The Research Of Prevalence Trends And The Quality Of Life And Related Factors In Patients With Chronic Hepatitis B

Hepatitis B virus infection were distributed worldwide, 2 billion people who have been infected, and about 0.35 billion people are in chronic infected state. China has a high incidence of hepatitis B, the situation is more serious, about 0.7 billion people who have been infected, 0.13 billion are in chronic infected state, and its incidence is rising every year. Limited to the current medical standards can not effectively eliminate hepatitis B virus, resulting in refractory protracted duration state and its curative effects are difficult to evaluate by the cure rate or survival. Therefore, on the depth excavating the previous incidence information, getting hold of the pathogenesis, improving the forecast accuracy, establishing the scientific preventive measures, a comprehensive evaluation of the curative effects in patients with chronic liver disease has become urgent problems. Clinical indicators such as physiological, biochemical test results, the cure rate and other indicators have not fully reflected the impact of disease on patients. These indicators reflect poorly to the actual functional status of patients and their feelings of personal health. The effects of persistent disease in patients with physical and mental health are very large, but the quality of life assessment is focused on the subjective feelings of patients, and more fully reflect the health status of patients. The purpose of the study is that establish mathematical models to improve the prediction accuracy of incidence of hepatitis B in Shijiazhuang City. At the same time, we evaluate of the patients'quality of life with chronic hepatitis B, find the relevant factors including the gene level factors, and find the interaction of factors which will be conducive to clinical for comprehensively improving the quality of life of patients.Part One: Application of Mathematical model in the Incidence trends and forecasting research of hepatitis B from 1999 to 2009 in Shijiazhuang city Objective: To establish the incidence of hepatitis B prediction model, and provide the according basis for future preventive measures.Methods: Hepatitis B epidemic from 1999 to 2009 in Shijiazhuang City was analyzed, mathematical model was established by using dynamic series method, regression analysis, ARIMA model, and then predicts the incidence rate in 2010.Results: The dynamic model, regression model, ARIMA (autoregressive integrated moving average) model predict the incidence of hepatitis B in Shijiazhuang City in 2010 was respectively 82.28/100000, 111.78/100000, 69.01/100000 . In order to evaluate the model, using the model forecast from 1999 to 2009, the incidence of ARIMA model results coincide with the original level of incidence of the best.Conclusion: the Incidence trend of hepatitis B is rising since 1999 in Shijiazhuang city. Compared the dynamic model, regression model and ARIMA model, ARIMA model is well fitted of predicted incidence with original incidence and the predicted incidence of hepatitis B was 69.01/100000 in Shijiazhuang City in 2010. The model can work as a mathematical model to predict and estimate the incidence of hepatitis B, and provide the according basis for future preventive measures.Part Two: The study of the quality of life and screening related factors in patients with chronic hepatitis BObjective: To assess the quality of life in patients with chronic hepatitis B status, to compare the epidemiological characteristics of the difference in the quality of life, to find out the quality of life changes in before and after clinical treatment, to evaluate the effect to QOL of different clinical measures, to screen the related factors to QOL of patients with chronic hepatitis B.Methods: Collection of 430 hospitalized patients diagnosed with chronic hepatitis B, with patients self-administered way, fill in the self-compiled epidemiological questionnaire by the topic organizing committee, the American Medical Outcome Study Group developed a universal SF-36 scale, Kunming Medical College developed QLICD-CH (V1. 0) Quality of Life scale for patients with chronic hepatitis, and record the patient's course of disease, family history, hospitalization time, height, weight, liver function and hepatitis B five test results, HBVDNA, chronic illness, combined with other disease conditions, using treatment methods and so on.Results: Totally distributed 430 questionnaires, returned 407 questionnaires, 407 were valid. SF-36 scale survey found that: Compared with the norm, scores of chronic hepatitis B patients were all lower in each dimension. P values were all less than 0.001.Reduced the most degree is RP dimension, the smallest is VT dimension. Compared with the norm, reduction ranges is between 11 ~ 29%. Sex, age, education, personality, personality types, emotional stability, employment, alcohol, severity of illness, social skills after illness, the ability to work after illness, past hospitalization and combined other disease total of 13 characteristics, the quality of life SF-36 scale scores respectively showed different dimension of difference. The difference between maximum mean score and minimum is 58.6 score in RP dimension of different ability to work after illness. QLICD-CH (V1. 0) scale survey found: five functional areas all in 70 scores around; IND side score is the highest (77.3±22.2) of ten small sides, AAS side score lowest (58.4±27.2). After clinical treatment, the five functional areas of QLICD-CH (V1. 0) scale, SOD area score was reduced, the remaining areas scores were increased. The ten small sides, AAS, SSS sides scores decreased, and the remaining sides increased. Four functional areas(PHD,SOD,SPD,TOT) and eight small sides'(IND,PHS,REC,ANX,DEP,SEC,SSS,SOE) scores improved after antiviral therapy, three functional areas(PSD,SPD,TOT) and eight small sides'(IND,PHS,REC,ANX,DEP,SEC,SSS,SOE) scores increased after hepatoprotective drugs treatment, three functional areas(PSD,SPD,TOT) and five small sides'(PHS,REC,ANX,SEC,SOE) scores rose after eliminating jaundice drugs treatment, three functional areas(PSD,SPD,TOT) and five small sides'(IND,REC,ANX,SEC,SOE) scores went up after supportive treatment. Balancing the difference of before treatment, the anti-viral treatments improved four functional areas(PHD,SOD,SPD,TOT) and three small sides'(IND,REC,SSS), other treatments didn't find the difference. The screening impact factors to quality of life in all dimensions and areas of patients with chronic hepatitis B by multiple linear regressions were different and so on and so forth. The most frequency factors are personality, severity of illness, liver function, family economic, social skills after illness, ability to work after illness, and sex. Extraverted personality, better family economic, free impactive of social skills and ability to work after illness were prefect factors to QOL, severity of illness, extremely high liver function were risk factors.Conclusion: 1.Patients with chronic hepatitis B have overall lower quality of life. 2.There were 13 characteristics had significant difference in QOL. 3.Compared before and after clinical treatment, SOD, AAS, SSS scores decreased, indicating that the family and social roles of patients, the impact of psychological stress is more prominent than before treatment, and the current clinical treatment measures have not changed great, so we suggest that pharmacological treatment of patients, while strengthening the care of family and society and psychological counseling, which would be more greatly improve their quality of life, beneficial to the treatment and prognosis of patients.4. Anti-viral treatments can improve QOL of hepatitis B patients. 5. Extraverted personality, better family economic, free impactive of social skills and ability to work after illness were prefect factors to QOL while severity of illness, extremely high liver function were risk factors.Part Three: The study of the relation between ACE, DRD4 gene polymorphism and chronic hepatitis B patients'QOLObjective: To study the relationship between the ACE gene insertion/deletion (I/D) polymorphism and the dopamine D4 receptor (dopamine D4 receptor, DRD4) gene 48bp variable number tandem repeats (variable number tandem repeat, VNTR) polymorphism with the QOL of chronic hepatitis B.Methods: Using polymerase chain reaction PCR to detect ACE gene, DRD4 gene polymorphisms of 407 cases of chronic hepatitis B patients, 162 cases of healthy control people, and 92 cases of asymptomatic hepatitis B carriers, and to compare their allele frequency and genotype. The ACE genotype divided into two groups (I/D genotype and DD genotype were combined into one group), DRD4 genotype was divided into two groups of long sequences and short sequences. To compare the QOL of chronic hepatitis B patients in different ACE and DRD4 genotype.Results: ACE allele frequency, chronic hepatitis B:Ⅰ53.7%, D 46.3%, the genotype frequencies were:Ⅱ12.7%, ID82.2%, DD5.2%, Hardy-Weinberg equilibrium testχ2=162.95, P=0.000; healthy control group:Ⅰ62.7%, D 37.3%, the genotype frequencies were:Ⅱ39.4%, ID46.7%, DD13.9%, Hardy-Weinberg balance testχ2=0.013, P=0.909; asymptomatic carry group:Ⅰ52.7%, D 47.3%, the genotype frequencies were:Ⅱ27.2%, ID51.1%, DD21.7%, Hardy -Weinberg equilibrium testχ2=0.010,P=0.920. Comparison of three ACE genotypes,χ2= 90.698, P=0.000, three ACE genotype distribution have significance, Multiple comparison : The control group compared with the asymptomatic carriers of hepatitis B,χ2=4.906, P=0.086, no significant difference; All compared with chronic hepatitis B hepatitis group, the chi- square values were 71.831 and 44.000, P values were 0.000,0.000, differences were statistically significant. DRD4 gene detected 2*2, 3*3, 4*4, 2*4, 2*5, 4*5, 2*7 of 7 genotypes, DRD4 4*4, the highest frequency, three groups were 64.0%, 66.4%, 69.0%, compared three groups of genotypeχ2=14.068, P=0.296, no statistically significant difference. ACE, DRD4 gene polymorphisms have no significant difference in all clinical and epidemiology features. PF and RE dimension scores in SF-36 scale have significant difference in ACE genotype. II genotype was higher 8.4, 15.2 points than I/D + DD genotype on average. PSD, SPD, TOT functional areas quality of life scores in QLICD-CH (V1.0) scale have statistically significant difference. II genotype were higher 7.1, 4.5, 4.4 points than I/D+DD genotype on average. Only BP dimension scores in SF-36 scale was significantly different in DRD4 genotype, short repeat sequences were higher 12.2 points on average. Five functional areas'quality of life scores have no statistically significant. ACE genotypes score changes after treatment only IND have significant, II genotype and I/D+DD genotype had increased after treatments, II genotype increased rate more than I/D+DD genotype , and the difference was 7.5 points. DRD4 genotypes score changes after treatments have no statistically significant.Conclusion: 1.ACE gene polymorphism may be related to the prevalence of chronic hepatitis B, ACE gene deletion (D) type may increase the risk of chronic hepatitis. DRD4 gene polymorphism and the prevalence of chronic hepatitis B was no correlation. 2. QOL of ACE II genotype were higher than I/D+DD genotype and DRD4 short repeat sequences gene genotype were higher than long's . 3. After treatment quality of life in ACE II genotype was higher than ID+DD genotype a large extent. The difference changes in the quality of life after treatment was not found in DRD4 genotype.Part Four: The interaction of related factors to quality of life in patients with chronic hepatitis BObjective: To explore the interaction of ACE, DRD4 gene polymorphism and related factors to quality of life in chronic hepatitis B patients.Methods: Application the factorial design statistical analysis to explore the interaction of the ACE, DRD4 gene and the epidemiology, clinical characteristics to quality of life in chronic hepatitis B patients.Results: ACE genotype has interaction with alcoholism, illness, smoking to quality of life scores of chronic hepatitis B patients. ACE genotype has interaction with alcohol to GH dimension, SOD area, and SOE side quality of life score. Drinking decreased GH, SOD, SOE mean scores by 19.6, 19.0, 29.5 points to II genotype, while the ID+DD genotype fell 0.3, 1.6, 3.9 points. The interaction between ACE genotype and severity illness was found in PHD area and IND side. Severe and severe disease decreased PHD, IND mean scores by 16.2, 18.5 points to ID+DD genotype, while the II genotype had increased by 6.4, 12.2 points. ACE genotype has interaction with smoking to VT dimensions score, smoking decreased VT dimensions score by 2.8 points to ID+DD genotype, while the II genotype but increased by 10.9 points. DRD4 genotype was not found the interaction with other factors.Conclusion: ACE genotype has interaction with alcoholism, illness, and smoking. 1. Drinking can quickly reduce the quality of life to II genotype. 2. As the disease increased, the quality of life decreased to ID+DD genotypes, II genotype but increased. 3. Smoking reduced the quality of life to ID + DD genotype, II genotype but increased.