Zalai Dora, Sherman Morris, McShane Kelly, Shapiro Colin M, Carney Colleen E
Dept. of Psychology, Ryerson University, Toronto, Canada.
Dept. of Gastroenterology, University Health Network, University of Toronto, Toronto, Canada.
J Psychosom Res. 2015 Feb;78(2):193-8. doi: 10.1016/j.jpsychores.2014.11.011. Epub 2014 Nov 18.
Chronic Hepatitis C virus (HCV) infection is a source of significant public health burden worldwide. Fatigue is a cardinal patient reported consequence of the disease. HCV infection associated fatigue leads to significant impairment in the quality of life and day-to-day functioning. Despite its clinical significance, the factors that contribute to adverse impact of fatigue in HCV infection are largely unknown.
This study evaluated the contributions of insomnia, depression symptoms, and fatigue-specific cognitions to fatigue-related functional impairment.
Fatigue, insomnia, depression symptoms, as well as fatigue cognitions were assessed in participants (36% females; age>18 years, N=115) with chronic HCV infection at a tertiary hepatitis clinic.
Sixty percent of participants reported clinically significant fatigue (Fatigue Severity Index FSS ≥ 4). Comorbidities and fatigue perceptions accounted for 61% of the variation of fatigue. Fatigue perceptions were the main predictors of adverse fatigue outcomes (B=.114, 95% CI=.054-.154). Patients with clinically significant fatigue were four-times more likely than less fatigued patients to believe that the main cause of their fatigue was the infection.
Patients' beliefs about their fatigue were the main predictors of adverse fatigue outcomes. These results suggest that fatigue associated with chronic hepatitis C infection can be conceptualized using a cognitive behavioral approach. This was the first study to evaluate the role of both comorbid mood/sleep and cognitive predictors of fatigue in a single model. Integrating the findings into existing treatment strategies could improve patient reported outcomes in chronic hepatitis C infection.
慢性丙型肝炎病毒（HCV）感染是全球重大公共卫生负担的一个来源。疲劳是患者报告的该疾病的主要后果。与HCV感染相关的疲劳会导致生活质量和日常功能的显著受损。尽管其具有临床意义，但导致HCV感染中疲劳产生不利影响的因素在很大程度上尚不清楚。
本研究评估失眠、抑郁症状以及特定于疲劳的认知对与疲劳相关的功能损害的影响。
在一家三级肝炎诊所，对慢性HCV感染的参与者（36%为女性；年龄>18岁，N = 115）进行疲劳、失眠、抑郁症状以及疲劳认知的评估。
60%的参与者报告有临床显著的疲劳（疲劳严重程度指数FSS≥4）。合并症和疲劳认知占疲劳变化的61%。疲劳认知是疲劳不良后果的主要预测因素（B = 0.114，95%置信区间 = 0.054 - 0.154）。有临床显著疲劳的患者认为其疲劳的主要原因是感染的可能性是疲劳程度较轻患者的四倍。
患者对自身疲劳的认知是疲劳不良后果的主要预测因素。这些结果表明，慢性丙型肝炎感染相关的疲劳可以用认知行为方法来概念化。这是第一项在单一模型中评估合并的情绪/睡眠以及疲劳的认知预测因素作用的研究。将这些发现整合到现有治疗策略中可能会改善慢性丙型肝炎感染患者报告的结局。
