慢性乙肝、乙肝后肝硬化患者及正常对照组随访8周的抑郁和焦虑症状

背景慢性乙肝（ChronicHepatitisB，CHB）和乙肝后肝硬化（HepatitisBCirrhosis，HBC）患者经常伴发抑郁、焦虑症状，但病程进展中的心理状况和CHB、HBC患者的病情之间的关系尚不清楚。目的对住院治疗的CHB和HBC急性发作患者的抑郁和焦虑症状的变化进行评估。方法对71例CHB和75例HBC患者在入院治疗时进行测评，其后治疗期间随访8周。同时，以健康志愿者65人作对照组。分别对3组对象在入院时和随访第8周时进行90项症状自评量表（SymptomCheckList-90，SCL-90）测评。采用汉密尔顿焦虑量表（HamiltonAnxietyScale，HAMA）、汉密尔顿抑郁量表（HamiltonDepressionScale，HAMD）、焦虑自评量表（Self—RatingAnxietyScale，SAS）及抑郁自评量表（Self—RmingDepressionScale，SDS）分别对3组研究对象每隔2周，即人院时、随访第2周、第4周、第6周、第8周时进行评定。结果每组均有60例对象完成测评。CHB组和HBC组的基线SCL-90总均分、大部分SCL-90因子分、HAMA、HAMD、SAS及SDS评分的均分均高于健康对照组。HAMA、HAMD评定显示，在入院时40％的CHB和80％的HBC患者有明显焦虑症状，78％的CHB和87％的HBC患者有明显的抑郁。治疗8周后，两组患者的SCL-90总均分、大部分SCL-90因子分均显著下降。治疗6周后，两组患者的HAMA、HAMD、SAS及SDS评分的均分也显著下降。治疗8周后，5％的CHB和28％的HBC患者仍有明显焦虑，7％的CHB和36％的HBC患者有明显抑郁。基线和4次测评分均提示，HBC组比CHB组患者的心理症状严重。结论在CHB、HBC患者急性发作入院时和经临床治疗急性症状缓解后，两组患者自评、他评的心理症状均比健康对照组严重。HBC组比CHB组患者的心理症状更严重。对急性发作的CHB、HBC患者的躯体症状治疗8周后，其。心理症状也可改善，但并不能完全消除。

Eight-week follow-up of depressive and anxiety symptoms in patients with chronic hepatitis B,patients with hepatitis B cirrhosis and normal control subjects

Background： Patients with Chronic Hepatitis B （CHB） and Hepatitis B Cirrhosis （HBC） often have associated depressive and anxiety symptoms, but the relationship of these psychological symptoms to the course and severity of CHB and HBC remain unclear, Objective： Assess the changes in depressive and anxiety symptoms among patients receiving treatment for acute exacerbations of CHB and HBC. Methods： 71 patients with CHB and 75 patients with HBC were enrolled at the time of admission and followed during the subsequent eight weeks of treatment. These subjects and 65 volunteer control subjects were administered the 90-item Symptom Checklist （SCL-90） on enrollment and eight weeks later; they were also administered the Hamilton Anxiety Scale （HAMA）, the Hamilton Depression Scale （HAMD）, the Self-Rating Anxiety Scale （SAS） and the Self-Rating Depression Scale （SDS） at enrollment and two, four, six and eight weeks after enrollment. Results： In each group 60 subjects completed the study. At baseline the mean SCL-90 total score, most of the SCL-90 subscale scores and the mean scores for the HAMA, HAMD, SAS and SDS were all significantly higher in patients with CriB and HBC than in the control subjects. Based on the HAMA and HAMD results, 40% of CHB patients and 80% of HBC patients had clinically significant anxiety and 78% of CHB patients and 87% of HBC patients had clinical significant depression at the time of admission. In both patient groups total SCL-90 score and most of the SCL-90 subscale scores decreased significantly over the eight weeks of treatment; there was also a significant decline in the mean scores of the HAMA, HAMD, SAS and SDS over the first six weeks of treatment. After eight weeks of treatment 5% of CHB patients and 28% of HBC patients still had clinically significant anxiety and 7% of CHB patients and 36% of HBC patients still had clinical significant depression. At baseline and at all four follow-up assessments the severity of psychological symptoms was significantly greater in the HBC group than in the CHB group. Conclusion： Self-reported and interviewer-assessed psychological symptoms in patients with CriB and HBC are significantly more severe than in normal control subjects both at the time of acute exacerbations of the illness and after the acu~e symptoms have resolved. The psychological symptoms in HBC patients are more severe than those in CHB patients. Treatment of the physical symptoms of acute CHB and HBC over an eight-week period is associated with improvementbut not full resolution-of these psychological symptoms.