The Impact Of Nucleos(T)ide Analogue Antiviral Therapy On Anxiety And Depression Of Patients With Chronic Hepiatitis B

Backgroung and ObjectiveChina is the high endemic area of Hepatitis B virus (HBV) infection.According to the epidemiologcal investigation in China at2006,the positive rate of HBsAg is7.18%among1to59years population. The infection of HBV could cause hepatitis,liver cirrhosis, hepatocellular carcinoma and other severe liver diseases,and the infection of HBV impacts psychological factor of patients,for example anxiety and depression and so on. The patients with hepatitis B are discriminated in their working and life.All the factors may bring about some psychological diseases.With the new biomedical model being introduced, psychological factors become more and more important in patients’life. Studies have been shown that the progress of the HBV related diseases could become slow through antiviral therapy, improve the prognosis. The studies of the quality of life of the patients with chronic hepatitis on antiviral therapy, mainly focus on the patients who are related to interferon antiviral therapy.While we haven’t seen the report that the effects of Nucleoside analogues antiviral therapy on anxiety and depression of the patients with chronic hepatitis b.This study make up for the vacancy.The aim of this study is to measure psychological factor of patients with chronic hepatitis B using self-rating anxiety scale(SAS)and self-rating depression scale(SDS),and to explore the the impact of Nucleos(t)ide Analogue antiviral therapy on anxiety and depression of patients with chronic hepatitis B, and analysed the related factors.Methods1. The object of this study was the patients with hepatitis B Who will accept the therapy of Nucleos(t)ide Analogue.The diagnosis of all the patients were consistent with Chronic Hepatits B:Update2005.2. All the patients will be more than18and the level of educatoin will be no less than primary school,who would do verbal and written communtication and informed consent.3.Excluding the infection of hepatitis c;autoimmune hepatitis;drug leading to the hepatitis;fatty hepatitis;liver cirrhosis;having the diease of psychology;malignant tumor;the women of pregnancy or lactation. All the patients signed the contract of agreement.4.The patients were guided to fill in the scale with unified language by special messengers,if the patients with lower education level couldn’t comprehend it,the investor could explain but couldn’t induce.5.All the patients were invested regularly every3months,and measured liver function and serological markers of virus,and the patients filled in the SAS SDS at the beginning of therapy, after1year treatment,2years treatment.6.The score of scale was between25and100, the score was more than50being seen in patients with anxiety or depression,then compared with normal scale score.7.SPSS13.0software was used to do the statistical analysis.The numeration data tested by chi square, measurement data was expressed by x±s and tested by t-test or completely trabant mono-factor analysis of variance;or redundancy tested data chi square.Results1. The total number of the patients was120,including110men and10women.The level of education:60patients whose education levels were no higher than middle school,and39patients whose education level was special course of study,and21patients’were others.The age of the patients were among19and69,the mean was(40.82±11.38)years.The number of the patients of HBeAg positive was106,and the other were HBeAg negative.29patients had been treated by interferon,and18patients had been treated by Nucleos(t)ide Analogue,19patients had been theapyed by interferon and Nucleos(t)ide Analogue,54patients hadn’t been treated.The base level of alanine aminotransferase (ALT) of all the patient is (104.35±94.94) U/L;the HBVDNA load was(6.41±1.25)lgcopies/ml.2. The recovery rate of all the questionnaires was100%.3.Before Nucle s(t)ide Analogue antiviral therapy,the mean score of SAS was higher than domestic norm,(39.31±6.98) vs.(33.82±5.90)(t=8.619,P<0.0001);the mean of SDS was no higher than domestic norm (42.11±8.97) vs.(41.88±10.57)(t=0.286,P=0.775).4.Before Nucleosid(t)e Analogue antiviral therapy and after1year antiviral therapy and2years,the mean score of SAS,SDS was(39.31±6.98) vs.(37.40±7.37) vs.(35.99±7.52),(42.11±8.97) vs (38.42±8.57) vs.(37.06±8.13),the score became lower when antiviral therapy went on (F=12.661,22.395,all P values <0.0001). Before Nucleos(t)ide Analogue antiviral therapy and after1year and2years,the percent of the score of SAS,SDS which was more than50was5.8%,4.2%,1.7%;13.3%,7.5%,5.0%.5.After2years therapy,the mean score of SAS,SDS was lower than before, the patients of HBVDNA<1000copies/ml descended(5.67±8.02),(7.69±10.33),the patients of HBVDNA≥1000copies/ml was (-2.15±6.08),(-1.11±7.18),the t value was-5.839(P<0.0001),-5.355(P<0.0001). After2years therapy, the anxiety improvement rate of the patients of HBVDNA<1000copies/ml was69.0%,the patients of HBVDNA≥1000copies/ml was22.2%,x2=22.325, P<0.0001;After2years therapy, the depression improvement rate of the patients of HBVDNA<1000copies/ml was77.4%. the patients of HBVDNA≥1000copies/ml was22.2%, x2=32.179, P<0.0001. After2years therapy, the anxiety improvement rate of the patients of ALT≤40U/L was59.1%, the patients of ALT>40U/L was40.7%, x2=2.862, P=0.091. After2years therapy, the depression improvement rate of the patients of ALT≤40U/L was67.7%, the patients of ALT>40U/L was37.7%,x2=8.280,P=0.004;After exclusing the other factors, analysed the impact factor on the improvement of anxiety and depression through multiple factors logistic regression analysis, the results was after2years therapy, the OR value of HBVDNA<1000copies/ml was7.751(3.026,19.853),15.069(5.309,42.770), the OR value of ALT≤40U/L was1.804(0.675,4.825),4.103(1.375,12.238)ConclusionNucleos(t)ide Analogue antiviral therapy could improve the anxiety and depression of patients with chronic hepatitis B.The negativity of HBVDNA was the independent impact factor on improvement of chronic hepatitis B of anxiety and depression.