Tired of Hepatitis B?
Tired of Hepatitis B?
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厌倦了乙型肝炎？
DOI：
10.1007/s10620-016-4067-8
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发表时间：
2016
影响因子：
3.1
通讯作者：
Bajaj,JasmohanS
中科院分区：
文献类型：
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作者：
Patidar,KavishR;Bajaj,JasmohanS
疲劳是一种综合症状，通常报告为不适、疲惫和嗜睡，在总人群中报告的患病率为25%[1]。虽然日常活动（即运动、工作、日常生活活动）会导致一定程度的疲劳，但这也是慢性疾病患者报告的重要结局。疲劳可以是中枢性或外周性（或两者）病因[2]。外周疲劳是神经肌肉功能障碍的结果，在临床上通常表现为晚期肝病患者的虚弱，而中枢疲劳通常与神经精神问题（即抑郁和焦虑）和睡眠问题有关。中枢疲劳通常表现为难以进行需要自我激励和内部信号的身体和精神活动。疲劳量表和评分用于定义其在几种慢性疾病中的存在、严重程度和对治疗的反应;然而，其在慢性肝病（如原发性胆汁性肝硬化、慢性丙型肝炎感染和非酒精性肝病）中的确切患病率不太明确[3]。疲劳作为慢性B型肝炎的主要结局研究更少。到目前为止，评估慢性B型肝炎疲劳的研究样本量有限，缺乏对疲劳作为一个独立症状的关注。疲劳与慢性丙型肝炎和原发性胆汁性肝硬化患者的抑郁、认知障碍、工作表现差和生活质量下降有关[4，5]。然而，疲劳与丙型肝炎病毒载量和基因型并不特别相关[6]。鉴于北美B型肝炎的患病率越来越高，慢性B型肝炎的炎症持续时间相对较长，患者报告的结局（如疲劳增加）增加了相关性。因此，需要回答的基本问题向前移动疲劳与慢性B型肝炎和持续的病毒血症和疾病的严重程度有任何关系，这种症状？在本期《消化系统疾病与科学》中，Evon et al. [7]解决了这个问题。作者使用B型肝炎研究网络（HBRN）招募了948名参与者，其中大多数是非活动性携带者（40.7%），亚洲人（74%），有有限的共病（27.8%）。只有2%的参与者有晚期纤维化，这是由天冬氨酸转氨酶（AST）血小板指数（APRI）估计。每名参与者都通过美国国立卫生研究院（NIH）患者报告结局系统（PROMIS）工具进行分析，该工具是一套高度有效和可靠的工具，可以测量身体，心理和社会功能。然而，该病例的作者使用了PROMIS疲劳简表，该简表仅包括来自较大PROMIS项目库的项目子集，以准确捕捉患者对疲劳及其频率的情绪反应。重要的是，与美国人群的标准相比，PROMIS工具的评分已用于评估几种慢性疾病的疲劳状态[8]以及阿尔茨海默病患者的患者报告结局[9]。此外，为了评估心理健康对疲劳的影响，每位参与者还接受了医学结局研究36项简明心理健康功能子量表的评估。为了进一步关注疲劳，该小组排除了那些
Fatigue is a symptom complex encompassing that is often reported as malaise, exhaustion, and lethargy, with a reported prevalence of 25% in the overall population [1]. While some fatigue is to be expected as a consequence of daily activities (ie, exercise, work, activities of daily living), it is also an important patient-reported outcome in chronic diseases. Fatigue can be either central or peripheral (or both) in etiology [2]. Peripheral fatigue is a result of neuromuscular dysfunction, which often manifests clinically as weakness in patients with advanced liver disease, whereas central fatigue is often associated with neuropsychiatric problems (ie, depression and anxiety) and sleep issues. Central fatigue often manifests as difficulty in performing physical and mental activities that require selfmotivation and internal signals. Fatigue scales and scores are used to define its presence, severity, and response to therapy in several chronic illnesses; however, its exact prevalence is less well defined in chronic liver diseases such as primary biliary cirrhosis, chronic hepatitis C infection, and nonalcoholic liver disease [3]. Fatigue as a primary outcome even less studied in chronic hepatitis B. Thus far, the studies that have evaluated fatigue in chronic hepatitis B have had limited sample size and lack of focus on fatigue as an independent symptom complex. Fatigue has been associated with depression, cognitive impairment, poor work performance, and reduced quality of life in chronic hepatitis C and in primary biliary cirrhosis [4, 5]. Yet, fatigue is not specifically associated with hepatitis C viral load and genotype [6]. Given the increasingly recognized hepatitis B prevalence in North America, and the relatively long duration of inflammation in chronic hepatitis B, patient-reported outcomes such as fatigue gain added relevance. Therefore, fundamental questions need to be answered moving forward—is fatigue associated with chronic hepatitis B and does ongoing viremia and disease severity have any relationship to this symptom?In this issue of Digestive Diseases and Sciences, Evon et al.[7] addressed this question. Using the Hepatitis B Research Network (HBRN), the authors enrolled 948 participants, of whom the majority were inactive carriers (40.7%), were Asian (74%), and had limited comorbid illnesses (27.8%). Only 2% of participants had advanced fibrosis that was estimated by the aspartate transaminase (AST) to platelet index (APRI). Each participant enrolled was analyzed by the National Institutes of Health (NIH) Patient-Reported Outcomes System (PROMIS) tools that are a highly valid and reliable set of instruments that measures physical, mental, and social functioning. The authors in the case, however, used the PROMIS Fatigue Short Form, which only included a subset of items from the larger PROMIS item bank in an effort to accurately capture the patient’s emotional responses toward fatigue and its frequency. Importantly, scoring from the PROMIS instruments, compared to norms from the US population, has been used to assess fatigue states in several chronic illnesses [8] as well as patient-reported outcomes in cirrhotic patients [9]. Furthermore, in order to evaluate the impact of mental health on fatigue, each participant also was evaluated by the Medical Outcomes Study 36-item Short Form Mental Health Functioning subscale. In order to further focus on fatigue, the group had excluded those being