Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Beijing, China.
Department of Hepatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
BMJ Open. 2023 Jun 20;13(6):e062131. doi: 10.1136/bmjopen-2022-062131.
Non-alcoholic fatty liver disease (NAFLD) is becoming the leading cause of chronic liver disease worldwide. However, treatment of NAFLD is potentially influenced by psychological conditions. Using the simplified version of the University of Rhode Island Change Assessment (URICA-SV) scale, this study aimed to evaluate the stage of psychological change as a prerequisite to refining implementation strategies for psychological change.
A multicentre cross-sectional survey.
Ninety hospitals in China.
5181 patients with NAFLD were included in this study.
All patients completed the URICA-SV questionnaire and were assigned to one of the three stages of change (precontemplation, contemplation or action) according to their readiness scores. A stepwise multivariate logistic regression analysis was used to identify independent factors associated with the stage of psychological change.
A total of 4832 (93.3%) patients were included in the precontemplation stage and only 349 (6.7%) considered making a change or preparing to make one. There were significant differences in gender (Cohen's d=0.039, p=0.005), age (Cohen's d=-0.327, p<0.001), waist circumference (Cohen's d=0.143, p=0.003), alanine transaminase (Cohen's d=0.347, p=0.001), triglyceride (Cohen's d=0.351, p=0.002), body mass index (BMI; Cohen's d=0.056, p<0.001), proportion of hyperlipidaemia (Cohen's d=0.068, p<0.001) and cardiovascular disease (Cohen's d=0.032, p=0.029), therapeutic regimen (Cohen's d=0.136, p<0.001), and Chronic Liver Disease Questionnaire-Non-Alcoholic Fatty Liver Disease overall score (Cohen's d=-0.420, p<0.001) between patients with NAFLD in the precontemplation stage and those in the contemplation/action stage. Logistic regression identified BMI (HR 0.659, 95% CI 0.469 to 0.928, p=0.017), cardiovascular disease (HR 2.161, 95% CI 1.089 to 4.287, p=0.027) and triglyceride (HR 0.751, 95% CI 0.591 to 0.955, p=0.020) as independent factors predicting psychological change.
The results demonstrated that very few patients with NAFLD presented psychological condition in the stage of action. Psychological condition was found to be significantly related to BMI, cardiovascular disease and triglyceride factors. Integrated diversity considerations for evaluating psychological change are necessary.
非酒精性脂肪性肝病（NAFLD）正成为全球慢性肝病的主要病因。然而，NAFLD 的治疗可能受到心理状况的影响。本研究使用罗得岛大学改变评估简化版（URICA-SV）量表来评估心理改变阶段，作为完善心理改变实施策略的前提。
多中心横断面调查。
中国 90 家医院。
纳入 5181 例 NAFLD 患者。
所有患者均完成 URICA-SV 问卷，并根据准备分数分为三个改变阶段（未考虑、考虑或行动）之一。采用逐步多变量逻辑回归分析确定与心理改变阶段相关的独立因素。
共有 4832 例（93.3%）患者处于未考虑阶段，只有 349 例（6.7%）考虑或准备做出改变。性别（Cohen's d=0.039，p=0.005）、年龄（Cohen's d=-0.327，p<0.001）、腰围（Cohen's d=0.143，p=0.003）、丙氨酸氨基转移酶（Cohen's d=0.347，p=0.001）、甘油三酯（Cohen's d=0.351，p=0.002）、体重指数（BMI；Cohen's d=0.056，p<0.001）、血脂异常比例（Cohen's d=0.068，p<0.001）和心血管疾病（Cohen's d=0.032，p=0.029）、治疗方案（Cohen's d=0.136，p<0.001）和慢性肝病问卷-非酒精性脂肪性肝病总评分（Cohen's d=-0.420，p<0.001）在未考虑阶段和考虑/行动阶段的 NAFLD 患者之间存在显著差异。逻辑回归确定 BMI（HR 0.659，95%CI 0.469 至 0.928，p=0.017）、心血管疾病（HR 2.161，95%CI 1.089 至 4.287，p=0.027）和甘油三酯（HR 0.751，95%CI 0.591 至 0.955，p=0.020）是预测心理改变的独立因素。
结果表明，NAFLD 患者中很少有处于行动阶段的心理状况。心理状况与 BMI、心血管疾病和甘油三酯因素显著相关。需要综合考虑多样性因素来评估心理改变。
