慢性乙型肝炎肝纤维化抗病毒治疗后生活质量与AST/PLT比率、肝硬度值、病理组织学的相关性分析

目的探讨慢性乙型肝炎肝纤维化患者恩替卡韦抗病毒治疗后生活质量与AST和PLT比率(APRI)、肝硬度(LSM)值、病理组织学的相关性。方法选择2013年10月—2015年3月在延边大学附属医院诊断为慢性乙型肝炎伴有肝纤维化的患者95例,全部患者进行恩替卡韦抗病毒治疗,在治疗前、治疗26周、52周和78周时采用SF-36量表进行生活质量测评,瞬时弹性成像技术测定LSM值,并检测血清APRI,其中31例患者在治疗前和治疗78周时进行肝穿刺活检病理组织学检查,观察炎症及纤维化程度,分析抗病毒治疗前后生活质量与APRI、LSM值和病理组织学的关系。计量资料同一指标不同时间点之间的比较采用Kruskal-Wallis H检验,相关性采用Spearman相关分析。结果抗病毒治疗后全部患者生活质量总体上呈上升趋势,健康状况、生理职能、情感职能、躯体疼痛、社会功能、精力状况不同时间点上差异均有统计学意义(H值分别为25.084、8.699、12.293、22.874、12.079、10.403,P值均<0.05)。全部患者的APRI呈下降趋势,治疗前后比较,差异有统计学意义(H=60.030,P<0.01),全部患者的LSM值呈下降趋势,治疗前后比较,差异有统计学意义(H=35.744,P<0.01),APRI和LSM与生活质量评分呈负相关(P值均<0.05)。肝穿刺活检患者抗病毒治疗后组织学炎症好转共22例,纤维化好转共15例,其中炎症好转的同时生活质量也提高有14例,纤维化好转的同时生活质量也提高有8例。结论恩替卡韦抗病毒治疗可提高慢性乙型肝炎肝纤维化患者的生活质量,APRI和LSM值下降可预测慢性乙型肝炎肝纤维化患者的生活质量好转,组织学炎症和纤维化好转对慢性乙型肝炎肝纤维化患者的生活质量好转有一定的影响。

Correlation of quality of life with aspartate aminotransferase-to-platelet ratio index,liver stiffness measurement,and histopathology after antiviral therapy for chronic hepatitis B liver fibrosis

Objective To investigate the correlation of quality of life(QOL)with aspartate aminotransferase-to-platelet ratio index(APRI),liver stiffness measurement(LSM),and histopathology after entecavir antiviral therapy for patients with chronic hepatitis B liver fibrosis.Methods A total of 95 patients who were diagnosed with chronic hepatitis B and liver fibrosis in The Affiliated Hospital of Yanbian University from October 2013 to March 2015 were enrolled,and all patients underwent entecavir antiviral therapy.Before treatment and at weeks 26,52,and 78 of treatment,SF-36 scale was used to assess QOL,transient elastography was used to measure LSM,and serum APRI was measured.Among these patients,31 underwent liver biopsy before treatment and at week 78 of treatment to observe the degree of inflammation and fibrosis,and QOL,APRI,LSM,and histopathology were analyzed before and after antiviral therapy.The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data at different time points,and a Spearman correlation analysis was performed.Results There was a tendency of increase in QOL after antiviral treatment,and there were significant differences in general health,role-physical,role-motional,bodily pain,social functioning,and vitality at different time points(H=25.084,8.699,12.293,22.874,12.079,and 10.403,all P<0.05).There was a tendency of reduction in APRI,with a significant change after treatment(H=60.030,P<0.01),and there was also a significant reduction in LSM after treatment(H=35.744,P<0.01).APRI and LSM were negatively correlated with QOL(all P<0.05).Among the patients who underwent liver biopsy,22 achieved the improvement in histological inflammation after antiviral therapy,15 achieved the improvement in fibrosis,14 achieved the improvement in both inflammation and QOL,and 8 achieved the improvement in both fibrosis and QOL.Conclusion Entecavir antiviral therapy can improve the QOL of patients with chronic hepatitis B liver fibrosis,and reductions in APRI and LSM can predict the improvement in QOL in patients with chronic hepatitis B liver fibrosis.Improvement in histological inflammation and fibrosis have a certain effect on the improvement in QOL in patients with chronic hepatitis B liver fibrosis.