晚期血吸虫病抗肝纤维化治疗临床路径的实施效果观察

目的观察晚期血吸虫病(晚血)肝纤维化治疗临床路径的实施效果。方法选择符合临床路径治疗入选标准的晚血患者,制定并实施晚血抗肝纤维化治疗临床路径方案。比较晚血患者经实施临床路径治疗前后的住院天数、住院总费用、个人承担费用,以及门静脉内径、肝纤维化4项指标透明质酸(HA)、层黏蛋白(LN)、Ⅲ型胶原前肽(P(P)、Ⅳ型胶原(CIV)]及血清酶活性3项丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)和γS谷氨酰转肽酶(γ氨酰转)]等。结果共有142例晚血患者纳入抗肝纤维化临床路径治疗。患者在实施临床路径治疗后,住院总费用和患者个人承担费用分别下降11.2%和16.1%(t=6.310、4.326,P均0.05);HA均值2倍于正常值,阳性率由70.4%升至83.1%,CC、γC.1阳性率分别为64.1%、28.9%。结论临床路径可大幅度降低晚血患者治疗费用。但晚血患者体内仍持续存在着纤维增生活跃和慢性肝损害现象,提示在临床上仍需寻找更为有效的晚血治疗方法。

Effectiveness of clinical pathway for treatment of advanced schistosomiasis hepatic fibrosis

Objective To assess the effectiveness of the clinical pathway for the treatment of advanced schistosomiasis hepatic fibrosis. Methods The duration of hospital stay， gross hospitalization expense， individual?paid expense， interior diameter of portal vein， levels of four serum hepatic fibrosis?related parameters （PIIIP， CIV， HA， and LN）， and activities of ALT， AST and γ?GT were assessed and compared between the advanced schistosomiasis patients receiving the clinical pathway and ones receiving non?clinical pathway. Results There were 142 advanced schistosomiasis patients with hepatic fibrosis receiving the clinical pathway of anti?hepatic fibrosis. Compared with the patients receiving non?clinical pathway， the gross hospitalization expenses reduced by 11.2% （t = 6.310， P < 0.05）， and the individual?paid expenses reduced by 16.1% （t = 4.326， P < 0.05）. The mean HA level was twice higher than the normal range， with a positive rising from 70.4% to 83.1%， and the abnormal rates of CIV and γ?GT were 64.1% and 28.9% respectively. Conclusions The clinical pathway can drastically reduce the treatment expenses in advanced schistosomiasis patients with hepatic fibrosis. However， the patients have a trend towards the persistent disease progression. Therefore， the researches of more effective therapeutic methods for advanced schistosomiasis hepatic fibrosis are urgently needed.