| [BACKGROUND] Hepatitis B virus (HBV) infection is a serious global health problem. According to the World Health Organization report, there were 4 billion people infected with HBV worldwide and 1 million people per year died by chronic hepatitis and the related diseases. Approximately 15-40% of HBV infected patients will develop cirrhosis, liver failure, or hepatocellular carcinoma. China is one of the high endemic areas of the hepatitis B. According to the latest epidemiological statistics data, the positive Rate of HBsAg for the general population in china was 7.18% and in some areas of China was more than 8%.The disease burden caused by chronic hepatitis B includes not only impairment in health status and mental status, but also enormous economic expenses. Hu Min, et al found that the total annual cost per patient for CHB was US＄1636 in Beijing and US＄1452 in Guangzhou. Health-related quality of life (HRQOL) of chronic hepatitis B patients decrease obviously. Yao Guang bi, et al found that Patients with chronic hepatitis B have significant improvement in quality of life after treatment with lamivudine. Li Wenwen, et al indicated HRQOL of patients with liver cirrhosis was impaired obviously and could be improved by short-term treatment.[OBJECTIVE] Now, entecavir (ETV) and adefovir (ADV) are nucleoside analogues which can inhibit HBV replication, control the progress of liver inflammation, and delay disease progression. The aim of this study is to explore the effect of the treatment of entecavir or adefovir on health-related quality of life (HRQOL) in chronic hepatitis B patients and analyze factors associated with improvement of HRQOL with the short-form 36 (SF-36) health survey. [METHODS] 120 chronic hepatitis B patients were randomized divided into two groups:group ETV (60 patients, ETV 0.5mg/d) and group ADV (60 patients, 10mg/d). The general information of all patients, the data of liver function, indexes of hepatitis B virus were collected at baseline, and week 24,48 during treatment. All patients completed the SF-36 assessments at baseline and week 24,48 during treatment. The HRQOL were compared between before and after the treatment to assess the effect by analysis of variance for repeated measures Data. The differences in value of all the domains of SF-36, Physical Component Summary (PCS), Mental Component Summary (MCS), and the total score of SF-36 between baseline and week 48 during treatment were set as dependent variable. Age, gender, household register, level of education, ALT at 48 weeks of treatment, HBV DNA at 48 weeks of treatment were set as independent variable. Factors associated with HRQOL were evaluated by univariate analysis and multivariate analysis.[RESULTS] Except Bodily pain (BP) and Mental Health(MH), the scores of other domains of SF-36 in chronic hepatitis B significantly decreased than that of healthy people at baseline. For both of patients treated with entecavir and adefovir, except Bodily pain (BP), the scores of other domains and the total score of SF-36 were statistically increased from baseline,24 weeks and 48 weeks (P<0.05) and the improvement of HRQOL mainly concentrated in mental components. Non-parametric tests showed that at 48 weeks of treatment the improvement rate of HRQOL was statistically different between HBV DNA negativity group than HBV DNA positive group in the following domains:BP (T=-0.259, P=0.010), General Health (GH) (T=-2.246, P=0.025), VT (T=-2.443, P=0.015), SF (T=-3.252, P=0.001), MH (T=-3.351, P=0.001), PCS (T=-2.567, P=0.010), MCS (T=-3.560, P=0.000), the total score (T=-3.433, P=0.001). Univariate analysis discovered that HBV DNA negativity was associated with the increase of score of the single domains including Vitality(VT,χ2=8.1, P=0.00), Social Functioning (SF,χ2=6.0, P=0.01), Mental Health (MH,χ2 =6.1, P=0.01), and PCS (χ2=4.8, P=0.03) and MCS (χ2=7.9, P=0.01). The improvement rate of the total score of HRQOL at 48 weeks of treatment was statistically higher in HBV DNA negativity group than in HBV DNA positive group (83.8% vs 63.0%,χ2=6.6, P=0.010).Logistic regression showed HBV DNA negativity was independent factor associated with improvement of HRQOL which mainly concentrated in mental components:VT(P=0.002, OR=4.022,95%CI:1.675～9.661); SF (P=0.016, OR=2.694,95%CI: 1.207～6.013); MH (P=0.020, OR=2.576,95%CI: 1.157～5.733); PCS (P=0.020, OR=2.993,95%CI:1.192～7.517); MCS (P=0.005, OR=3.901,95%CI: 1.519～10.018); the total score (P=0.007,OR=3.665,95%CI: 1.416～9.488).[CONCLUSION] HRQOL of chronic hepatitis B significantly decreased than that of healthy people. HRQOL of chronic hepatitis B patients can be significantly improved by antiviral treatment with nucleoside analogues. HBV DNA negativity was independent factor associated with improvement of HRQOL. |
PDF Full Text Request