Watchful waiting: role of disease progression on uncertainty and depressive symptoms in patients with chronic hepatitis C.
Watchful waiting: role of disease progression on uncertainty and depressive symptoms in patients with chronic hepatitis C.
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注意等待：疾病进展对慢性肝炎患者不确定性和抑郁症状的作用。
DOI：
10.1111/jvh.12207
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发表时间：
2014-10
影响因子：
2.5
通讯作者：
Lai M
中科院分区：
文献类型：
--
作者：
Colagreco JP;Bailey DE;Fitzpatrick JJ;Musil CM;Afdhal NH;Lai M
治疗丙型肝炎的新疗法正在迅速涌现，提供者建议选定的患者推迟治疗，并选择“警惕等待”。在警惕的等待期内，患者被证明有较高的疾病不确定性和抑郁症发生率。我们试图回答这样一个问题，即令人放心的组织学数据(显示随着时间的推移，纤维化轻微或无纤维化进展)是否与较少的疾病不确定性和抑郁症状相关。这是一项单中心门诊前瞻性队列研究，旨在确定观察等待后患者的纤维化阶段、纤维化进展和推迟治疗的原因是否与疾病不确定性和抑郁症状有关。疾病不确定性与抑郁症状显著相关(r=0.49，p<；0.01)。超过一半的参与者(54%)有中等程度的不确定性。约40%的参与者有临床抑郁症的风险(21.7%为轻度至中度风险，18.5%为高风险)。与治疗失败或干扰素不耐受或不合格的受试者相比，治疗天真的受试者在CES-D(抑郁症状测量)和MUIS-A(疾病不确定性测量)总分、MUIS-A模糊性分量表和MUIS-A不一致性分量表上的平均得分都较低。令人惊讶的是，肝纤维化的分期和进展与总体疾病不确定性或抑郁症状没有显著相关性。处于警觉等待状态的慢性丙型肝炎患者患重大疾病、不确定和抑郁症状的风险很高。令人放心的组织学数据似乎与较少的不确定性或抑郁症状无关。
New therapies for HCV are rapidly emerging and providers are advising select patients to defer treatment and elect “watchful waiting.” During the watchful waiting period, patients have been shown to have high rates of illness uncertainty and depression. We sought to answer the question of whether reassuring histological data (showing minimal fibrosis or no fibrosis progression over time) is associated with less illness uncertainty and depressive symptoms. This was a single-center outpatient prospective cohort study to determine whether stage of fibrosis, fibrosis progression, and reasons for treatment deferral were related to illness uncertainty and depressive symptoms in patients following watchful waiting. Illness uncertainty was significantly related to depressive symptoms (r = 0.49, p<0.01). More than half of the participants (54%) had moderate levels of uncertainty. About 40% of the participants were at risk for clinical depression (21.7 % at mild to moderate risk and 18.5% at high risk). Treatment naïve subjects had lower mean scores on both the CES-D (depressive symptoms measure) and the MUIS-A (illness uncertainty measure) total score, MUIS-A Ambiguity sub-scale and MUIS-A Inconsistency sub-scale than subjects who failed treatment or were interferon intolerant or ineligible. Surprisingly, liver fibrosis stage and progression were not significantly associated with overall illness uncertainty or depressive symptoms. Patients with chronic hepatitis C on watchful waiting are at high risk for significant illness uncertainty and depressive symptoms. Reassuring histological data does not seem to correlate with less uncertainty or depressive symptoms.
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