De Bona M, Ponton P, Ermani M, Iemmolo R M, Feltrin A, Boccagni P, Gerunda G, Naccarato R, Rupolo G, Burra P
Department of Surgical and Gastroenterological Sciences, University of Padua, Italy.
J Hepatol. 2000 Oct;33(4):609-15. doi: 10.1034/j.1600-0641.2000.033004609.x.
BACKGROUND/AIM: The impact of liver disease and medical complications on quality of life (QOL) and psychological distress before and after orthotopic liver transplantation (OLT) is a matter of growing interest.
Perceived QOL (LEIPAD Quality of Life test) and psychological distress (Brief Symptom Inventory, BSI) were assessed in 40 cirrhotic patients listed for OLT (Group A) and in 101 liver transplant recipients (Groups B to G=0-6, 7-12, 13-24, 25-36, 37-48, 49-60 months post-OLT). Patients were also evaluated for medical complications, blood levels of immunosuppressive agents and recurrence of liver disease.
QOL and psychological distress were significantly better in most of the post-OLT groups than in cirrhotic patients. Among post-OLT patients, a significantly worse QOL was perceived at 13-24 months (Life Satisfaction: Group D vs G, p=0.024; Cognitive Functioning: Group D vs F, p=0.024), while significantly greater psychological distress was detected at 7-12 months (Anxiety and Interpersonal Sensitivity: Group C vs Group B, p=0.032 and p=0.023, respectively). Medical complications and immunosuppressive therapy did not influence QOL or psychological distress after OLT. Within 6 months after OLT, patients with HCV recurrence showed significantly greater Depression (p=0.023), Anxiety (p=0.038), Phobic Anxiety (p=0.001), and Paranoid Ideation (p=0.033) than anti-HCV negative patients.
Liver transplantation improves psychological distress and most, but not all, QOL domains. Recurrent HCV infection is associated with greater psychological distress.
背景/目的：肝脏疾病及医学并发症对原位肝移植（OLT）前后生活质量（QOL）及心理困扰的影响愈发受到关注。
对40例等待OLT的肝硬化患者（A组）及101例肝移植受者（B至G组，OLT术后0 - 6、7 - 12、13 - 24、25 - 36、37 - 48、49 - 60个月）进行感知生活质量（LEIPAD生活质量测试）及心理困扰（简明症状量表，BSI）评估。对患者的医学并发症、免疫抑制剂血药浓度及肝病复发情况也进行了评估。
大多数OLT术后组的生活质量和心理困扰明显优于肝硬化患者。在OLT术后患者中，13 - 24个月时生活质量明显较差（生活满意度：D组与G组比较，p = 0.024；认知功能：D组与F组比较，p = 0.024），而7 - 12个月时心理困扰明显更严重（焦虑和人际敏感性：C组与B组比较，p分别为0.032和0.023）。医学并发症和免疫抑制治疗对OLT术后的生活质量或心理困扰无影响。OLT术后6个月内，丙型肝炎病毒（HCV）复发的患者比HCV抗体阴性患者的抑郁（p = 0.023）、焦虑（p = 0.038）、恐惧焦虑（p = 0.001）及偏执观念（p = 0.033）更严重。
肝移植可改善心理困扰及大部分（但非全部）生活质量领域。HCV感染复发与更严重的心理困扰相关。
