慢性乙型肝炎患者情绪和应对方式对生活质量的影响

doi:10.3969/j.issn.1672-5069.2018.04.021

摘要/Abstract

摘要： 目的分析慢性乙型肝炎（CHB）患者焦虑和抑郁情绪以及应对方式对患者出院后生活质量的影响。方法 2015年6月~2016年12月在我院治疗的CHB患者75例,另选同期体检的健康人70例作为对照组。采用焦虑自评量表（SAS）、抑郁自评量表（SDS）、特质应对方式问卷（TCSQ）和世界卫生组织生活质量测定简表（WHOQOL-BREF）对两组人群进行评分,采用多元回归分析SAS评分、SDS评分、TCSQ评分对患者生活质量的影响。结果 CHB患者SAS得分为（66.8±9.5）分、SDS得分为（64.5±10.2）分、TCSQ中消极应对（NC）得分为（38.3±9.6）分,均显著高于健康人[分别为（37.9±8.4）分、（41.3±9.1）分和（23.1±6.4）分 ,P<0.05];CHB患者积极应对（PC）得分为（26.4±8.1）分,HOQOL-BREF总分为（65.7±14.3）分,均显著低于健康人[分别为（23.1±6.4）分和（78.4±8.2）分,P<0.05] ;经Pearson相关分析,结果显示WHOQOL-BREF生活质量中的生理和心理领域得分与SAS评分、SDS评分、TCSQ评分中的PC和NC因子之间均存在相关性（P<0.05或P<0.01）,多元线性回归分析结果表明,SDS、PC和NC评分是CHB患者生活质量中生理领域的影响因子,而PC评分是CHB患者心理领域的影响因子（均P<0.01）。结论慢性乙型肝炎患者的生活质量较正常人明显降低,尤其是在生理和心理领域,其生活质量与焦虑和抑郁情绪及积极应对方式有关。

关键词: 慢性乙型肝炎, 情绪, 应对方式, 生活质量

Abstract: Objective To investigate the changes of emotion,attitude and quality of life in patients with chronic hepatitis B（CHB）. Methods 75 patients with CHB and 70 healthy persons were recruited in our hospital between June 2015 and December 2016. The self rating anxiety scale（SAS）,self rating depression scale （SDS） and trait coping style questionnaire（TCSQ） and quality of life scale by WHO（WHOQOL-BREF） were obtained in the two groups. Logistic analysis was applied to evaluate the impact of them on the quality of life in patients with CHB. Results The SAS score,SDS score and the negative score of TCSQ in patients with CHB were （66.8±9.5）,（64.5±10.2） and （38.3±9.6）,respectively,much higher than [（37.9±8.4）,（41.3±9.1） and （23.1±6.4）,P<0.05] in the control;the positive score of TCSQ in patients with CHB was （26.4±8.1）,and HOQOL-BREF score was （65.7±14.3）,much lower than [（23.1±6.4） and （78.4±8.2）,P<0.05] in the control; the physical and psychological score of WHOQOL-BREF in patients with CHB were positively correlated to positive score and negative score of SAS,SDS and TCSQ（P<0.05 or P<0.01）,and Logistic analysis showed than the SDS,PC and NC score were the factors influencing the quality of life in patients with CHB（P<0.01）. Conclusions The quality of life in patients with CHB is relatively decreased, especially in physiological and psychological fields, which warrants social and clinical concerns.

Key words: Chronic hepatitis, Emotion, Attitude, Quality of life

王新钊, 马丽娟, 段心科, 孙选, 王怀海. 慢性乙型肝炎患者情绪和应对方式对生活质量的影响[J]. 实用肝脏病杂志, 2018, 21(4): 569-572.

Wang Xinzhao, Ma Lijuan, Duan Xinke, et al. Emotion, attitude and quality of life in patients with chronic hepatitis B[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(4): 569-572.

参考文献

[1] Ishak K,Baptista A,Bianchi L,et al.Histological grading and staging of chronic hepatitis. J Hepatol,1995,22(6):696-697.
[2] Gundling F,Seidl H,Schmidtler F,et al.Nonhepatic cancer in liver cirrhosis:a retrospective study of prevalence,complication rate after specific oncological treatment,follow-up and prognostic predictors of outcome in 354 patients with cirrhosis. Anticancer Res,2011,31(9):2931-2938.
[3] Lok ASF,Mcmahon BJ.Chronic hepatitis B:Update 2009. Hepatology,2009,50(3):661.
[4] Schramm C,Wahl I,Weilernormann C,et al.Health-related quality of life,depression,and anxiety in patients with autoimmune hepatitis. J Hepatol,2014,60(3):618-624.
[5] 居朝霞,吴桂香,张波. 院外延伸性护理对慢性丙型肝炎患者负性情感和自我效能的正性作用研究. 实用肝脏病杂志, 2017,20(6):701-704.
[6] 中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南(2010年版).实用肝脏病杂志,2011,14(2):81-89.
[7] Zettinig G,Asenbaum S,Fueger BJ,et al.Increased prevalence of sublinical brain perfusion abnormalities in patients with autoimmune thyroiditis:evidence of Hashimoto's encephalitis. Clin Endocrinol,2003,59(5):637.
[8] Luo Y,Wang H.Correlation research on psychological health impact on nursing students against stress,coping way and social support. Nurse Educ Today,2009,29(1):5-8.
[9] Min S K,Kim K I,Lee C I,et al.Development of the Korean versions of WHO quality of life scale and WHOQOL-BREF. Qua Life Res,2002,11(6):593-600.
[10] 王松贤. 慢性乙型肝炎患者肝组织学检查的意义. 实用肝脏病杂志,2014,17(3):297-298.
[11] Chao J,Long S,Hua Z,et al.Effects of comprehensive intervention on health-related quality of life in patients with chronic hepatitis B in China. BMC Health Serv Res,2013,13(1):1-9.
[12] Pawlowski T,Radkowski M,Malyszczak K,et al.Depression and neuroticism in patients with chronic hepatitis C:correlation with peripheral blood mononuclear cells activation. J Clin Virol,2014,60(2):105-111.
[13] Yang JH.Development and evaluation of a program to promote self management in patients with chronic hepatitis B. J Korean Acad Nurs,2012,42(2):258.
[14] Zhang CX,Tse LA,Ye XQ,et al.Moderating effects of coping styles on anxiety and depressive symptoms caused by psychological stress in Chinese patients with type 2 diabetes. Diabet Med,2009,26(12):1282-1288.
[15] Ahmet Y,Feyzullah U,Süleyman D,et al.Somatosensory amplification,anxiety,and depression in patients with hepatitis B:impact on functionality. Medicine,2016,95(21):e3779.
[16] Bakhshi Aliabad MH,Jafari E,Karimi K M,et al.Anxiety leads to up-regulation of CD36 on the monocytes of chronic hepatitis B-infected patients. Int J Psychiat Med,2016,51(5):467.
[17] Arslan N,Büyükgebiz B,Oztürk Y,et al.Depression and anxiety in chronic hepatitis B:effect of hepatitis B virus infection on psychological state in childhood. Turk J Pediatr,2003,45(1):26.
[18] Rashid A,Torres HA,Jorewicz L,et al.Incidence and characteristics of depression in cancer patients with chronic hepatitis C infection. J Clin Oncol, 2014,32(5):432-438.
[19] Altindag A,Cadirci D,Sirmatel F.Depression and health related quality of life in non-cirrhotic chronic hepatitis B patients and hepatitis B carriers. Neurosciences,2009,14(14):56-59.
[20] Ozkan M,Corapcioglu A,Balcioglu I,et al.Psychiatric morbidity and its effect on the quality of life of patients with chronic hepatitis B and hepatitis C. Int J Psychiat Med,2006,36(3):283.
[21] 俞伟. 慢性乙型肝炎患者抑郁状态实施心理干预的效果分析. 实用肝脏病杂志,2009,12(4):297-298.