The Study Of Nursing Intervention To Improve Life Quality In Chronic Hepatitis C Patients With Diabetes Mellitus

Chronic hepatitis C(CHC)is a kind of chronic infectious liver disease caused by Chronic hepatitis C virus(HCV) infection. After 1989, the time hepatitis C virus was first discovered, more and more studies have been confirming that HCV can cause disfunction of extrahepatic organizations and tissues such as mixed type congealed globulinemia,thyroiditis,porphyria cutanea tarda,angitis and so on except for liver damage, like liver steatosis,hepatic cirrhosis,hepatocellular carcinoma. Owing to liver playing a very important role in saccharometabolism, approaching researches between internal and domestic all discover that HCV infection may result in Diabetes Mellitus, especially Type 2 diabetes,it is the consequence of progressing damage of insulin resistance (IR) and together with secretion. The association between CHC and DM was first discovered in patients with hepatic cirrhosis. Allison etc. reported that 50% persons suffered hepatic cirrhosis after HCV infection also have been accompanying with non-insulin dependent diabetes mellitus (NIDDM), whereas there are only 9% persons suffered hepatic cirrhosis due to other reasons accompanying with NIDDM, Logic multiple regression analysis indicates the development of DM has statistically significant associativity with HCV infection. Along with deeply investigating, more and more findings indicate that hepatic cirrhosis contributes to a significant role in CHC complicating DM, but it is not the prerequisite of DM, what important is that HCV itself concerned with the development of DM. Knobler and Mehte also reported that even though not combined with hepatic cirrhosis, the occasion CHC complicating DM is notable elevated, and the chance will be more higer in persons with hepatic cirrhosis.On the other hand, liver is the critical organ in glycometabolism, DM reverses to aggravate the impairment of hepatic function. The reason may be that the disturbance of glycometabolism and fat metabolism in DM patients leads to total lipids increasing, which caused hepar adiposum,hepatomegalia and so on. Some researches has shown serum glutamic-oxaloacetic transaminase (AST), glutamate-pyruvate transaminase (ALT), total bile acids (TBA), r-glutamate-trans- peptidase (GGT) in DM patients are all higher than non-DM, which indicates that DM is the consideration factor of liver functional lesion. Tazawa etc. did a more further study and research, he considered DM is the independence and association factor of CHC patients not with hepatic cirrhosis developed primary hepatocellular carcinoma (HCC), and handling DM may reduce the occurrence of HCC.To sum up we arrived at such a conclusion: HCV infection may result in CHC which can damage hepatic function and induce DM, DM reverses to aggravate the impairment of hepatic function, which results to vicious circle, accelerating the progress of hepatic cirrhosis,hepatoma in CHC patient, at last becoming the significant life-threatening factor. It should be especially to emphasis that many contraries exist in the treatment and nursing procedure of these two diseases, for instance, we encourage patients with CHC to take drink and foods containing sugar especially laevoglucose in order to supply metabolic exhaustion of liver, but it is undoubtedly contraindicated for CHC patients with DM. Nowadays, therapeutics to CHC or to DM are successful, however, it has been becoming the same problem to all health staffs how to integrate these two diseases, avoid contradictions in the treating and nursing procedure, and eventually try to find out interventions in common to improve life quality of patients. 【Purpose】To explore nursing interventions which were used to help HCV infection patients combined with DM to build healthy habits whether or not can avoid contradictions in the treating and nursing procedure, strengthen therapeutic efficacy of medication, and at last improve life quality of patients.【Methods】100 patients who are anti-HCV positive combined with DM were divided randomly into control group (n=48), and intervention group (n=52). Patients'therapeutic regimen and duration of medication therapy of both groups are identical. Medicine administer instruction is given to 48 patients in control group to enhance patient's medication compliance so that to ensure drug treatment effect. Instruction not only on medication administer but on psychology,dietary and physical exercise are given to 52 patients in intervention group so that they could rebuild healthy living style. Patients'attitude and confidence of diseases was evaluated by General Perceived Self-Efficacy Scale (GSES) pre- and post-nursing intervention in two groups.Six months duration follow-up visit was given to patients of two groups at same time. FBG, HbA1c and HCV-RNA were observed and recorded relatively pre-intervention, and 3 months, 6 months after intervention in order to distinguish that nursing intervention whether or not can improve life quality except for medication effect.【Results】At the situation of identical medication, the effcativity of nursing instruction is shown in:1. HCV–RNA was significantly decreased at 3 months after nursing instruction (P=0.0026) when compared with that of pre-instruction in intervention group, whereas there was no statistically significant difference in control group. The difference of HCV-RNA therapeutic efficacy 6 months after instruction was statistically significant between two groups(P=0.04). 2. There was no statistically significant difference of FBG and HbA1c between two groups at 3 months after nursing instruction, but the variation of difference was significant (P<0.05). At 6 months after nursing instruction there was statistically significant difference of FBG and HbA1c between two groups , and the variation of difference of FBG and HbA1c was significant (P<0.05). FBG and HbA1c were reduced significantly in intervention group.3. There was statistically significant difference of the mental scale score before and after 6 months of nursing instruction (P<0.0001) between two groups. The patients'attitude and confidence to treating disease has been improved in intervention group.【Conclusion】1. Nursing intervention made the anti-HCV infection therapeutic efficacy of medication appeared to an earlier time and made it more significantly.2. Nursing intervention strengthened the results of medication, made FBG,HbA1c reduced more significantly.3. Nursing intervention helped patients to recognize their disease rationally and meanwhile enhanced their confidence to overcome diseases.4. Nursing intervention helped patients to rebuilded healthy living habits and eventually enhanced their life quality.