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目的:探讨酒精性肝硬化(alcoholic cirrhosis,AC)与肝炎后肝硬化(posthepatitic cirrhosis,PC)患者社会心理学的异同。方法:选取2016年1月至2016年6月于北京佑安院人工肝住院的AC患者40例及PC患者77例,对2组患者在一般社会学资料、临床特征以及心理学等方面进行对比分析。结果:AC患者以男性居多,其男性比例高于肝炎后肝硬化组,差异具有统计学意义(P<0.05);社会学方面,AC患者居住在城市的比例高于PC患者组(P<0.05);夫妻关系中,PC患者夫妻关系相比AC患者组较好,差异具有统计学意义(P<0.05)。2组患者在付费形式上略有不同,PC患者外地医保的比例稍高,差异具有统计学意义(P<0.05)。临床特征上,AC组患者黄疸、腹胀、腹痛、乏力、蜘蛛痣及肝病面容的发生率均明显高于PC组,差异均有统计学意义(均P<0.05)。心理学方面,AC患者组在是否有过自杀想法上阳性率达12.5%,明显高于PC组(0%),差异具有统计学意义(P<0.05)。进一步通过单因素及多因素logistic回归分析所有肝硬化(liver cirrhosis,LC)患者及AC患者自杀想法的危险因素发现,腹水为LC患者存在自杀想法的独立危险因素(OR=0.363,95%CI=0.134~0.982,P=0.046);户口的形式为AC患者存在自杀想法的独立危险因素(OR=11.549,95%CI=1.035~128.937,P=0.047),且农村户口的患者存在自杀想法的阳性率显著高于城市户口的患者(P<0.05)。结论:腹水可能为LC患者存在自杀倾向的危险因素,而AC患者比PC患者的社会心理学问题可能更为严重,尤其是农村户口的患者,临床诊疗过程中应给予更多的心理护理。
Objective: To explore the similarities and differences of social psychology between alcoholic cirrhosis (AC) and posthepatitic cirrhosis (PC). Methods: From January 2016 to June 2016, 40 AC patients hospitalized with artificial liver in Beijing You’an Hospital and 77 patients with PC were enrolled in this study. The general sociological data, clinical characteristics and psychology were compared between the two groups analysis. Results: The prevalence of AC in male patients was higher than that in post-hepatitis cirrhosis patients (P <0.05). In sociology, the proportion of AC patients living in urban areas was higher than that in PC patients (P <0.05) ). In the couple relationship, the relationship between husband and wife in PC patients was better than that in AC patients, the difference was statistically significant (P <0.05). There was a slight difference in the form of payment among the two groups. The proportion of PC patients in the field was slightly higher, with a statistically significant difference (P <0.05). Clinical features, the incidence of jaundice, abdominal distension, abdominal pain, fatigue, spider nevus and liver disease were significantly higher in AC group than in PC group (all P <0.05). In psychology, the positive rate of AC patients was 12.5%, which was significantly higher than PC group (0%), the difference was statistically significant (P <0.05). Further analysis of risk factors for suicidal ideation in all patients with cirrhosis (LC) and AC with univariate and multivariate logistic regression found that ascites was an independent risk factor for suicidal ideation in LC patients (OR = 0.363, 95% CI = (OR = 11.549, 95% CI = 1.035 ~ 128.937, P = 0.047), and the sufferers’ thoughts of suicidal ideation in rural areas were 0.134 ~ 0.982 (P = 0.046). The form of hukou was independent risk factors for suicidal thoughts in AC patients The rates were significantly higher in urban hukou patients (P <0.05). Conclusions: Ascites may be a risk factor for suicidal tendency in LC patients. However, the social psychology problems of AC patients may be more serious than that of PC patients. In particular, patients in rural areas should be given more psychological care in the clinical diagnosis and treatment.