Clinical Characteristics And Mechanism Of Chronic Hepatitis B Patients With Depression And Insomnia

Objectives This study investigated the incidence of depression in patients with chronic hepatitis B(CHB)and sought to identify risk factors for depression and insomnia in these patients,focusing on changes in liver function and thyroid hormone levels.Methods 209 patients with CHB were enrolled in the Department of Infectious Diseases,The Affiliated Hospital of Qingdao University from June 2017 to May 2018.Each patient was inspected and evaluated by two specially trained medical staff.We used the Hamilton Depression Scale(HAMD)to assess depression and the Athens Insomnia Scale(AIS)to assess sleep.According to the degree of depression,patients were divided into CHB non-depression group,CHB sub-clinical depression group and CHB clinical depression group.According to the sleep situation,the patients were divided into CHB sleep normal group,CHB subclinical insomnia group and CHB clinical insomnia group.All patients recorded general information(gender,age,BMI,marital status,education level,duration of hepatitis B infection,smoking,alcohol consumption,blood pressure,blood glucose,etc.),and at the same time,all patients were tested for liver function,serum thyroid hormone levels(FT3,FT4,TSH),HBeAg and HBV-DNA load.Liver cirrhosis was evaluated by imaging(color Doppler ultrasound,CT).Finally,the multivariate logistic regression model was used to analyze the correlation between the above factors and depression and insomnia.Results A total of 209 CHB patients were eligible for inclusion in the study,including 139 males(66.5%)and 70 females(33.5%).Of the 209 subjects,150(71.8%)had no depression,50(23.9%)had subclinical depression and 11(5.3%)had clinical depression.Of 209 patients,112(53.6%)had normal sleep,23(11.0%)had subclinical insomnia and 74(35.4%)had clinical insomnia.Multivariate logistic regression analysis showed that the severity of depression and insomnia was correlated with the increase of TBil(>34?mol/L).ORs of high TBil in subclinical depression and clinical depression were 2.01(95%CI,1.501-3.027)and 3.02(95%CI,2.031-6.034),respectively.The OR of high TBil in clinical insomnia were 2.32(95%CI,1.321-5.033).The severity of depression and insomnia were significantly correlated with low FT3 level(<3.5 pmol/L).The OR of low FT3 level in subclinical depression and clinical depression were 3.07(95%CI,1.248-7.568)and 7.85(95%CI,1.839-33.547),respectively.The OR of low FT3 level in clinical insomnia was 3.91(95%Cl,1.417-10.789).Conclusion CHB patients are prone to depression and insomnia.Depression and insomnia in CHB patients may be related to serum TBil level and thyroid hormone level.Reduction of FT3 may be an important risk factor for psychological disorders in CHB patients.