Younossi Z M, Kiwi M L, Boparai N, Price L L, Guyatt G
Department of Gastroenterology, and Liver Transplant Center, The Cleveland Clinic Foundation, Ohio 44195, USA.
Am J Gastroenterol. 2000 Feb;95(2):497-502. doi: 10.1111/j.1572-0241.2000.01774.x.
Symptoms associated with primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) negatively affect health-related quality of life (HRQL). The aim of this study was to measure HRQL in patients with chronic cholestatic liver diseases and to determine factors associated with more severe impairment.
We conducted a cross-sectional study in which we documented patients' demographic and clinical characteristics, and measured their HRQL using the Short Form-36 and Chronic Liver Disease Questionnaire. We assessed the association of HRQL impairment with disease severity (Child's-Pugh class and Mayo PBC Risk Score) and compared patients' HRQL with those of a healthy population, and patients with congestive heart failure, chronic obstructive pulmonary disease, and diabetes.
One hundred and four patients with PBC and PSC participated, of whom 73% were women, with an average age of 55+/-12 yr. Of these patients, 61% had cirrhosis (37% Child's A, 23% Child's B, and 2% Child's C). Patients with cholestatic liver disease showed more HRQL impairment than the healthy population and were similar to patients with other chronic conditions. Additionally, patients who experienced severe itching showed profound HRQL impairment. In patients with PBC, Physical Component Summary (PCS) scores of the SF-36 and Chronic Liver Disease Questionnaire (CLDQ) scores fell from noncirrhotic to Child's A to Child's B/C and with worsening Mayo PBC Risk Scores. No other clinicodemographic data were associated with patients' well-being.
Patients with cholestatic liver disease (PBC and PSC) showed substantial impairment of HRQL, which is further affected by worsening disease severity. Disease-specific measures were better able to discriminate patients with varying severities.
原发性胆汁性肝硬化（PBC）和原发性硬化性胆管炎（PSC）相关症状对健康相关生活质量（HRQL）有负面影响。本研究旨在测量慢性胆汁淤积性肝病患者的HRQL，并确定与更严重损害相关的因素。
我们进行了一项横断面研究，记录患者的人口统计学和临床特征，并使用简短健康调查量表-36（Short Form-36）和慢性肝病问卷（Chronic Liver Disease Questionnaire）测量他们的HRQL。我们评估了HRQL损害与疾病严重程度（Child-Pugh分级和梅奥PBC风险评分）之间的关联，并将患者的HRQL与健康人群、充血性心力衰竭患者、慢性阻塞性肺疾病患者和糖尿病患者进行比较。
104例PBC和PSC患者参与研究，其中73%为女性，平均年龄55±12岁。这些患者中，61%有肝硬化（37%为Child A级，23%为Child B级，2%为Child C级）。胆汁淤积性肝病患者的HRQL损害比健康人群更严重，与其他慢性病患者相似。此外，经历严重瘙痒的患者HRQL损害严重。在PBC患者中，SF-36的身体成分总结（PCS）评分和慢性肝病问卷（CLDQ）评分从非肝硬化患者到Child A级再到Child B/C级逐渐下降，且随着梅奥PBC风险评分的恶化而下降。没有其他临床人口统计学数据与患者的健康状况相关。
胆汁淤积性肝病（PBC和PSC）患者的HRQL有显著损害，疾病严重程度的恶化会进一步影响HRQL。针对疾病的测量方法更能区分不同严重程度的患者。
