Häuser Winfried, Holtmann Gerald, Grandt Daniel
Department of Internal Medicine I, Klinikum Saarbrücken gGmbH, Winterberg 1, D-66119, Saarbruecken, Germany.
Clin Gastroenterol Hepatol. 2004 Feb;2(2):157-63. doi: 10.1016/s1542-3565(03)00315-x.
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.
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.
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).
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.
本研究旨在评估肝脏疾病、现存的内科和精神科合并症以及社会人口统计学变量，对未经过挑选的慢性肝病患者通过通用量表和肝脏特异性量表所测得的健康相关生活质量（HRQOL）的影响。
在一家三级医疗中心就诊的255例患有不同阶段各种肝病的连续患者中，有204例（80%）完成了以下自我报告问卷：炎症性肠病能力网络社会人口学问卷、德国疼痛问卷中的疾病列表、德语版医院焦虑抑郁量表（HADS-D）以及作为通用量表的医学结局研究简明健康调查问卷（SF-36）；以及作为疾病特异性HRQOL量表的德语版慢性肝病问卷（CLDQ）。
逐步多元回归显示，肝病病因、疾病严重程度（肝硬化与无肝硬化、Child-Pugh评分）、性别、年龄和社会阶层对HRQOL均无影响。在德语版HADS中焦虑或抑郁评分≥11分表明可能存在精神障碍，这独立导致了CLDQ总分以及SF-36身心总结评分中HRQOL受损（P<0.0001）。现存内科合并症的数量独立导致了CLDQ总分以及SF-36身体总结评分中HRQOL降低（P<0.0001）。此外，现存心血管合并症对SF-36精神总结评分有负面影响（P<0.003）。
慢性肝病患者HRQOL降低是由精神科合并症和现存内科合并症决定的，而非根据Child-Pugh评分所反映的肝脏疾病严重程度。
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