Schwarzenberg Sarah Jane, Ling Simon C, Cloonan Yona Keich, Lin Hsing-Hua S, Evon Donna M, Murray Karen F, Rodriguez-Baez Norberto, Rosenthal Philip, Teckman Jeffrey, Schwarz Kathleen B
*University of Minnesota Masonic Children's Hospital, Minneapolis, MN †Department of Paediatrics, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario ‡Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA §Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC ||Department of Pediatrics, University of Washington, Seattle, WA ¶Department of Pediatrics, UTSW, Dallas, TX #Department of Pediatrics, UCSF, San Francisco, CA **Department of Pediatrics, Saint Louis University, Saint Louis, MO ††Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD.
J Pediatr Gastroenterol Nutr. 2017 May;64(5):760-769. doi: 10.1097/MPG.0000000000001525.
The aim of the study was to determine whether selected sociodemographic and hepatitis B virus (HBV)-specific clinical factors are associated with health-related quality of life (HRQoL) among pediatric patients chronically infected with HBV.
Children with chronic HBV enrolled in the Hepatitis B Research Network completed the Child Health Questionnaire at study entry. Caregivers of children 5 to <10 years completed the parent-reported form (CHQ-Parent Report Form); youth 10 to <18 years completed the child-reported CHQ-Child Report Form. We examined univariable associations of the Child Health Questionnaire scores with selected independent variables: sex, adoption status, maternal education, alanine aminotransferase (U/L), aspartate aminotransferase-to-platelet ratio index, and HBV-specific symptom count.
A total of 244 participants (83 young children 5-<10 years, 161 youth 10-<18 years) were included, all HBV treatment-naïve. Among young children, increased alanine aminotransferase level was negatively associated with CHQ-Parent Report Form psychosocial summary t score (r = -0.28, P = 0.01). No other subscale comparisons for young children were statistically significant. Among youth, adoption was associated with better physical functioning and general health (P < 0.01). Higher maternal education was associated with better role/functioning-physical and -emotional scores (P < 0.05). Maternal education and adoption status were linked with adoption associated with higher maternal education. Increased symptom count in youth was associated with worse HRQoL in subscales measuring bodily pain, behavior, mental health, and self-esteem (P < 0.01).
Although overall HRQoL is preserved in children with chronic HBV, some sociodemographic and HBV-related clinical factors were associated with impaired HRQoL in our pediatric patients at baseline. Measurement of HRQoL can focus resources on education and psychosocial support in children and families most in need.
本研究旨在确定特定的社会人口统计学和乙型肝炎病毒（HBV）相关临床因素是否与慢性感染HBV的儿科患者的健康相关生活质量（HRQoL）有关。
参与乙型肝炎研究网络的慢性HBV感染儿童在研究开始时完成了儿童健康问卷。5至<10岁儿童的照顾者完成家长报告表（CHQ-家长报告表）；10至<18岁的青少年完成儿童报告的CHQ-儿童报告表。我们检查了儿童健康问卷得分与选定自变量之间的单变量关联：性别、收养状况、母亲教育程度、丙氨酸转氨酶（U/L）、天冬氨酸转氨酶与血小板比值指数以及HBV特异性症状计数。
共纳入244名参与者（83名5至<10岁的幼儿，161名10至<18岁的青少年），均未接受过HBV治疗。在幼儿中，丙氨酸转氨酶水平升高与CHQ-家长报告表心理社会总结t得分呈负相关（r = -0.28，P = 0.01）。幼儿的其他子量表比较均无统计学意义。在青少年中，收养与更好的身体功能和总体健康相关（P < 0.01）。母亲教育程度较高与更好的角色/身体和情感功能得分相关（P < 0.05）。母亲教育程度和收养状况与母亲教育程度较高的收养相关。青少年症状计数增加与身体疼痛、行为、心理健康和自尊等子量表中较差的HRQoL相关（P < 0.01）。
虽然慢性HBV感染儿童的总体HRQoL得以保留，但一些社会人口统计学和HBV相关临床因素与我们儿科患者基线时受损的HRQoL有关。HRQoL的测量可以将资源集中于最需要帮助的儿童和家庭的教育及心理社会支持。
