核苷(酸)类似物抗病毒治疗对慢性乙型肝炎患者焦虑和抑郁状态的影响

目的 探讨核苷(酸)类似物抗病毒治疗对慢性乙型肝炎患者的焦虑和抑郁状态的影响,并分析其影响因素.方法 用中文版焦虑自评量表(SAS)和抑郁自评量表(SDS)测量核苷(酸)类似物抗病毒治疗的120例慢性乙型肝炎患者治疗前、治疗1年和治疗2年时的焦虑和抑郁状态.记录患者的人口学资料,并定期检测患者的ALT和HBV DNA等指标.计数资料采用x2检验,计量资料采用t检验、单因素方差分析,多因素Logistic回归分析.结果 慢性乙型肝炎患者抗病毒治疗前、治疗1年、治疗2年的SAS、SDS平均得分随抗病毒治疗时间的延长而降低(F=12.661、22.395,均P＜0.01).治疗前、治疗1年、治疗2年时SAS、SDS得分大于50分的患者分别为5.8％、4.2％、1.7％和13.3％、7.5％、5.0％.治疗2年时,HBV DNA转阴和未转阴的患者,焦虑改善率分别为69.0％、22.2％(x2 =22.325,P＜0.01)；抑郁改善率分别为77.4％、22.2％(x2＝32.179,P＜0.01).多因素Logistic回归分析显示,与HBV DNA未阴转的患者相比,阴转的患者焦虑、抑郁改善的比值比(OR)及其95％可信区间(CI)分别为7.751 (3.026～19.853)、15.069(5.309～42.770)；与ALT未复常的患者相比,ALT复常的患者抑郁改善的OR值及其95％CI为4.103(1.376～12.238).结论 核苷(酸)类似物抗病毒治疗能改善慢性乙型肝炎患者的焦虑和抑郁状态.HBV DNA阴转是焦虑和抑郁改善的独立影响因素.

The impact of nucleos(t)ide analogue antiviral therapy on anxiety and depression of patients with chronic hepatitis B

Objective To explore the impact of nucleos(t)ide analogue antiviral therapy on anxiety and depression of patients with chronic hepatitis B (CHB),and analyze the related factors.Methods Before nucleos(t)ide analogue antiviral therapy,1 year and 2 years after antiviral therapy,120 CHB patients were investigated with self-rating anxiety scale (SAS) and self-rating depression scale (SDS).The demography data of patients were collected.Serum levels of alanine transaminase (ALT) and hepatitis B virus (HBV) DNA and other biochemical indicators were measured regularly.Results Before nucleos(t)ide analogue antiviral therapy,1 year and 2 years after antiviral therapy,both the mean scores of SAS and SDS became lower gradually (F=12.661 and 22.395,respectively;both P＜0.01).The percentage of patients with SAS and SDS scores more than 50 were 5.8％,4.2％,1.7％ and 13.3％,7.5％,5.0％,respectively.After 2 years of therapy,the anxiety improvement rate of the patients obtained HBV DNA＜1000 copy/mL was 69.0％,while those with HBV DNA≥1000 copy/mL was 22.2％ (x2 =22.325,P＜0.01).Meanwhile,after 2 years of therapy,the depression improvement rate of the patients obtained HBV DNA＜1000 copy/mL was 77.4％,while those with HBV DNA≥1000 copy/mL was 22.2％ (x2 =32.179,P＜0.01).Multiple factors Logistic regression analysis indicated that the odds ratios (OR) of improvement of anxiety and depression in patients with HBV DNA＜1000 copy/mL were 7.751 (95％ CI:3.026-19.853) and 15.069(95％ CI:5.309-42.770),respectively,compared with those with HBV DNA≥1000 copy/mL; and OR of improvement of depression in patients with ALT≤40 U/L waa 4.103 (95％ CI: 1.376 - 12.238).Conclusions Nucleos(t) ide analogue antiviral therapy could improve the anxiety and depression of CHB patients.The HBV DNA negativity is the independent impact factor of improvement of anxiety and depression in CHB the patients.