Research On Health-Related Quality Of Life In Patients With Hepatitis B Virus Related Cirrhosis

BACKGROUND Chronic hepatitis B virus (HBV) infection is one of the major health problems worldwide, especially in Asia. Current estimates are that about 2 billion people have been infected all over the world, 360 million of them suffer from HBV infection. In China, Southeast Asia and Africa, HBV infection is responsible for over 50% of cirrhosis and 70%～90% hepatocellular carcinoma. The reported yearly incidence of hepatic decompensation is about 3%, with a cumulative 5-year rate of progression of 16%.The 5-year mortality rate is 0%～2% for patients with chronic hepatitis B without cirrhosis, 14%～20% for patients with compensated cirrhosis, and 70%～86% after the occurrence of decompensation. About one million persons died from cirrhosis of the liver and liver cancer diseases each year.So currently, experts of liver disease call on attaching importance to research on the treatment outcomes. The quality of life need to be think highly in clinical medical treatment.OBJECTIVE It has been shown that health-related quality of life (HRQOL) is impaired in patients with chronic hepatitis and hepatocellular carcinoma. No data are available in patients with HBV related liver cirrhosis in Chinese population. The aim of this study was to analyze the health related quality of life among patients with cirrhosis developed from chronic hepatitis B(CHB),to investigate whether inpatient care could improve their HRQOL and the factors associated with the HRQOL of cirrhosis patients.METHODS The Chinese version of Short Form-36 was used to measure HRQOL of 180 patients with HBV-related liver cirrhosis before and after treatment and 180 patients with chronic hepatitis B before treatment. For all patients, demographic data including sex, age, educational background, medical payment, anorexia, ascites, alanine aminotransferase (ALT), albumin, total bilirubin(TBIL) and Child-Pugh score were collected. All patients completed a health-related quality of life questionnaire in the clinic prior to any laboratory procedures. Data were compared with a healthy Chinese population. Factors associated with poor HRQOL were identified by univariate analysis and multiple logistic regressions. All statistical analyses were carried out by using SPSS13. 0 for Windows.RESULTS In all except one domain (mental health, MH) of SF-36, HRQOL scores were significantly lower in cirrhosis group than in the healthy group(p<0. 001). The cirrhosis patients had significantly lower scores in Physical Function(PF), Role Physical(RP) and Vitality(VT) domains than hepatitis patients. The HRQOL of cirrhosis was improved after treatment. Child-Pugh grade was mainly associated with score in Physical Component Summary (PCS) while female gender affected both PCS and Mental Component Summary(MCS) score. Logistic regression shows the severity of disease(Child-Pugh grade)and female gender were the factors associated with poor HRQOL, with an odds ratio(OR) of 2.89(95%CI:1. 25-6.69, p =0.013)and 4.97(95%CI:1.65-14. 98, p =0.004) respectively. CONCLUSIONS HRQOL of patients with cirrhosis were impaired obviously. Severity of disease (Child-Pugh grade)and female gender are independent factors associated with poor HRQOL.Short period therapy could improve the quality of life. These data are the basis for longitudinal studies.