Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
Duke Clinical Research Institute, Durham, NC, USA.
J Viral Hepat. 2021 May;28(5):699-709. doi: 10.1111/jvh.13474. Epub 2021 Feb 13.
Alcohol consumption in the setting of chronic HCV is associated with accelerated progression towards cirrhosis, increased risk of hepatocellular carcinoma and higher mortality. This analysis contextualizes how sociodemographic factors, chronic pain and depression relate to the motivations of individuals with chronic HCV to consume alcohol. We conducted a secondary analysis of baseline data from the Hep ART trial of behavioural interventions on alcohol use among patients with HCV. Alcohol consumption was measured using the Drinking Motives Questionnaire and a novel 6-item measure of pain-related drinking motives. Statistical analyses performed included ANOVA for bivariate analyses and multivariable ordinary least-squares linear regression. At study baseline, 181 participants had an average age of 55 years; the majority (66.7%) reported beyond-minor pain; and a third (37%) met criteria for depression; drinking motives were higher for individuals with beyond-minor pain (means 9.9 vs. 4.6, p < .001) and who met criteria for depression (means 10.9 vs. 6.4, p < .001) when using the pain-related drinking motives items. Average pain(coef = 1.0410067141 < .001) was significantly associated with increased motives to drink to relieve pain in the full baseline model specification controlling for all covariates using ordinary at least squares; depression (coef = 7.06; 95% CI 1.32, 12.81; p = .016) was significantly associated with increased non-pain-related motives to drink. From baseline to 3-month follow-up, compared to participants who had mean average pain scores among the sample, motives to drink to relieve pain decreased in participants who had higher average pain scores (coef = -0.30; 95% CI -0.59, -0.01; p = .40). Physical pain and depression are associated with increased motives to consume alcohol. Patients with chronic liver disease should be screened for chronic pain and depression and, if present, referred to pain specialists or co-managed in partnership with pain specialists in hepatology clinics.
在慢性 HCV 的情况下饮酒与肝硬化进展加速、肝细胞癌风险增加和死亡率升高有关。本分析将社会人口因素、慢性疼痛和抑郁与慢性 HCV 患者饮酒的动机联系起来。我们对 HepART 试验中关于行为干预对 HCV 患者饮酒影响的基线数据进行了二次分析。使用饮酒动机问卷和一种新的 6 项疼痛相关饮酒动机测量来衡量饮酒量。进行的统计分析包括双变量分析的 ANOVA 和多变量普通最小二乘法线性回归。在研究基线时，181 名参与者的平均年龄为 55 岁；大多数人（66.7%）报告有中度以上疼痛；三分之一（37%）符合抑郁标准；使用疼痛相关饮酒动机项目时，有中度以上疼痛（平均值 9.9 分比 4.6 分，p<.001）和符合抑郁标准的个体（平均值 10.9 分比 6.4 分，p<.001）的饮酒动机更高。在使用普通最小二乘法对所有协变量进行全基线模型规范控制时，平均疼痛（系数=1.0410067141<.001）与增加以缓解疼痛为目的的饮酒动机显著相关；抑郁（系数=7.06；95%CI 1.32，12.81；p=0.016）与增加与疼痛无关的饮酒动机显著相关。从基线到 3 个月随访，与样本中平均平均疼痛评分的参与者相比，疼痛评分较高的参与者的以缓解疼痛为目的的饮酒动机降低（系数=-0.30；95%CI -0.59，-0.01；p=0.40）。身体疼痛和抑郁与增加饮酒动机有关。慢性肝病患者应接受慢性疼痛和抑郁的筛查，如果存在，应转介给疼痛专家或在肝病学诊所与疼痛专家共同管理。
