| 1BACKGROUND AND OBJECTIVE Approximately one third of population worldwide has evidence of previous or current hepatitis B virus(HBV)infection,of which about 350 million are chronic HBV infection.HBV chronic infection may lead to chronic hepatitis B(CHB),liver cirrhosis and hepatocellular carcinoma.Nucleos(t)ide analogs(NUC)are a class of antiviral drugs for the treatment of CHB,which can effectively inhibit HBV replication in patients with CHB and improve their long-term prognosis.Currently,the studies about the quality of life,fatigue,and its related risk factors among CHB patients with NUC treatment are limited.Analyzing the severity of life quality and the severity of fatigue in patients with chronic hepatitis B in China,and evaluating the factors associated with the quality of life and fatigue,are beneficial to the clinical screening of high risk groups with low quality of life and high fatigue,to put forward targeted health education programs to improve patient quality of life,and to relieve their fatigue discomfort,increase treatment compliance.In this study,the quality of life and fatigue of patients with CHB were investigated,in order to analyze the related factors that affect the quality of life and fatigue.The changes of quality of life before and after the administration of nucleoside drugs and before and after treatment were analyzed.Hepatitis B patients with quality of life and fatigue,reasonable intervention in CHB patients with poor quality of life and severe clinical symptoms provide evidence-based evidence.2 SUBJECTS AND METHODS2.1 Subjects(1)Part I:Patients with CHB infection from a hospital in Guangzhou City from January 2016 to August 2016 were enrolled.Inclusion criteria:① age≥18 years;② patients understand and sign informed consent;③ HBsAg positive for more than 6 months;④ treatment baseline within 180 days,more than two weeks apart ALT elevated twice(>1×ULN);⑤ NUC treatment of CHB patients,nearly 6 months without IFN treatment ⑥ agreed to not receive IFN treatment during the study.Exclusion criteria(Subjects eligible for one of the following conditions were not eligible for inclusion in this study):① Imaging findings revealed suspicious nodules or AFP>50ng/mL;② Baseline medical evidence Support for decompensated liver disease;③ evidence of active liver disease due to other causes,including but not limited to HAV,HCV,HDV,HEV,HIV,autoimmune liver disease,etc;④ any serious or active other than hepatitis B Physical and mental illness;⑤into the study within 6 months before the application of other drugs affect the mental state of mind.(2)The second part:continuous enrollment from March 2010-July 2014 in a hospital in Guangzhou Infection outpatient clinic patients with chronic hepatitis B virus.Inclusion and exclusion criteria Ibid.2.2 Methods2.2.1 Research Tools(1)SF-36:SF-36 quality of life questionnaire is an internationally accepted universal quality of life test.The SF-36 is divided into 8 dimensions.Among them,physiological function,physiological function,somatic pain and general health are the four dimensions of the physiological quality of CHB patients.Vitality,social function,emotional function and mental health belong to 4 dimensions of psychological quality of CHB patients.The score range is 0-100 points.The higher the score,the better the quality of life of this chronic hepatitis B patient in this dimension.(2)Multi-dimensional fatigue scale MFI-20 assessment:MFI-20 assessment includes comprehensive fatigue,physical fatigue,activity reduction,power decline and mental fatigue,a total of five dimensions,5 grades.A higher score indicates a higher degree of fatigue.2.2.2 Survey methodDirect on-site investigation.After clinical staff trained,the patients were investigated on the spot.Patients fill out the questionnaire in a quiet investigation room,and to ensure that patients with chronic hepatitis B were investigated without any interference and hints.2.2.3 Quality Control(1)The research team includes 1 Master of Nursing tutor and 5 follow-up nurses.Before the survey,the research team members conducted a unified training to ensure that research team members grasp the entire investigation process,a clear implementation of the details of the questionnaire in the process,once found that the patient is immediately added to avoid the phenomenon.(2)Data recovery after rigorous examination,the questionnaire recovery and assessment were separately examined by two trained follow-up nurses at the same time.A total of 430 questionnaires were sent out in the survey,404 valid questionnaires were collected,and the effective recovery rate was 94%.Double entry of data,cross-check to ensure the accuracy of data entry.2.3 StatisticsContinuity variables were expressed as mean ± standard deviation(SD),and categorical variables were expressed as percentages.Serum HBV DNA expression was expressed as logarithmic units(log 10 IU/mL).χ2 test and t test were used to detect whether the two groups of data were statistically different.Statistical differences were defined as P<0.05(bilateral test).The data analysis and quality control program is SPSS for windows,version 13.0.3 RESULTS3.1 Clinical charactersiticsA total of 404 eligible patients were enrolled in this study,with 346(85.6%)male and 58(14.4%)female.The average age was 38.06 ±9.75 years,the average duration of CHB infection history was 13.91 ± 7.78 years,and the average duration of antiviral treatment was 6.56±4.11 years.3.2.Physiological Quality of Life in CHB PatientsAccording to the average physiological quality of life 79.18,which was divided into high physiological quality group(physiological quality>79.18)and low physiological quality group(physiological quality ≤ 79.18).Among them,the proportion of male and female in low quality group was 120:28,the proportion of male in high quality group was higher than that in low group,and the difference was statistically significant(χ2=4.191,P=0.041).The marital status of the two groups of patients was also statistically different:unmarried 37 people,married 102 people,divorced 9 people,compared with high group of 38 people were unmarried,212 married,2 divorced,the difference was statistically significant(χ2＝17.12,P<0.001).There were 110 patients with regular physical exercise,compared with 208 in the high group,the difference was statistically significant(χ2=3.861,P=0.049).At the same time,the data analysis showed that the proportion of cirrhosis in the low group was much higher than that in the high group(χ2=7.445,P = 0.015).We further analyzed the differences in the four dimensions of the physiological quality of life by four factors:gender,marital status,exercise,and cirrhosis.Statistical results showed that male patients in the physiological function and general health dimensions were significantly higher than female patients,and physiological function and physical pain was no significant difference.Similarly,for patients with divorced status,physiological,physiological,physical,and general health dimensions were all significantly lower than those of unmarried and married patients.Whether the patient has exercise habits on the physiological survival of patients also have an impact.Regularly exercised patients had a significantly higher quality of life in general health dimensions than those who did not exercise regularly.In patients with cirrhosis,the quality of life in patients with cirrhosis was significantly lower than that in non-cirrhotic patients.Unit correlation and multivariate correlation regression analysis showed that marital status and cirrhosis were independent factors affecting the physiological quality of life of patients with chronic hepatitis B.When the patient is in a divorced state or diagnosed with cirrhosis,its physiological quality of life is significantly reduced.3.3 Psychological Quality of Life in CHB PatientsAccording to the average psychological quality of patients was 73.43,which was divided into high psychological quality group(psychological quality>73.43)and low psychological quality group(psychological quality≤73.43).Among them,the proportion of male patients(134/167)in the low-quality group was significantly lower than that in the high-quality group(208/232),the difference was statistically significant(χ2=7.030,P=0.008).In the low-quality group,the proportion of patients with low education was higher than that of the high-quality group(χ2=10.829,P=0.004).Low-quality patients and high-quality patients in the exercise habits are also different.There were significant differences between the two groups.For low-quality patients,the proportion of cirrhosis in the low-quality group was significantly higher than in the high-quality group(55/167 vs 45/232),and the difference between the two groups was statistically significant χ2=10.051,P=0.002).There was also a significant difference in antiviral duration between the two groups:the antiviral duration of the low-quality group was shorter,which was 5.99± 3.77 years,which was statistically significant(t=2.149,P=0.032)compared with the high-quality group.We further analyzed the differences in the four dimensions of psychological quality of life,such as gender factors,educational status,exercise situation and whether or not cirrhosis.The statistical results showed that the dimensions of the dimension and emotional function of male patients were significantly higher than those of female patients.For patients with regular exercise,exercise habits in patients with mental dimensions and mental health dimensions were significantly higher than those who did not exercise.For patients with primary education and below,only the energy dimension is statistically different.There was significant difference in the intensity dimension and the social function dimension between the patients with liver cirrhosis and the patients with non-cirrhosis.The results of unit correlation analysis and multivariate correlation analysis showed that the educational status and antiviral duration were independent factors affecting the psychological quality of life of patients.Low degree of education and low antiviral duration of patients,the emergence of low psychological quality of life the greater the possibility.3.4 Fatigue in CHB PatientsThe average fatigue score of the patients was 47.34,which was divided into fatigue group(psychological quality>47.34)and non fatigue group(psychological quality<47.34).Among them,the proportion of male patients(164/201)in the fatigue group was significantly lower than that in the non fatigue group(182/203),the difference was statistically significant(χ2=5.340,P=0.021).In the fatigue group,there were 147 patients(147/201)who had regular physical exercise,which were significantly lower than those in the non-fatigue group(175/203),the difference was statistically significant(χ2=10.669,P=0.001).In addition,the height of the fatigue group was significantly lower than that of the non fatigue group(166.84±6.26 vs 168.90±6.53,t=3.217,P=0.001)and the body weight was significantly lower than that in the non fatigue group(61.97±10.01 vs 65.31±10.13,t=3.140,P=0.002).Female patients were significantly higher in the three dimensions of physical fatigue,mental fatigue and decreased power than in male patients.For patients with regular exercise,patients with exercise habits in the comprehensive fatigue,physical fatigue and activity to reduce the three dimensions of the fatigue score was significantly lower than no exercise habits of patients.But the regular exercise does not affect the fatigue score of mental retardation and mental fatigue in three dimensions.Unit correlation analysis and multivariate correlation analysis showed that height and regular exercise habits were independent factors affecting the patient’s fatigue.The greater the likelihood of fatigue in a patient with shorter and irregular exercise habits.3.5 The relationship between fatigue and quality of life in CHB patientsThe average fatigue score of patients with high physiological quality of life was 41.91 points,and the average fatigue score of patients with low quality of life was 56.18 points,the difference was statistically significant(t = 12.253,P<0.001).Patients with low quality of life had significantly higher levels of fatigue than those with high quality of life.In the quality of life,the average fatigue score was 41.23 in low psychological quality of life group and 55.25 in high psychological quality of life group,the difference was statistically significant(t = 12.326,P<0.001).Patients with low psychological quality of life were significantly more fatigue than those with high quality of life.Physiological quality of life scores were negatively correlated with fatigue scores(r =-0.639,P<0.001).Patients feel more tired,the lower the quality of life.By the same token,the score of mental quality of life was negatively correlated with fatigue score(r =-0.655,P<0.001).The lower the patient’s sense of fatigue,the higher the quality of psychological life.3.6 The relationship between quanlity of life and antiviral treatment in CHB patientsAfter 96 weeks of antivirus,the physiological quality of patients increased,the physiological function increased from 92.13 ± 10.58 to 94.91±7.11(P = 0.005),and the physiological function,somatic pain and general health increased from 71.76±4.01 and 82.85 ± 12.88,53.52 ± 16.79 to 81.94 ± 24.96(P = 0.011),87.72± 8.64(P = 0.001)and 59.63 ± 14.59(P<0.001).However,after vitality and social function and emotional function of patients with anti-virus and information after 96 weeks,no significant improvement compared with the previous.The quality of life of patients after discontinuation was compared with that before discontinuation,with only physiological function(P = 0.008),general health(P = 0.002)and mental health(P = 0.043)increased after stopping treatment with statistically significant differences.Multivariate correlation analysis suggested that marital status was the only factor influencing the quality of life of antiviral therapy(P = 0.02).4 CONCLUSION4.1 The quality of life of patients with CHB was at a moderate level.(1)Patients with eclampsia had poor quality of life.In clinical practice,we should pay more attention to patients who are divorced and encourage them to participate more in social activities so as to fully understand their own disease conditions and reduce errors beyond the assessment of the severity of their illness.Encourage patients to exercise regularly.Focus on the liver symptoms and complications of patients with cirrhosis Care,comfort patients actively face the disease,intervention in patients with treatment compliance,reduce the occurrence and development of complications.(2)Patients with low education and short anti-virus life experience poorer quality of life.For CHB patients with low education and initial NUC treatment,their quality of life should be monitored and disease-related health guidance provided.Emphasis should be placed on the need for regular treatment to avoid unintended discontinuation or depression.4.2 CHB patients were at a moderate level of fatigue.Patients with lower height and irregular exercise experienced more severe fatigue.We can help patients develop a specific exercise program,to carry out sustained walking,jogging,swimming and other sports step by step.4.3 CHB patients with fatigue levels will affect their quality of life conditions.The higher the fatigue score,the lower the quality of life.Therefore,We should reduce or avoid the incentive to increase the patient’s fatigue in order to improve the quality of life.4.4 Antiviral treatment can effectively improve the quality of life of patients.Antiviral treatment are generally effective in improve patients’ physiological,but can not effectively improve the psychological quality of life of patients;After stopping the medicine,it is beneficial to improve the quality of life in three dimensions of physiological function,general health and mental health.For patients with chronic hepatitis B treated with nucleotide drugs,attention should be paid to their psychological quality changes and changes in fatigue;for patients with chronic hepatitis B after discontinuation,the ongoing monitoring of viral load and changes in liver function,prevention Recurrence at the same time,but also need to give timely psychological intervention to ease fatigue. |
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