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目的探讨抗病毒治疗对慢性丙型肝炎(CHC)合并冷球蛋白血症患者生存质量(QOL)的影响。方法随机选取2009年2月至2014年10月在河北省玉田县医院及石家庄市第五医院就诊的CHC合并冷球蛋白血症75例患者的临床资料进行回顾性分析。以采用聚乙二醇干扰素α-2a联合利巴韦林抗病毒治疗的40例为治疗组,采用常规保肝治疗的35例为对照组,疗程48周。比较分析两组患者治疗前、治疗24、48周时生化、病毒学指标及慢性肝病问卷(CLDQ)评分的变化情况。结果 (1)治疗组治疗24、48周时ALT、TBIL值及HCV RNA载量低于对照组,ALB高于对照组,差异有统计学意义(P均<0.05)。(2)治疗组治疗48周时冷球蛋白检出率为42.5%(17/40),病毒学应答率(HCV RNA<10~3拷贝/ml)为72.5%(29/40);而对照组两者均无变化。(3)治疗组治疗48周时CLDQ评分均较治疗前明显提高,差异有统计学意义(P均<0.05),对照组治疗48周时腹部症状、全身症状评分较治疗前明显降低,差异具有统计学意义(P均<0.05);治疗组治疗24周时乏力评分明显高于对照组(P<0.05),但腹部症状、全身症状、活动、情感功能、焦虑评分差异不明显(P均>0.05),治疗48周时乏力、全身症状、活动、情感功能、焦虑评分明显高于对照组(P均<0.05),但腹部症状差异不明显(P>0.05)。结论抗病毒治疗可以明显改善CHC合并冷球蛋白血症患者的生存质量。
Objective To investigate the effect of antiviral therapy on quality of life (QOL) in patients with chronic hepatitis C (CHC) complicated with cryoglobulinemia. Methods The clinical data of 75 patients with CHC combined with cryoglobulinemia who were treated in Yutian County Hospital and Shijiazhuang No. 5 Hospital of Hebei Province from February 2009 to October 2014 were randomly selected and analyzed retrospectively. To use pegylated interferon alpha-2a combined with ribavirin antiviral therapy in 40 cases as the treatment group, the use of conventional liver protection in 35 cases as the control group, the course of 48 weeks. The changes of biochemical, virological indexes and CLDQ scores of two groups before and 24 and 48 weeks of treatment were compared and analyzed. Results (1) ALT, TBIL and HCV RNA were lower in the treatment group than those in the control group at 24 and 48 weeks of treatment, and the difference was statistically significant (all P <0.05). (2) The cold globulin detection rate was 42.5% (17/40) and the virological response rate (HCV RNA <10 ~ 3 copies / ml) was 72.5% (29/40) There was no change in both groups. (3) The CLDQ scores of the treatment group at 48 weeks after treatment were significantly higher than those before treatment (all P <0.05). The scores of abdominal symptoms and general symptoms in the control group were significantly lower than those before treatment (P <0.05). The fatigue score of the treatment group at 24 weeks was significantly higher than that of the control group (P <0.05), but there was no significant difference in abdominal symptom, general symptom, activity, emotional function and anxiety score (P> 0.05). After 48 weeks of treatment, the symptoms of fatigue, systemic symptoms, activities, emotional functions and anxiety scores were significantly higher than those of the control group (all P <0.05). However, there was no significant difference in abdominal symptoms (P> 0.05). Conclusion Antiviral therapy can significantly improve the quality of life of CHC patients with cryoglobulinemia.