Pugh class C, history of hepatocellular carcinoma (HCC) demonstrated low HRQOL scores. Recipients without post-operative surgical complications had a statistically better HRQOL using the disease-specific, but not the SF-36v2 component. On the other hand, both components demonstrated non-significant lower scores in recipients with rejection episodes, cytomegalovirus (CMV) infection and hepatitis C recurrence had compared to those without medical complications.Conclusion. Generally HRQOL improves dramatically after LT as assessed by LDQOL questionnaire. Moreover, combined questionnaires can provide accurate information about the possible impaired HRQOL post-LT due to pre-transplant disease severity and post-operative complications.     

Health-related quality of life in chronic hepatitis B patients

The relationship between stages of chronic hepatitis B liver disease and health-related quality of life (HRQoL) is an important aspect of the overall management of hepatitis B virus (HBV) infection, yet is not well characterized. Consequently we sought to examine HRQoL in HBV patients, stratified by disease severity, compared with normal controls and hypertensive patients, using the Short Form 36 Health Survey (SF-36) and the EQ-5D self-report questionnaire. Univariate and multivariate analyses were then performed. A total of 432 HBV (156 asymptomatic carriers, 142 chronic hepatitis B, 66 compensated cirrhosis, 24 decompensated cirrhosis, 22 hepatocellular carcinoma, and 22 post-liver transplant) patients, 93 hypertensive patients, and 108 normal controls participated in the study. Multivariate analysis showed that normal controls and asymptomatic carriers had similar SF-36 scores, which were better than those for hypertensive patients, but with development of chronic hepatitis B and compensated cirrhosis, showed a significant decrease in general health and the mental dimension, whereas those with advanced liver disease (decompensated cirrhosis and hepatocellular carcinoma) had significantly lower scores in all components (P < 0.05), indicating that the physical component deteriorates only with advanced liver disease. Similar results were obtained with EQ5D. Post-liver transplant patients had similar HRQoL to patients with decompensated cirrhosis and hepatocellular carcinoma, although there was a trend toward improvement. Conclusion: Our results showed that HRQoL in asymptomatic carriers is comparable to those of normal controls and better than hypertensive patients, but deteriorates with disease progression, initially in general health and mental dimensions, but with advanced disease all dimensions are affected.     

Health-related quality of life outcomes in patients with active ankylosing spondylitis treated with adalimumab: results from a randomized controlled study

OBJECTIVE: To evaluate the impact of adalimumab on health-related quality of life (HRQOL) in patients with active ankylosing spondylitis (AS). METHODS: Patients >or=18 years enrolled in the Adalimumab Trial Evaluating Long-Term Efficacy and Safety in Ankylosing Spondylitis, a randomized controlled study, were randomly assigned to receive either adalimumab 40 mg subcutaneously or placebo every other week for 24 weeks. ASsessment of Ankylosing Spondylitis (ASAS) International Working Group criteria were used to evaluate clinical efficacy. HRQOL outcomes were assessed using the Short Form 36 (SF-36) Health Survey and Ankylosing Spondylitis Quality of Life (ASQoL) Questionnaire. RESULTS: A total of 315 patients enrolled (208 in the adalimumab group and 107 in the placebo group). Patients in the adalimumab group showed significant improvements in SF-36 Physical Component Summary (PCS) and ASQoL scores versus placebo at weeks 12 and 24 (P < 0.001). The observed differences between adalimumab and placebo patients exceeded the a priori minimum important difference (MID) at the group level, and significantly more adalimumab-treated patients achieved improvements greater than the MID on the patient level. These data suggest the HRQOL improvements were clinically meaningful. No differences were observed in SF-36 Mental Component Summary (MCS) scores. Significant differences favoring adalimumab were observed for SF-36 domains physical function, bodily pain, role-physical, general health, vitality, social function, and role-emotional. There was significant association between HRQOL improvements (measured by SF-36 PCS and MCS, and ASQoL scores) and ASAS clinical responses (P < 0.001). CONCLUSION: Adalimumab significantly improved physical health status and overall HRQOL through 24 weeks in patients with active AS.