酒精性病因肝病患者的生物心理社会功能与自我感知疼痛水平的关系。

Pérez-San-Gregorio M A, Martín-Rodríguez A, Domínguez-Cabello E, Fernández-Jiménez E, Pérez-Bernal J

Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatments, University of Seville, Seville, Spain.

Transplant Proc. 2012 Nov;44(9):2612-5. doi: 10.1016/j.transproceed.2012.09.055.

OBJECTIVE

To compare the biopsychosocial functioning among liver transplantation and cirrhotic patients as a function of self-perceived pain level.

METHODS

We selected two groups of liver patients of the same gender (men) and disease etiology (alcoholic): there were 39 liver transplant recipients and 34 severe cirrhotic patients. The Hospital Anxiety and Depression Scale and the SF-36 Health Questionnaire were used. We applied analysis of covariance, with age and model end-stage liver disease (MELD) scores as covariates to assess the influence of two independent factors: (1) group (liver transplant recipients and cirrhotic patients), and (2) self-perception of pain (mild and high). We also calculated Cohen's d as an effect size index.

RESULTS

No interactive effects were found between factors group and self-perceived pain in any of the variables studied. With regard to the main effects, we found statistically significant differences in the following variables between: a) liver transplant recipients and cirrhotic patients: anxiety (P = .000), depression (P = .003), role-physical (P = .001), mental health (P = .016), general health (P = .000), vitality (P = .000), and physical functioning (P = .000); and b) liver patients with mild and high self-perceived pain: anxiety (P = .008), depression (P = .000), role-physical (P = .002), mental health (P = .000), vitality (P = .000), and physical functioning (P = .001). In all the indicated variables, with medium and large effect sizes (Cohen's ds from 0.58 to 1.64), the cirrhotic patients and patients with a high level of self-perceived pain had much poorer mental health and quality of life.

CONCLUSION

Alcoholic cirrhotic male patients with a high level of self-perceived pain had the greatest biopsychosocial impairment, even exceeding the clinical threshold in the anxiety and depression scales; and the highest biopsychosocial well-being was associated with liver transplant recipients with a mild level of self-perceived pain.

目的

根据自我感知疼痛水平，比较肝移植患者和肝硬化患者的生物心理社会功能。

方法

我们选取了两组性别相同（男性）且疾病病因相同（酒精性）的肝病患者：39例肝移植受者和34例重度肝硬化患者。使用医院焦虑抑郁量表和SF-36健康调查问卷。我们应用协方差分析，将年龄和终末期肝病模型（MELD）评分作为协变量，以评估两个独立因素的影响：（1）组别（肝移植受者和肝硬化患者），以及（2）疼痛自我感知（轻度和重度）。我们还计算了科恩d值作为效应大小指标。

结果

在所研究的任何变量中，均未发现组别和疼痛自我感知因素之间存在交互作用。关于主效应，我们发现在以下变量中存在统计学显著差异：a）肝移植受者和肝硬化患者之间：焦虑（P = 0.000）、抑郁（P = 0.003）、角色-身体功能（P = 0.001）、心理健康（P = 0.016）、总体健康（P = 0.000）、活力（P = 0.000）和身体功能（P = 0.000）；b）自我感知疼痛轻度和重度的肝病患者之间：焦虑（P = 0.008）、抑郁（P = 0.000）、角色-身体功能（P = 0.002）、心理健康（P = 0.000）、活力（P = 0.000）和身体功能（P = 0.001）。在所有上述变量中，效应大小为中等和较大（科恩d值从0.58至1.64），肝硬化患者和自我感知疼痛程度高的患者心理健康和生活质量差得多。