目的：長效型干擾素合併 Ribavirin 治療會使慢性 C 型肝炎 (chronic hepatitis C, CHC) 患者之健康相關生活品質 (health related quality of life, HRQL) 降低。本研究旨在探討不同治療階段的 CHC 患者 HRQL 之影響。研究方法：以橫斷式研究設計，採立意取樣方式選取南部某區域教學醫院 149 位符合全民健保加強 CHC 治療試辦計畫患者為對象。採用台灣簡明版世界衛生組織生活品質量表為研究工具。相關資料以描述性統計分析與單因子變異數分析。研究結果：治療前與治療結束後第 24 週的 CHC 患者之環境健康範疇顯著低於其他健康範疇，而治療期間之 CHC 患者的社會關係範疇顯著較其他健康範疇佳。治療前與治療結束後第 24 週之CHC 患者的生理健康範疇、心理健康範疇與整體健康相關生活品質之平均得分著顯著高於治療期間第 4 週與第 12 週者，但治療期間第 24 週的 CHC 患者之心理健康範疇比治療前者差，未顯著差異。治療結束後第 24 週的 CHC 患者之環境健康範疇顯著比治療期間第 24 週者佳。社會健康範疇並未因治療階段不同而有顯著差異。結論﹕CHC 患者在不同治療階段有不同的 HRQL 之影響，故了解治療對其不同階段的影響，助於臨床照護 CHC 患者的醫護人員參考。

Objectives: Combination therapy of pegylated interferon (PEG-IFN) and ribavirin (RBV) in chronic hepatitis C (CHC) is associated impaired health-related quality of life during therapy. The purpose of this study was to evaluate the patients' perceptions of health-related quality of life (HRQL) during different time periods of the therapy. Methods: Cross-sectional study of a purposive sample of patients recruited from a regional teaching hospital in southern Taiwan. A total of 149 patients with CHC who were enrolled in the Bureau of National Health Insurance (BNHI) demonstration project for enhancement of hepatitis C virus treatment had evaluation of HRQL using the short version of the world health organization quality of life (WHOQOL-BREF) questionnaire. Descriptive statistics were used to describe the basic features of the subjects in the study. One-way analysis of variance was applied to compare the differences of HRQL in the different periods during PEG-IFN and RBV combination therapy. Results: Patients with chronic hepatitis C at pretreatment and the 24-week after stopping PEG-IFN and RBV treatment had significantly lower HRQL on environmental health domain than other domains of the WHOQOL-BREF, while the score of social relationships domain at the time periods during PEG-IFN and RBV treatment was significantly higher HRQL than other domains’ score of the WHOQOL-BREF. Compared to the patients at the 4-week and 12-week periods of PEG-IFN and RBV treatment, patients at the pretreatment and 24-week after stopping treatments had significantly higher physical health, psychological health and global HRQL scores, however, at the 24-week periods in treatment of patients with chronic hepatitis C had lower psychological health domains scores than the pretreatment, but no significant differences. Patients with chronic hepatitis C at the 24-week after stopping PEG-IFN and RBV treatment had significantly higher HRQL on environmental health domain scores than the 24-week periods. There was no significant difference in social relationships HQRL over the entire treatment period of PEG-IFN and RBV treatment. Conclusions: For patients with CHC, PEG-IFN and RBV combination therapy related HRQL impairment could be inconsistent over the different time periods of treatment. The author hopes this study will provide references for nursing care patients with CHC.

中文摘要 Ⅰ
Abstract Ⅱ
誌謝 Ⅳ
目錄 Ⅴ
表目錄 Ⅷ
圖目錄 Ⅸ
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 4
第三節 名詞界定 5
第二章 文獻探討 6
第一節 慢性C型肝炎疾病之流行病學 6
第二節 慢性C型肝炎之治療與治療反應之評估 10
第三節 慢性C型肝炎之治療健康相關生活品質 13
第三章 研究方法 40
第一節 研究設計 40
第二節 研究對象及資料收集 41
第三節 研究工具 43
第四節 研究變項與操作型定義 49
第五節 資料處理與分析 50
第四章 研究結果 51
第一節 研究對象基本特性分布 51
第二節 各治療階段不同健康範疇之差異 56
第三節 CHC患者不同治療階段之健康相關生活品質的變化 59
第四節 各健康相關生活品質範疇不同治療階段之差異 60
第五章 討論 64
第一節 長效型干擾素合併RBV治療之CHC患者健康相關生活品質
現況 64
第二節 長效型干擾素合併RBV治療之CHC患者各健康相關生活品
質不同治療階段之差異 66
第六章 結論與建議 71
第一節 結論 71
第二節 研究限制 71
第三節 建議 72
參考文獻 74
中文部分 74
英文部分 76
附錄 83
附錄一 同意臨床試驗證明書 83
附錄二 台灣版世界衛生組織生活品質問卷使用授權書 84

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