健康相关生活质量评估在慢性乙型肝炎患者中的应用及进展

黄菲; 韩梅芳

doi:10.12449/JCH250120

健康相关生活质量评估在慢性乙型肝炎患者中的应用及进展

DOI: 10.12449/JCH250120

黄菲,
韩梅芳^, ,

华中科技大学同济医学院附属同济医院感染科，武汉 430030

基金项目:

国家重点研发计划 (2023YFC2308600)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：黄菲负责查阅及分析文献，撰写论文；韩梅芳负责指导文章结构及论文修改，最终定稿。

详细信息

通信作者:
韩梅芳， mfhan@foxmail.com （ORCID： 0000-0002-1948-8128）

计量
- 文章访问数: 788
- HTML全文浏览量: 1841
- PDF下载量: 85
- 被引次数: 0
出版历程
- 收稿日期: 2024-05-07
- 录用日期: 2024-08-09
- 出版日期: 2025-01-25

Application of health-related quality of life assessment in patients with chronic hepatitis B and related advances

Fei HUANG,
Meifang HAN^{,
,}

Department of Infectious Disease，Tongji Hospital，Tongji Medical College of Huazhong University of Science and Technology，Wuhan 430030，China

Research funding:

National Key Research and Development Program of China (2023YFC2308600)

More Information

Corresponding author: HAN Meifang， mfhan@foxmail.com （ORCID： 0000-0002-1948-8128）

摘要

摘要: 传统的生物医学模式转换为生物-心理-社会医学模式，意味着临床诊治的目的不仅局限于疾病本身，更要关注患者的生活质量和幸福指数。由于慢性乙型肝炎（CHB）具有传染性，且易复发和进展，患者需承受生理、心理、经济及社会诸多方面的压力，严重影响其生活质量。因此，对CHB患者进行健康相关生活质量（HRQoL）评估至关重要。本文就CHB患者HRQoL评估的临床意义及价值、测量工具等进行总结，概述影响CHB患者HRQoL的因素和改善其生活质量的措施。本文旨在为临床动态监测CHB患者的HRQoL提供理论支持，也是为优化CHB临床诊疗方案及改善CHB患者的生活质量提供实践指导。
- 乙型肝炎，慢性 /
- 生活质量 /
- 患者健康问卷
Abstract: The transformation of traditional biomedical model into the bio-psycho-social medical model means that the purpose of clinical diagnosis and treatment not only focuses on the disease itself， but also emphasizes the quality of life and happiness index of patients. Since chronic hepatitis B （CHB） is infectious and has high rates of recurrence and progression， patients have to bear many pressures in terms of physiology， psychology， economy， and society， which seriously affects their quality of life. Therefore， it is very important to perform health-related quality of life （HRQoL） assessments for patients with CHB. This article reviews the clinical significance and measurement tools of HRQoL assessments in patients with CHB and summarizes the influencing factors for HRQoL in CHB patients and the measures to improve their HRQoL. This article will provide theoretical support for dynamic monitoring of HRQoL in CHB patients and practical guidance for optimizing the clinical diagnosis and treatment regimens for CHB and improving the quality of life of patients.
- Hepatitis B， Chronic /
- Quality of Life /
- Patient Health Questionnaire

HTML全文

表 1 CHB患者HRQoL评价的主要量表特征总结

Table 1. Summary of the characteristics of the major scales to evaluate the HRQoL of patients with CHB

分类	量表名称	纳入健康领域/条目	计算得分方法	优点	缺点
普适性量表	SF-36	躯体健康维度包括生理机能（10个条目）、生理职能（4个条目）、躯体疼痛（2个条目）、一般健康状况（5个条目）；精神健康维度包括精力（4个条目）、社会功能（2个条目）、情感职能（3个条目）、精神健康（5个条目）	采用Likert累加法，按照题值计算原始分数，再用标准公式计算转换分数	（1）应用广泛，信效度高；（2）可用于不同疾病人群或某疾病人群与健康人HRQoL的评估和比较	缺乏疾病特异性，未纳入肝病相关指标如黄疸等
	EQ-5D	行动能力（1个条目）、自我照顾（1个条目）、日常活动（1个条目）、疼痛或不适（1个条目）、焦虑或沮丧（1个条目）	每个健康领域中的健康水平从轻到重分别由1～5表示，每一个健康状态可以用一个5位数的代码表示，总共可定义3 125种健康状态，其中，健康状态11111指在五个维度均没有问题	（1）可用于不同人群HRQoL的评估和比较；（2）可进行卫生经济学方面的研究，利于医疗资源分配	（1）缺乏疾病特异性；（2）比较无症状HBV携带者、轻型CHB患者和健康人的HRQoL受到限制
	PROMIS-29	抑郁（4个条目）、焦虑（4个条目）、生理功能（4个条目）、疼痛干扰（4个条目）、疲劳（4个条目）、睡眠障碍（4个条目）、社会参与（4个条目）	各领域的分值为4～20，加上一个疼痛强度条目，以0～10分的数字评分法进行测评	（1）能够可靠且有效地反应疾病状态或治疗对患者生活质量的影响；（2）易于被患者理解；（3）融入计算机辅助技术使之更高效	（1）缺乏疾病特异性；（2）有待进一步在CHB人群中进行验证
特异性量表	LDQOL 1.0 （中文版）	SF-36量表的基础上加上12个疾病特异性维度，含肝病的症状（17个条目）、肝病的影响（10个条目）、注意力（7个条目）、记忆力（6个条目）、社交质量（5个条目）、肝病产生的消极情绪（4个条目）、睡眠（5个条目）、孤独感（5个条目）、绝望感（4个条目）、肝病产生的耻辱感（6个条目）、性功能（3个条目）、性功能障碍（3个条目）	总分经公式转化为标准分0～100分，再进行简单求和，各维度得分越高，患者生活质量越高	（1）纳入肝病相关临床症状等疾病特异性维度；（2）量表完成率高、可行性好；（3）适用于所有肝病患者，可用于CHB和其他类型肝病患者HRQoL的比较	（1）由国外量表汉化而来，存在中西方文化差异，需要文化调适；（2）不能很好地反映患者活力或疲乏状态、社交质量、睡眠、孤独感、绝望感等感受；（3）有待进一步扩大样本量进行验证
	QLICD-CH	共性模块（28个条目）：生理功能（含生理机能、独立性、精力共9个条目）、心理功能（含认知、情绪、意志与个性共11个条目）、社会功能（含人际交往、社会支持、社会角色共8个条目）；肝病特异性模块（18个条目）：含消化道症状、黄疸、社交影响、治疗副作用、治疗的心理影响、疾病的心理影响	采用1～5分Likert 5级计分法，在量表中有正负性条目之分，正向条目得分越高代表生活质量越好，逆向条目得分越高代表生活质量越差。对逆向条目，需对其进行“正向转换”	（1）该量表可适用于我国各种类型的慢性肝炎患者，可用于发病期、治疗期、康复期等各时期患者HRQoL的评价；（2）可区分患者病情的严重程度	不适用于比较慢性肝炎和健康人的HRQoL差异
	CLDQ	腹部症状（3个条目）、疲劳（5个条目）、系统症状（5个条目）、活动（3个条目）、情感功能（8个条目）及焦虑（5个条目）	采用7分制标准（1～7分），各条目、维度及总得分均为正向，分数越高代表生活质量越好	量表可根据患者的肝病类型进一步扩展为相应的亚型	不适用于晚期肝硬化（Child-Pugh B级/C级）患者和健康人的评估

下载: 导出CSV

参考文献(51)

[1]	KAPLAN RM, HAYS RD. Health-related quality of life measurement in public health[J]. Annu Rev Public Health, 2022, 43: 355- 373. DOI: 10.1146/annurev-publhealth-052120-012811.
[2]	CHURRUCA K, POMARE C, ELLIS LA, et al. Patient-reported outcome measures(PROMs): A review of generic and condition-specific measures and a discussion of trends and issues[J]. Health Expect, 2021, 24( 4): 1015- 1024. DOI: 10.1111/hex.13254.
[3]	HSU YC, HUANG DQ, NGUYEN MH. Global burden of hepatitis B virus: Current status, missed opportunities and a call for action[J]. Nat Rev Gastroenterol Hepatol, 2023, 20( 8): 524- 537. DOI: 10.1038/s41575-023-00760-9.
[4]	WU D, HUANG D, NING Q. New strategies for clinical cure and institute of hepatitis B: Viral suppression combined with immune modulation and its road map[J]. J Clin Hepatol, 2018, 34( 5): 919- 925. DOI: 10.3969/j.issn.1001-5256.2018.05.002. 吴迪, 黄达, 宁琴. 慢性乙型肝炎临床治愈新策略: 病毒抑制联合免疫调节及其路线图[J]. 临床肝胆病杂志, 2018, 34( 5): 919- 925. DOI: 10.3969/j.issn.1001-5256.2018.05.002.
[5]	van der PLAS SM, HANSEN BE, de BOER JB, et al. The liver disease symptom index 2.0; validation of a disease-specific questionnaire[J]. Qual Life Res, 2004, 13( 8): 1469- 1481. DOI: 10.1023/B: QURE.0000040797.17449.c0.
[6]	COONS SJ, RAO S, KEININGER DL, et al. A comparative review of generic quality-of-life instruments[J]. Pharmacoeconomics, 2000, 17( 1): 13- 35. DOI: 10.2165/00019053-200017010-00002.
[7]	LI YP, HUANG ZJ, ZHANG H, et al. Feasibility of the MOS 36-item short form health survey in the assessment of the quality of life in hepatitis B patients[J]. China Prev Med, 2007, 8( 4): 352- 355. DOI: 10.3969/j.issn.1009-6639.2007.04.007. 李跃平, 黄子杰, 张宏, 等. SF-36量表在乙型肝炎患者生存质量测量中的可行性评价[J]. 中国预防医学杂志, 2007, 8( 4): 352- 355. DOI: 10.3969/j.issn.1009-6639.2007.04.007.
[8]	DEVLIN NJ, BROOKS R. EQ-5D and the EuroQol Group: Past, present and future[J]. Appl Health Econ Health Policy, 2017, 15( 2): 127- 137. DOI: 10.1007/s40258-017-0310-5.
[9]	CAI YF, WU HY, YANG ZH. Comparison analysis of European quality of life-5 dimensions with three-level and five-level based on four types of people in China[J]. Chin J Dis Contr Prev, 2020, 24( 10): 1190- 1194. DOI: 10.16462/j.cnki.zhjbkz.2020.10.016. 蔡一凡, 伍红艳, 杨智豪. 基于中国四类人群的EQ-5D-3L和EQ-5D-5L量表比较分析[J]. 中华疾病控制杂志, 2020, 24( 10): 1190- 1194. DOI: 10.16462/j.cnki.zhjbkz.2020.10.016.
[10]	WANG H, DENG M, SHI LM, et al. The application of the Chinese version of the European quality of life five-dimension scale in China[J]. Chin J Postgrad Med, 2023, 46( 2): 97- 101. DOI: 10.3760/cma.j.cn115455-20220926-00832. 王惠, 邓明, 时黎明, 等. 欧洲五维健康量表中文版在我国的应用[J]. 中国医师进修杂志, 2023, 46( 2): 97- 101. DOI: 10.3760/cma.j.cn115455-20220926-00832.
[11]	HAMMERT WC, CALFEE RP. Understanding promis[J]. J Hand Surg Am, 2020, 45( 7): 650- 654. DOI: 10.1016/j.jhsa.2020.03.016.
[12]	DESAI AP, MADATHANAPALLI A, TANG Q, et al. PROMIS Profile-29 is a valid instrument with distinct advantages over legacy instruments for measuring the quality of life in chronic liver disease[J]. Hepatology, 2023, 78( 6): 1788- 1799. DOI: 10.1097/HEP.0000000000000480.
[13]	QI MH, HUANG H, DONG JX, et al. Reliability and validity of the Chinese version of the liver disease quality of life questionnaire(LDQOL 1.0)[J]. World Chin J Dig, 2015, 23( 12): 1973- 1979. 齐明华, 黄海, 董娇璇, 等. 肝病生存质量量表中文版的信度、效度测试[J]. 世界华人消化杂志, 2015, 23( 12): 1973- 1979.
[14]	WAN CH, ZHANG XQ, LI XM, et al. Psychometrics of the different scales of the system of quality of life instruments for chronic diseases QLICD[J]. J Kunming Med Univ, 2009, 30( 8): 40- 45. 万崇华, 张晓磬, 李晓梅, 等. 慢性病患者生命质量测定量表体系QLICD各量表的测量学特性分析[J]. 昆明医学院学报, 2009, 30( 8): 40- 45.
[15]	YOUNOSSI ZM, GUYATT G, KIWI M, et al. Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease[J]. Gut, 1999, 45( 2): 295- 300. DOI: 10.1136/gut.45.2.295.
[16]	CHEN YT. Chinesization of the quality of life scale and its application for non-alcoholic fatty liver disease[D]. Hangzhou: Hangzhou Normal University, 2023. 陈雨彤. 非酒精性脂肪性肝病特异性生活质量量表的汉化及应用研究[D]. 杭州: 杭州师范大学, 2023.
[17]	YOUNOSSI ZM, STEPANOVA M, YOUNOSSI I, et al. Development and validation of a hepatitis B-specific health-related quality-of-life instrument: CLDQ-HBV[J]. J Viral Hepat, 2021, 28( 3): 484- 492. DOI: 10.1111/jvh.13451.
[18]	SPIEGEL BMR, BOLUS R, HAN S, et al. Development and validation of a disease-targeted quality of life instrument in chronic hepatitis B: The hepatitis B quality of life instrument, version 1.0[J]. Hepatology, 2007, 46( 1): 113- 121. DOI: 10.1002/hep.21692.
[19]	LUO XW, CAI TS. Development of a quality of life scale for patients with chronic hepatitis B[J]. Chin J Clin Psychol, 2010, 18( 3): 317- 319. DOI: 10.16128/j.cnki.1005-3611.2010.03.003. 罗兴伟, 蔡太生. 慢性乙肝患者生活质量量表的编制[J]. 中国临床心理学杂志, 2010, 18( 3): 317- 319. DOI: 10.16128/j.cnki.1005-3611.2010.03.003.
[20]	CORTESI PA, CONTI S, SCALONE L, et al. Health related quality of life in chronic liver diseases[J]. Liver Int, 2020, 40( 11): 2630- 2642. DOI: 10.1111/liv.14647.
[21]	ZHOU FQ, WANG WX, WANG FL. Influencing factors of life quality in patients with chronic hepatitis B[J]. Chin Clin Nurs, 2023, 15( 7): 438- 441, 445. DOI: 10.3969/j.issn.1674-3768.2023.07.011. 周丰勤, 王伟仙, 王凤林. 慢性乙型肝炎患者生存质量影响因素研究[J]. 中国临床护理, 2023, 15( 7): 438- 441, 445. DOI: 10.3969/j.issn.1674-3768.2023.07.011.
[22]	ZHANG MD, WAN MJ, WANG W, et al. Effect of interferon therapy on quality of life in patients with chronic hepatitis B[J]. Sci Rep, 2024, 14( 1): 2461. DOI: 10.1038/s41598-024-51292-4.
[23]	CHEN P, ZHANG F, SHEN YQ, et al. Health-related quality of life and its influencing factors in patients with hepatitis B: A cross-sectional assessment in Southeastern China[J]. Can J Gastroenterol Hepatol, 2021, 2021: 9937591. DOI: 10.1155/2021/9937591.
[24]	LAM ETP, LAM CLK, LAI CL, et al. Health-related quality of life of Southern Chinese with chronic hepatitis B infection[J]. Health Qual Life Outcomes, 2009, 7: 52. DOI: 10.1186/1477-7525-7-52.
[25]	ONG SC, MAK B, AUNG MO, et al. Health-related quality of life in chronic hepatitis B patients[J]. Hepatology, 2008, 47( 4): 1108- 1117. DOI: 10.1002/hep.22138.
[26]	ZHANG M, LI YG, FAN ZH, et al. Assessing health-related quality of life and health utilities in patients with chronic hepatitis B-related diseases in China: A cross-sectional study[J]. BMJ Open, 2021, 11( 9): e047475. DOI: 10.1136/bmjopen-2020-047475.
[27]	WANG H, MENG MF, FAN LM. Research progress of stigma in patients with hepatitis B[J]. Chin Gen Pract Nurs, 2017, 15( 7): 791- 793. DOI: 10.3969/j.issn.1674-4748.2017.07.008. 王慧, 孟美芬, 范卢明. 乙型肝炎病人病耻感的研究进展[J]. 全科护理, 2017, 15( 7): 791- 793. DOI: 10.3969/j.issn.1674-4748.2017.07.008.
[28]	ALTINDAG A, CADIRCI D, SIRMATEL F. Depression and health related quality of life in non-cirrhotic chronic hepatitis B patients and hepatitis B carriers[J]. Neurosciences(Riyadh), 2009, 14( 1): 56- 59.
[29]	WANG YD, SUN YL, ZHANG XJ, et al. Mediating effect of mental resilience on coping style and treatment compliance in patients with chronic hepatitis B[J]. J Beihua Univ Nat Sci, 2024, 25( 2): 239- 243. DOI: 10.11713/j.issn.1009-4822.2024.02.017. 王元迪, 孙亚丽, 张晓杰, 等. 心理弹性在慢性乙型肝炎患者应对方式与治疗依从性之间的中介效应[J]. 北华大学学报(自然科学版), 2024, 25( 2): 239- 243. DOI: 10.11713/j.issn.1009-4822.2024.02.017.
[30]	KARACAER Z, CAKIR B, ERDEM H, et al. Quality of life and related factors among chronic hepatitis B-infected patients: A multi-center study, Turkey[J]. Health Qual Life Outcomes, 2016, 14( 1): 153. DOI: 10.1186/s12955-016-0557-9.
[31]	WU XN, HONG J, ZHOU JL, et al. Health-related quality of life improves after entecavir treatment in patients with compensated HBV cirrhosis[J]. Hepatol Int, 2021, 15( 6): 1318- 1327. DOI: 10.1007/s12072-021-10240-4.
[32]	LU J, PIAO HX, JIN XM, et al. Correlation of quality of life with aspartate aminotransferase-to-platelet ratio index, liver stiffness measurement, and histopathology after antiviral therapy for chronic hepatitis B liver fibrosis[J]. J Clin Hepatol, 2021, 37( 4): 813- 816. DOI: 10.3969/j.issn.1001-5256.2021.04.018. 卢晶, 朴红心, 金雪梅, 等. 慢性乙型肝炎肝纤维化抗病毒治疗后生活质量与AST/PLT比率、肝硬度值、病理组织学的相关性分析[J]. 临床肝胆病杂志, 2021, 37( 4): 813- 816. DOI: 10.3969/j.issn.1001-5256.2021.04.018.
[33]	LI JX, WANG Q, CHEN Y. Correlation between oral antiviral drug compliance and quality of life in patients with chronic hepatitis B and the impacting factors of compliance[J]. China Med Pharm, 2023, 13( 6): 126- 130. DOI: 10.3969/j.issn.2095-0616.2023.06.033. 李佳鑫, 王清, 陈雁. 慢性乙型肝炎患者口服抗病毒药物依从性与生活质量的相关性及其影响因素[J]. 中国医药科学, 2023, 13( 6): 126- 130. DOI: 10.3969/j.issn.2095-0616.2023.06.033.
[34]	ABU-FREHA N, TAILAKH M ABU, FICH A, et al. Adherence to anti-viral treatment for chronic hepatitis B[J]. J Clin Med, 2020, 9( 6): 1922. DOI: 10.3390/jcm9061922.
[35]	DENG W, JIANG TT, BI XY, et al. Progress on the treatment of chronic hepatitis B with interferons[J/CD]. Chin J Liver Dis(Electronic Version), 2023, 15( 2): 1- 6. DOI: 10.3969/j.issn.1674-7380.2023.02.001. 邓雯, 蒋婷婷, 毕潇月, 等. 干扰素治疗慢性乙型肝炎研究进展[J/CD]. 中国肝脏病杂志(电子版), 2023, 15( 2): 1- 6. DOI: 10.3969/j.issn.1674-7380.2023.02.001.
[36]	WU D, WANG P, HAN MF, et al. Sequential combination therapy with interferon, interleukin-2 and therapeutic vaccine in entecavir-suppressed chronic hepatitis B patients: The endeavor study[J]. Hepatol Int, 2019, 13( 5): 573- 586. DOI: 10.1007/s12072-019-09956-1.
[37]	NING Q, HAN MF, SUN YT, et al. Switching from entecavir to PegIFN Alfa-2a in patients with HBeAg-positive chronic hepatitis B: A randomised open-label trial(OSST trial)[J]. J Hepatol, 2014, 61( 4): 777- 784. DOI: 10.1016/j.jhep.2014.05.044.
[38]	ABDELAZIZ H, SEIFELDIN S, ELHOSSEINY M, et al. Health related quality of life in chronic hepatitis C patients before and after treatment[J]. QJM, 2020, 113( Supplement_1): hcaa052.046. DOI: 10.1093/qjmed/hcaa052.046.
[39]	COFFIN C, ELKHASHAB M, DOUCETTE K, et al. WED-191 Assessment of clinical and patient reported outcome measures in individuals with chronic hepatitis B who clear HBsAg, followed by the Canadian hepatitis B network[J]. J Hepatol, 2023, 78: S1115. DOI: 10.1016/S0168-8278(23)03233-6.
[40]	ZHOU XL, ZHOU YT. Effect of stress reaction to mental health of chronic asymptomatic HBV carrier[J]. China J Health Psychol, 2006, 14( 3): 309- 311. DOI: 10.13342/j.cnki.cjhp.2006.03.026. 周秀莲, 周媛婷. 应激反应对乙肝病毒携带者心理健康的影响[J]. 中国健康心理学杂志, 2006, 14( 3): 309- 311. DOI: 10.13342/j.cnki.cjhp.2006.03.026.
[41]	GUO Y, ZHANG XN, SU S, et al. β-adrenoreceptor-triggered PKA activation negatively regulates the innate antiviral response[J]. Cell Mol Immunol, 2023, 20( 2): 175- 188. DOI: 10.1038/s41423-022-00967-x.
[42]	LI C, LIU J, WU YF. Advances in immunomodulatory effects of catecholamines in critical illness[J]. Chin Crit Care Med, 2019, 31( 10): 1295- 1298. DOI: 10.3760/cma.j.issn.2095-4352.2019.10.023. 李超, 刘军, 吴允孚. 儿茶酚胺免疫调节效应的研究进展[J]. 中华危重病急救医学, 2019, 31( 10): 1295- 1298. DOI: 10.3760/cma.j.issn.2095-4352.2019.10.023.
[43]	WU F, HU CH, LI YZ, et al. Correlation of psychological distress with quality of life and efficacy of immune checkpoint inhibitors in patients with newly diagnosed stage IIIB-IV NSCLC[J]. J Clin Oncol, 2022, 40( 16_suppl): 12001. DOI: 10.1200/jco.2022.40.16_suppl.12001.
[44]	JIANG MP. Study on sleep quality and related factors in patients with chronic hepatitis B[J]. World J Sleep Med, 2022, 9( 4): 609- 611. DOI: 10.3969/j.issn.2095-7130.2022.04.007. 江漫萍. 慢性乙型肝炎患者睡眠质量现状及相关影响因素研究[J]. 世界睡眠医学杂志, 2022, 9( 4): 609- 611. DOI: 10.3969/j.issn.2095-7130.2022.04.007.
[45]	LANNA A, VAZ B, D’AMBRA C, et al. An intercellular transfer of telomeres rescues T cells from senescence and promotes long-term immunological memory[J]. Nat Cell Biol, 2022, 24( 10): 1461- 1474. DOI: 10.1038/s41556-022-00991-z.
[46]	PRATHER AA, GURFEIN B, MORAN P, et al. Tired telomeres: Poor global sleep quality, perceived stress, and telomere length in immune cell subsets in obese men and women[J]. Brain Behav Immun, 2015, 47: 155- 162. DOI: 10.1016/j.bbi.2014.12.011.
[47]	MARJOT T, RAY DW, WILLIAMS FR, et al. Sleep and liver disease: A bidirectional relationship[J]. Lancet Gastroenterol Hepatol, 2021, 6( 10): 850- 863. DOI: 10.1016/S2468-1253(21)00169-2.
[48]	HU DQ, WANG P, WANG XJ, et al. Disease severity and antiviral response in patients with chronic hepatitis B with non-obese NAFLD[J]. J Formos Med Assoc, 2024, 123( 7): 773- 780. DOI: 10.1016/j.jfma.2023.12.001.
[49]	HICKMAN IJ, JONSSON JR, PRINS JB, et al. Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life[J]. Gut, 2004, 53( 3): 413- 419. DOI: 10.1136/gut.2003.027581.
[50]	HAQ H, HASSALI A, SHAFIE AA, et al. Association between hepatitis B-related knowledge and health-related quality of life[J]. Trop J Pharm Res, 2014, 13( 7): 1163. DOI: 10.4314/tjpr.v13i7.22.
[51]	LUO XW, CAI TS. Effects of illness perceptions on quality of life in patients with chronic hepatitis B[C]// The 90th Anniversary Commemorative Meeting of Chinese Psychological Society and the 14th Chinese Psychological Society. Xi’an: Chinese Psychological Association, 2011: 487. 罗兴伟, 蔡太生. 慢性乙型肝炎患者疾病认知对生活质量的影响[C]// 中国心理学会成立90周年纪念大会暨第十四届全国心理学学术会议论文集. 西安: 中国心理学会, 2011: 487.