Psychological status and depression in patients with liver cirrhosis

BACKGROUND: Previous studies reported an impairment of both the physical and mental dimensions of quality of life in patients with cirrhosis. Very few data are available on the psychological impact of the disease and its relation to liver function. AIM: To measure the psychological status of patients with cirrhosis in relation to the severity of the liver impairment. PATIENTS AND METHODS: One hundred and fifty-six patients with cirrhosis were studied. Two questionnaires (the Beck Depression Inventory and the Psychological General Well-Being Index) were self-administered in random order. Clinical and laboratory data were collected using standardised forms. RESULTS: The global score of Psychological General Well-Being Index was severely reduced compared to Italian population norm. Among individual domains, the more severely affected was General Health, the less compromised was Positive Well-Being. A negative relation was found between Child-Pugh score (a comprehensive measure of disease severity) and global Psychological General Well-Being Index and several individual subscales. The Beck Depression Inventory scores were indicative of a depressed mood in over 50% of patients, in relation to the presence of clinical symptoms. CONCLUSIONS: Patients with cirrhosis have signs of psychological distress and depression, as assessed by Beck Depression Inventory and Psychological General Well-Being Index, in relation to the severity of liver disease. Accordingly, a non-negligible number of patients warrant treatment.     

Anxiety and depression in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) mostly follows a painful, progressively disabling course, and individuals with RA experience more psychological distress than healthy individuals. The objective of the present study is to examine the prevalences of accompanying anxiety and depression in RA cases. The study included 82 RA cases and 41 age- and sex-matched healthy volunteers as the control group. Psychiatric examinations of all cases of the patient and control groups were performed according to DSM-IV criteria. Hamilton Anxiety Scale or Hamilton Depression Scale was applied to those who were found to have anxiety or depression. Total prevalence of anxiety, depression, and mixed anxiety-depressive disorder was found to be 70.8% (n=58) in the patient group and 7.3% (n=3) in the control group, and the difference was significant (p<0.001). Of the RA patients, 41.5% (n=34) was found to have depression, 13.4% (n=11) anxiety, and 15.9% (n=13) mixed anxiety-depressive disorder. The disease duration in patients with anxiety was shorter than the RA patient with depression (p<0.05). The disease duration was positively correlated with the degree of depression and negatively correlated with the degree of anxiety (r=0.341, p<0.05; r=−0.642, p<0.05, respectively). The results of our study suggest that prevalences of anxiety and mainly depression, increase in RA cases. When the clinical picture in RA cases becomes complicated with anxiety or depression, some problems at patients’ adaptation and response to treatment may be possible. RA cases should be monitored for accompanying anxiety or depression during follow-up.     

Anxiety and depression symptoms in patients with diabetes

Aims To identify the prevalence and major determinants of anxiety and depression symptoms in patients with diabetes. Methods A cross‐sectional study of 2049 people with Types 1 and 2 diabetes, selected from patients experiencing three different models of care in Ireland: (i) traditional mixed care; (ii) hospital/general practitioner (GP) shared care; (iii) structured GP care. Anxiety and depression symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS). Analyses were conducted primarily using logistic regression with adjustment for relevant confounders. Results The overall response rate was 71% (n = 1456). Based on the HADS, there was evidence of high levels of anxiety and depression symptoms in patients with diabetes; 32.0% (95% confidence interval = 29.5–34.6%) exceeded the HADS cut‐off score of ‘mild to severe’ anxiety and 22.4% (95% confidence interval = 20.2–24.7%) exceeded the HADS cut‐off score of ‘mild to severe’ depression. Diabetes complications, smoking, uncertainty about glycaemic control and being an ex‐drinker or a heavy drinker were risk factors for both higher anxiety and depression scores in multivariate analysis. Female gender and poor glycaemic control were risks factors associated only with higher anxiety scores. Higher socio‐economic status and older age were protective factors for lower anxiety and depression scores. Type of diabetes, insulin use, marital status and models of care were not significant predictors of anxiety and depression scores. Conclusions The prevalence of anxiety and depression symptoms in patients with diabetes is considerably higher than in general population samples. These data serve as a benchmark for the prevalence of anxiety and depression symptoms in patients with diabetes.     

接受肝移植患者术前焦虑抑郁情绪分析

目的 调查接受体外肝移植患者术前焦虑和抑郁情绪发生率,分析其发生的相关影响因素。方法 采用横断面调查设计和抽样的方法,研究2011年5月～2016年4月在我院接受肝移植患者72例,另选择同期健康体检者72例,采用焦虑自评量表（SAS）和抑郁自评量表（SDS）调查两组人群情绪变化,分别对人口社会学特征和焦虑或抑郁情绪进行调查和评定,应用二分类Logistic逐步回归分析影响因素。结果 接受肝移植的患者焦虑与抑郁评分分别为（46.40±5.30）分和（48.25±4.14）分,焦虑发生率为30.6%,抑郁发生率为43.1%,均明显高于健康人的（29.45±6.34）分、（28.13±5.42）分、5.6%和8.3%（P<0.05）;二分类Logistic逐步回归分析结果显示年龄、受教育程度、家庭月收入和婚姻状况为导致接受肝移植患者焦虑和抑郁情绪发生的主要独立危险因素（P<0.05）。结论 接受肝移植患者术前焦虑和抑郁情绪比较严重,多与患者的年龄、受教育程度、家庭月收入和婚姻状况有关,要积极进行对症护理和干预。     

急性胰腺炎合并肝损害临床分析

目的分析急性胰腺炎合并肝损害的临床特点。方法回顾性分析2009年2月至2012年8月西安市中心医院收治的116例急性胰腺炎患者的临床资料。结果67％（78／116）的急性胰腺炎患者合并肝损害。按病因分类,胆源性胰腺炎合并肝损害者的发病率为79％（38／48）,胰胆手术后（含胆囊切除术后及经内镜逆行性胰胆管造影术后）所致的急性胰腺炎合并肝损害的发病率为68％（15／22）,暴饮暴食所致的急性胰腺炎合并肝损害的发病率为67％（20／30）,其他因素所致的急性胰腺炎合并肝损害的发生率低。胆源性胰腺炎较非胆源性胰腺炎肝功能损害更明显,总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶、γ-谷氨酰转肽酶、碱性磷酸酶浓度差异均有统计学意义（t值分别为3．16、3．72、4．12、3．26、3．64、3．25,P均〈0．01）。结论胆源性胰腺炎患者大多合并肝损害。     

Anxiety, depression and quality of life (QoL) in patients with chronic dizziness

Mood disorders and the severity of dizziness often interact with each other. However, the impact of age on anxiety and depression in dizzy patients has rarely been explored. The purpose of this study was to evaluate the correlation between the Dizziness Handicap Inventory (DHI) and the Hospital Anxiety and Depression Scale (HADS) in a group of patients with dizziness. The statistical relationships between age and each scale were studied. This cross-sectional study revealed a high correlation between DHI subgroups and HADS subscales. We found statistical correlation between neither age and HADS subscales nor age and DHI subgroups. In addition, Short-Form 36 Health Survey Questionnaires (SF-36) showed a high correlation with the dizziness handicap severity. The present study revealed that age does not influence mood disorders and the severity of dizziness in dizzy patients.     

Anxiety and depression in adult patients with celiac disease on a gluten-free diet

AIM: To compare anxiety and depression levels in adult patients with celiac disease (CD) on a gluten-free diet (GFD) with controls.METHODS: The levels of anxiety, depression and of a probable anxiety or depressive disorder were assessed by the Hospital Anxiety and Depression Scale in 441 adult patients with CD recruited by the German Celiac Society, in 235 age-and sex-matched patients with inflammatory bowel disease (IBD) in remission or with slight disease activity, and in 441 adult persons of a representa...     

焦虑和抑郁量表在肝硬化患者临床应用中的信效度评价*

目的 应用焦虑自评量表（SAS）和抑郁自评量表（SDS）调查肝硬化患者心理障碍状况,评价其在肝硬化患者中应用的信效度。方法 应用SAS和SDS量表对138例肝硬化患者进行问卷调查, 采用Cronbach’s α系数、分半系数、组内相关系数（ICC）反映量表的同质信度。采用探索性因子分析量表的结构效度,计算Kaiser-Meyer-Olkin（KMO）值,并作巴特利特球形检验（BTS）判断因子分析是否合适,采用主成分分析法提取因子。结果 本组肝硬化患者焦虑和抑郁患病率分别为38.2%和63.1%;SAS量表的Cronbach’s α系数为0.777,SDS量表的Cronbach’s α系数为0.782,两个量表具有良好的同质性信度;分别对SAS量表提取4个主要因子,其方差解释比例分别为15.4%、14.9%、10.6%和10.2%,4个因子累计解释总方差的51.1%;对于SDS量表提取5个主要因子,其方差解释比例分别为14.0%、12.6%、11.9%、10.3%和8.4%,5个因子累计解释总方差的57.4%;SAS和SDS量表重测分析发现,两次测量结果高度相关（P<0.001）。结论 应用SAS和SDS量表调查肝硬化患者焦虑和抑郁情况具有良好的信效度,可以用于肝硬化患者心理障碍的测定。     

Anxiety and depression in patients with gastroesophageal reflux disease and their effect on quality of life

AIM: To explore the role of psychological factors in gastroesophageal reflux disease(GERD) and their effect on quality of life(Qo L) of GERD patients.METHODS: A total of 279 consecutive patients with typical symptoms and 100 healthy controls were enrolled in the study.All of the participants wereevaluated with the Zung Self-Rating Anxiety Scale(ZSAS), the Zung Self-Rating Depression Scale(ZSDS) and the SF-36 questionnaire.The scores for anxiety, depression and Qo L of the two groups were analyzed.The correlation between psychological factors and Qo L was also analyzed.RESULTS: Compared with healthy controls(34.70 ± 8.00), the scores of ZSAS in the non-erosive reflux disease( N E R D) group(48.27±10.34) and the reflux esophagitis(RE) group(45.38 ± 10.27) were significantly higher(P 0.001).The mean ZSAS score of the NERD group was significantly higher than that of the RE group(P = 0.01).Compared with healthy controls(37.61 ± 8.44), the mean ZSDS scores were significantly higher in the NERD group(49.65 ± 11.09, P 0.001) and the RE group(46.76 ± 11.83, P 0.001).All dimensions of the SF-36 form were negatively correlated with the SAS and SDS scores in patients with NERD and RE(P 0.05).According to the S F- 3 6 form, vitality, mentalhealth and social functioning were significantly correlated with symptoms of depression in patients with NERD and RE.General health was obviously affected by symptoms of depression in patients with NERD(P 0.05).CONCLUSION: Anxiety and depression may play an important role in the occurrence of GERD and especially that of NERD.The Qo L of patients with GERD is reduced by anxiety and depression.     

急性冠脉综合征患者焦虑抑郁情绪的随访

目的观察急性冠脉综合征（acute coronary syndrome,ACS）患者焦虑抑郁情绪的变化。方法对782例ACS患者的焦虑抑郁情绪进行平均（8．0±5．8）m的随访测评,应用综合性医院情绪测量表（hospit alanxiety and depressionscales,HADS）、贝克焦虑量表（Beck Anxiety Inventory,BAI）和贝克抑郁量表（Beck Depression Inventory,BDI）,分析ACS患者焦虑抑郁情绪的变化。结果与基线期相比,ACS患者的抑郁评分下降具有统计学意义[（7．07±5．37）vs（6．28±5．51）,P〈0．05],焦虑评分下降无统计学意义（P〉0．05）,焦虑、抑郁的构成比例无统计学意义（P〉0．05o结论ACS后抑郁程度虽然呈现自然下降趋势,但构成比例降低却无统计学意义,故仍需早发现,早治愈。关于ACS后的焦虑有待进一步深入研究。     

急性药物性肝损伤患者肝病相关抗体阳性率调查及其临床意义

目的 分析急性药物性肝损伤患者肝病相关抗体阳性情况。方法 复习2002年6月～2012年3月大连医科大学附属第一医院住院患者中诊断为急性药物性肝损伤患者的资料,分析肝病相关抗体的阳性情况。结果 104例患者中肝病相关抗体阳性率为54.81%,其中ANA 45.19%,ASMA 14.42%;ANA高滴度（≥1:320）的患者占ANA阳性患者的34.04%;2种抗体同时阳性的占阳性患者的26.32%,以ANA和ASMA阳性最常见;3种抗体同时阳性的占阳性患者的8.77%,以ANA/AMA/AMA-M2同时阳性多见;女性患者抗体阳性率高于男性,肝细胞损伤型患者抗体阳性率高于胆汁淤积型和混合型患者（P<0.05）。结论 急性药物性肝损伤患者肝病相关抗体的阳性率高达一半以上,尤其是女性、肝细胞损伤型患者,应注意鉴别。     

169例急性药物性肝损害的临床特征及易感因素分析

目的探讨急性药物性肝损伤(DILI)的临床特征及易感因素。方法选择本院2008年1月至2012年12月诊治的169例急性DILI患者的临床特征、易感因素及药物变化趋势等进行回顾性分析。结果本组病例中,女性患者占56.80%,50岁以上患者占46.15%,体重55 kg者占64.50%。临床表现无特异性,还有39例患者(23.08%)无任何症状,以肝功能异常为首发表现。肝损害以轻度(66.27%)及中度为主(22.49%);分型以肝细胞损伤型最多见(73.37%),其次是混合型(16.57%)和胆汁淤积型(10.06%)。多种给药途径均可能引起DILI,但以口服给药为主(67.46%)。多种药物可能引起DILI,以中草药(37.28%)、抗结核药物(21.30%)及抗菌药物(17.16%)最多见。其中,中草药引起的肝损害有逐年上升趋势,而抗菌药物引起的肝损害有下降趋势。经及时停药和保肝治疗,治愈81例(53.85%),好转65例(38.46%),无效17例(10.06%),死亡6例(2.96%)。结论药物性肝损伤的的致病药物种类较多,临床表现缺乏特异性。临床医生应严格把握用药指征,严密监测不良反应。     

急性及慢性药物性肝损害患者肝功能及自身抗体检测的临床意义

目的 探讨急性及慢性药物性肝损害患者肝功能及自身抗体检测的临床意义,为临床诊断及鉴别诊断药物性肝损害提供依据.方法 回顾性分析北京佑安医院2006-2008年收治的药物性肝损害患者51例的临床资料,将其分为急性药物性肝损害及慢性药物性肝损害两组,并对两组患者肝功能及自身抗体的检测结果进行分析对比.对数据用SPSS10.0软件进行Mann-Whitney秩和检验.结果 急性及慢性药物性肝损害两组患者ALT水平分别为(412.1±387.5)U/L和(376.0±319.7)U/L,AST为(352.5±457.9)U/L和(198.8±142.7)U/L,总胆红素为(109.7±104.8)μmol/L和(102.4±135.7)μmol/L,直接胆红素为(66.4±73.3)μmoL/L和(61.2±72.1)μmol/L,碱性磷酸酶为(133.4±50.1)U/L和(147.4±97.3)U/L,γ-谷氨酰转肽酶为(139.9±134.1)U/L和(180.6±227.9)U/L,白蛋白为(41.3±4.9)g/L和(39.8±5.3)g/L,球蛋白为(25.1±5.3)g/L和(28.6±5.1)g/L,经秩和检验分析,两组患者除球蛋白的水平差异有统计学意义外(P<0.05),其余指标的差异均无统计学意义(P>0.05).两组患者中部分可检出自身抗体,急性药物性肝损害组抗核抗体(ANA)、平滑肌抗体滴度均≤1:320;慢性药物性肝损害患者中可检出高滴度ANA、抗线粒体抗体,其中ANA滴度≥1:320的患者15例,7例患者ANA为1:1000.结论 肝功能指标无助于鉴别急性或慢性药物性肝损害;药物性肝损害患者可检测出多种自身抗体,慢性药物性肝损害患者可出现高滴度自身抗体,应注意与自身免疫性肝炎鉴别诊断.     

失代偿期肝硬化患者急性肾损伤相关危险因素分析

探讨失代偿期肝硬化患者发生急性肾损伤的危险因素。方法收集254例失代偿期肝硬化伴有腹水患者的相关临床资料,以血肌酐高于正常参考值上限为标准,将研究对象分为急性肾损伤观察组和无急性肾损伤的对照组,回顾性分析入选病例基础临床资料和相关实验室指标,应用单因素和多因素分析统计学方法,分析失代偿期肝硬化发生急性肾损伤的相关危险因素。结果观察组患者肝性脑病发生率为50.4%,对照组为10.1%（P＜0.01）;观察组自发性细菌性腹膜炎和其他部位感染发生率分别为70.4%和32.6%,显著高于对照组的41.2%和19.3%（P＜0.05）;观察组血钠、血清总胆红素和白细胞计数水平分别为128 mmol/L、391.8μmol/L和9.33×10^9/L,均显著低于或高于对照组的136.8 mmol/L、51.58μmol/L和3.9×10^9/L （P＜0.05）;观察组血浆凝血酶原活动度为（34.2±17.3）%,显著低于对照组的（52.1±16.1）%（P＜0.01）;Logistic回归分析结果提示肝性脑病、低血钠、总胆红素水平、血浆凝血酶原活动度、白细胞计数均为失代偿期肝硬化患者发生急性肾损伤的独立危险因素（P＜0.05）。结论失代偿期肝硬化伴有肝性脑病、感染、低血钠、高胆红素血症和严重凝血功能障碍是发生急性肾损伤的高危人群。     

乙型肝炎肝硬化患者并发急性肾损伤危险因素分析*

目的 分析探讨乙型肝炎肝硬化患者并发急性肾损伤(AKI)的危险因素。方法 2018年3月～2020年3月于我院进行治疗的乙型肝炎肝硬化患者136例,通过电子病历收集一般资料和实验室指标,根据相关标准诊断诊断并发AKI者40例,无AKI者96例。应用Logistic回归分析影响AKI发生的危险因素。结果 单因素分析结果表明,并发AKI患者失代偿期肝硬化占比为52.5%,显著高于无AKI患者的31.3%(P<0.05),腹水发生率为55.0%,显著高于无AKI患者的29.2%(P<0.05),并发肝性脑病发生率为22.5%,显著高于无AKI患者的4.2%(P<0.05),而两组性别、年龄、病程、Child-Pugh分级差异无统计学意义(P>0.05);多元Logistic回归分析结果显示肝硬化分期、腹水和并发肝性脑病是乙型肝炎肝硬化患者发生AKI的独立危险因素(P<0.05)。结论 乙型肝炎肝硬化患者发生肝功能失代偿、腹水或并发肝性脑病容易诱发AKI,临床需要行针对性的预防措施,以提高生存率。     

传染性非典型性肺炎患者肝功能变化

目的 探讨严重急性呼吸综合征(SARS)患者病程中出现肝功能异常的情况及可能的影响因素。方法 普通型SARS组91例,重型23例,普通肺炎组61例,入院后检测肝功能情况。结果 普通型SARS组肝功能异常发生率68.1%,显著高于普通肺炎组的24.6%(x~2=27.7,P<0.01),以丙氨酸氨基转移酶和天门冬氨酸氨基转移酶的轻、中度升高为主。重型患者肝功能异常发生率高达95.7%,年龄明显增大。结论 SARS患者发生肝功能损害的机会较大,可能与疾病本身有关,程度较轻,重型SARS的肝功能损害则与年龄有关。     

Anxiety and depression affects life and sleep quality in adults with beta-thalassemia

Purpose  The aim of this study was to investigate the association of anxiety and depression symptoms with health related quality of life (HRQoL) and sleep quality in patients with beta-thalassemia. Methods  In a cross-sectional study between 2006 and 2007, 292 thalassemic patients were assessed for symptoms of anxiety and depression (Hospital Anxiety Depression Scale; HADS), HRQoL (Short Form-36, SF-36) and quality of sleep (Pittsburgh Sleep Quality Index; PSQI). Linear regression models were used to determine possible predictive value of high anxiety and depressive symptoms on HRQoL and sleep quality, separately. Results  Mental and physical quality of life scores were predicted by symptoms of depression and somatic comorbidities. Total sleep quality was predicted by anxiety symptoms and somatic comorbidities. Conclusions  Screening for anxiety and depression in patients with thalassemia is essential. Further studies should test if appropriate treatment of these conditions may improve patients HRQoL and sleep quality or not.     

血清胱抑素C对肝硬化患者肾损伤的诊断效能研究

目的 探讨应用血清胱抑素C水平诊断肝硬化患者并发急性肾损伤（AKI）的临床价值。方法 2015年1月~2017年2月我院接受治疗的114例肝硬化患者,按照血清肌酐水平在48 h内≥25.5 μmol/L诊断,结果并发AKI患者62例【其中急性肾小管坏死（ATN)8例,肝肾综合症（HRS）16例和前性氮质血症(PRA)38例】,非AKI患者52例。采用增强免疫比浊法检测血清胱抑素C。结果 AKI组合并冠心病19例,糖尿病17例,高血压16例,显著高于非AKI组的12例、10例和11例（P<0.05）;AKI组血清胱抑素C水平为（2.4±0.2） mg/L,显著高于非AKI组的（0.9±0.1） mg/L,白蛋白为（28.3±4.8） g/L,显著低于非AKI组的（34.1±7.3） g/L（P<0.05）;尿素氮为（15.3±5.4） mmol/L,血小板计数为（73.1±11.3）×10⁹/L,总胆红素为（43.8±9.5） μmol/L,血肌酐为（127.6±23.5） μmol/L,与非AKI组的（6.4±3.3） mmol/L、（90.6±12.7）×10⁹/L、（23.6±6.4） μmol/L和（73.4±15.2） μmol/L比,差异显著（P<0.05）;ATN组血胱抑素C水平为（3.6±1.6） mg/L,血小板计数为（102.6±21.7）×10⁹/L,总胆红素为（73.2±16.8） μmol/L,血肌酐为（346.8±30.7） μmol/L,均显著高于HRS组或PRA组（P<0.05）;血清胱抑素C诊断AKI的准确度为92.1%,特异度为95.7%,显著高于血肌酐或尿素氮。结论 血胱抑素C水平检测可帮助早期诊断肝硬化患者并发AKI,或有利于临床早期处理。     

抑郁症与抑郁/焦虑共病患者的人格特征及社会支持对比研究

目的 探讨抑郁症与抑郁/焦虑共病患者的人格特征及社会支持的特点及与正常人的差异.方法 对同时符合美国精神疾病和统计手册第四版(DSM-IV)抑郁障碍和焦虑障碍诊断标准的36例患者(共病组)与33例仅符合抑郁障碍诊断者(抑郁症组)分别进行艾森克个性问卷(EPQ)和社会支持评定量表(SSRS)评定,并与30名正常人(正常组)对照,然后进行对比分析.结果 共病组和抑郁症组的EPQ-N、L因子分均高于正常组,EPQ-E因子分低于正常组,差异有显著性(P《0.05或P《0.01),SSRS总分及主观支持和对支持利用度两个因子分均低于正常组(P《0.05或P《0.01).共病组与抑郁症组的EPQ和SSRS总分及因子分组间差异无显著性(P》0.05).结论 抑郁症与抑郁/焦虑共病患者均具有神经质、内向和过度掩饰的个性特征,需要更多的社会支持.