乙型肝炎肝硬化失代偿期患者抑郁焦虑状态的影响因素及其对短期预后的影响

目的 探讨乙型肝炎肝硬化失代偿期患者抑郁、焦虑状态的影响因素,同时分析其对患者短期预后的影响。方法 选取2020年6月至2021年6月就诊于华中科技大学同济医学院附属协和医院的乙型肝炎肝硬化失代偿期患者206例为研究对象,病情稳定后即采用抑郁症筛查量表(PHQ-9)、广泛性焦虑障碍量表(GAD-7)对其抑郁、焦虑状态进行评价;根据3个月内随访结果将患者分成生存组(n=133)和死亡组(n=73),比较两组患者抑郁、焦虑评分差异,采用受试者工作特征(ROC)曲线分析抑郁、焦虑评分对乙型肝炎肝硬化失代偿期患者3个月内预后的预测价值。结果 206例乙型肝炎肝硬化失代偿期患者随访3个月,其中73例患者死亡,占比35.44%,其中死亡占比由高到低分别为抑郁合并焦虑、单焦虑、单抑郁、无抑郁和焦虑,组间比较差异有统计学意义(P<0.05)。谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBil)、清蛋白水平、凝血酶原时间、是否合并上消化道出血以及GAD-7、PHQ-9得分是影响乙型肝炎肝硬化失代偿期患者短期预后的影响因素(P均<0.05)。ROC曲线分析结果显示,PHQ-9量表和GAD-7量表得分对乙型肝炎肝硬化失代偿期患者短期预后预测的曲线下面积分别为0.784、0.840,敏感度分别为0.822、0.904,特异度分别为0.619、0.739。结论 乙型肝炎肝硬化失代偿期患者短期预后受多种因素影响,抑郁、焦虑情分对其短期预后有较高的预测价值。

Influencing factors of depression and anxiety in patients with decompensated hepatitis B cirrhosis and its effect on short-term prognosis

Objective To explore the influencing factors of depression and anxiety in patients with decompensated hepatitis B cirrhosis, and to analyze its impact on the short-term prognosis of patients.Methods A total of 206 patients with decompensated hepatitis B cirrhosis treated in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from June 2020 to June 2021 were selected as the research object. After the condition was stable, their depression and anxiety were evaluated by depression screening scale (PHQ-9) and generalized anxiety disorder scale (GAD-7). According to the follow-up results within three months, the patients were divided into survival group (n=133) and death group (n=73). The differences in depression and anxiety scores between the two groups were compared. The predictive value of depression and anxiety scores on the prognosis of patients with decompensated hepatitis B cirrhosis within three months was analyzed by receiver operating characteristic (ROC) curve.Results A total of 206 patients with decompensated hepatitis B cirrhosis were followed up for 3 months. Among them, 73 patients died, accounting for 35.44%. The death proportions from high to low were depression with anxiety, single anxiety, single depression, no depression and anxiety, respectively; there was significant difference between the groups (P<0.05). ALT, AST, TBIL, albumin level, prothrombin time, upper gastrointestinal bleeding, GAD-7 and PHQ-9 scores were the influencing factors on the short-term prognosis of patients with decompensated hepatitis B cirrhosis (P<0.05). ROC analysis showed that the AUC of PHQ-9 and GAD-7 in predicting the short-term prognosis of patients with decompensated hepatitis B cirrhosis was 0.784 and 0.840, respectively, with sensitivity of 0.822 and 0.904, and specificity of 0.619 and 0.739, respectively.Conclusions The short-term prognosis of patients with decompensated hepatitis B cirrhosis is affected by many factors, and depression and anxiety have high predictive value for the short-term prognosis.