Zheng Caixia, Zhong Chunxiu, Tang Qingyun, Xie Hongyan, Gao Xinrui, Li Bing, Yin Junhua, Wei Li
Department of Infectious Diseases, The First Affiliated Hospital of Xiamen University, Xiamen, China.
Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Front Public Health. 2025 Jun 13;13:1535916. doi: 10.3389/fpubh.2025.1535916. eCollection 2025.
Chronic hepatitis B (CHB) remains a significant public health challenge. Many CHB patients experience fatigue and impaired mental health, affecting their health-related quality of life (HRQoL). This study investigates the relationships between fatigue, well-being, and HRQoL, while identifying risk factors for poor well-being in CHB patients.
A cross-sectional study was conducted with 428 CHB patients. HRQoL, fatigue, and well-being were evaluated using the 36-Item Short Form Health Survey (SF-36), fatigue was measured using the Multidimensional Fatigue Inventory (MFI-20), and well-being was evaluated using the WHO-Five Well-Being Index (WHO-5). Logistic regression was conducted to evaluate the independent risk factor, and structural equation modeling was performed to explore the relationship between fatigue, well-being and HRQoL.
A total of 315 CHB patients were classified as having high well-being, and 113 as having low well-being, based on WHO-5 scores. Patients in the low well-being group were more likely to be female (26.5% vs. 9.5%, < 0.001), had lower body weight (60.88 ± 9.19 kg vs. 64.47 ± 10.96 kg, = 0.002), and a higher prevalence of cirrhosis (35.4% vs. 21.6%, = 0.004). Well-being scores were positively correlated with all eight HRQoL dimensions, and patients with higher well-being had significantly better HRQoL scores. Conversely, well-being was negatively correlated with fatigue levels, with higher fatigue scores linked to lower well-being. Structural equation modeling showed that fatigue significantly reduced well-being, which in turn decreased HRQoL. Multivariable analysis indicated that independent factors of poor well-being included female gender (OR = 2.692, = 0.004), lower weight (OR = 0.971, = 0.038), lower education level (OR = 0.642, = 0.028), lack of physical exercise (OR = 0.541, < 0.001), and cirrhosis (OR = 1.944, = 0.017). For patients with cirrhosis, only female gender (OR = 5.884, = 0.007) and lack of exercise (OR = 0.541, = 0.023) were significant factors.
Well-being mediates the relationship between fatigue and HRQoL in CHB patients, underscoring its critical role in improving patient outcomes. Interventions targeting well-being, such as promoting physical activity, may enhance HRQoL and overall mental health in CHB patients.
慢性乙型肝炎（CHB）仍然是一项重大的公共卫生挑战。许多CHB患者经历疲劳和心理健康受损，影响他们的健康相关生活质量（HRQoL）。本研究调查疲劳、幸福感与HRQoL之间的关系，同时确定CHB患者幸福感差的风险因素。
对428例CHB患者进行了一项横断面研究。使用36项简短健康调查（SF - 36）评估HRQoL、疲劳和幸福感，使用多维疲劳量表（MFI - 20）测量疲劳，使用世界卫生组织五福幸福感指数（WHO - 5）评估幸福感。进行逻辑回归以评估独立危险因素，并进行结构方程模型分析以探讨疲劳、幸福感与HRQoL之间的关系。
根据WHO - 5评分，共有315例CHB患者被归类为高幸福感，113例为低幸福感。低幸福感组的患者更可能为女性（26.5%对9.5%，<0.001），体重较低（60.88±9.19 kg对64.47±10.96 kg，=0.002），肝硬化患病率较高（35.4%对21.6%，=0.004）。幸福感得分与所有八个HRQoL维度呈正相关，幸福感较高的患者HRQoL得分明显更好。相反，幸福感与疲劳水平呈负相关，疲劳得分越高，幸福感越低。结构方程模型表明，疲劳显著降低幸福感，进而降低HRQoL。多变量分析表明，幸福感差的独立因素包括女性性别（OR = 2.692，=0.004）、体重较低（OR = 0.971，=0.038）、教育水平较低（OR = 0.642，=0.028）、缺乏体育锻炼（OR = 0.541，<0.001）和肝硬化（OR = 1.944，=0.017）。对于肝硬化患者，只有女性性别（OR = 5.884，=0.007）和缺乏锻炼（OR = 0.541，=0.023）是显著因素。
幸福感在CHB患者的疲劳与HRQoL之间起中介作用，强调了其在改善患者预后中的关键作用。针对幸福感的干预措施，如促进体育活动，可能会提高CHB患者的HRQoL和整体心理健康。
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