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

卢晶; 朴红心; 金雪梅; 崔京淑; 金仁顺

doi:10.3969/j.issn.1001-5256.2021.04.018

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

DOI: 10.3969/j.issn.1001-5256.2021.04.018

a.
延边大学附属医院病理科，吉林延吉 133000
b.
延边大学附属医院感染性疾病科，吉林延吉 133000

基金项目:

“十三五”国家科技重大专项课题 (2017ZX10203202-003)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：朴红心、金仁顺对研究的思路有关键贡献；卢晶、金雪梅、崔京淑参与了研究数据的分析解释过程；金仁顺、卢晶参与了起草和修改了论文的关键内容。

详细信息

作者简介:
卢晶(1979—)，女，主治医师，主要从事肝脏病学研究

朴红心(1969—)，女，主任医师，博士生导师，主要从事肝纤维化机制及治疗的研究

通信作者:
金仁顺，rsjin@163.com

二者对本文贡献相同，同为第一作者

中图分类号: R512.62; R575.2
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出版历程
- 收稿日期: 2020-10-16
- 录用日期: 2020-12-26
- 出版日期: 2021-04-20

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

a.
Department of Pathology, The Affiliated Hospital of Yanbian University, Yanji, Jilin 133000, China
b.
Department of Infectious Diseases, The Affiliated Hospital of Yanbian University, Yanji, Jilin 133000, China

摘要

摘要: 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。
- 乙型肝炎, 慢性 /
- 肝硬化 /
- 生活质量 /
- 组织学
Abstract: 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.
- Hepatitis B, Chronic /
- Liver Cirrhosis /
- Quality of Life /
- Histology

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表 1 全部患者SF-36量表生活质量评分

指标	0周(n=95)	26周(n=88)	52周(n=83)	78周(n=54)	H值	P值
GH	45.0(30.0~55.0)	55.0(40.0~70.0)¹⁾	60.0(45.0~70.0)¹⁾	57.5(45.0~75.0)¹⁾	25.084	＜0.001
PF	95.0(80.0~95.0)	95.0(85.0~100.0)	95.0(80.0~100.0)	90.0(80.0~100.0)	3.333	0.541
RP	50.0(0~100.0)	100.0(25.0~100.0)²⁾	100.0(25.0~100.0)²⁾	100.0(18.8~100.0)²⁾	8.699	0.034
RE	67.0(0~100.0)	100.0(33.0~100.0)¹⁾	100.0(0~100.0)	100.0(33.0~100.0)¹⁾	12.293	0.006
SF	75.0(62.5~87.5)	87.5(65.6~100.0)¹⁾	87.5(62.5~100.0)¹⁾	75.0(62.5~100.0)²⁾	12.079	0.007
BP	74.0(62.0~84.0)	82.0(74.0~100.0)¹⁾	84.0(74.0~100.0)¹⁾	84.0(74.0~100.0)¹⁾	22.874	＜0.001
VT	60.0(50.0~75.0)	65.0(55.0~78.8)²⁾	70.0(55.0~80.0)²⁾	70.0(55.0~80.0)¹⁾	10.403	0.015
MH	64.0(48.0~76.0)	68.0(52.0~80.0)	64.0(52.0~80.0)	68.0(56.0~77.0)	4.911	0.178
注：与0周比较，1)P＜0.01；2)P＜0.05。

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表 2 全部患者0~78周APRI和LSM

周数	例数	APRI	LSM(kPa)
0	95	1.05(0.84~2.16)	16.20(9.40~21.90)
26	88	0.51(0.34~0.90)¹⁾	10.35(7.60~16.40)¹⁾
52	83	0.61(0.38~0.98)¹⁾	8.40(6.70~13.30)¹⁾²⁾
78	54	0.46(0.27~0.83)¹⁾⁴⁾	8.25(6.45~11.48)¹⁾³⁾
H值		60.030	35.744
P值		＜0.001	＜0.001
P趋势		＜0.001	＜0.001
注：与0周比较，1)P＜0.01；与26周比较，2)P＜0.05，3)P＜0.01；与52周比较，4)P＜0.05。

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表 3 25例治疗前后炎症、纤维化与生活质量评分

生活质量	炎症[例(%)]			纤维化[例(%)]
生活质量	好转	不变	进展	好转	不变	进展
提高	14(56)	1(4)	1(4)	8(32)	6(24)	1(4)
下降	8(32)	1(4)	0(0)	7(28)	1(4)	2(8)

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表 4 APRI和LSM与生活质量的相关分析

指标	GH	PF	RP	RE	SF	BP	VT	MH
APRI
r值	-0.201	-0.110	-0.243	-0.021	-0.125	-0.291	-0.139	-0.109
P值	＜0.001	0.049	＜0.001	＜0.001	0.025	＜0.001	0.013	0.052
LSM
r值	-0.191	-0.117	-0.016	-0.218	-0.077	-0.188	-0.090	-0.191
P值	0.001	0.036	0.005	＜0.001	0.169	0.001	0.108	0.001

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