Simptome frecvente în hepatita cronică virală – manifestări extrahepatice sau simptome asociate?

Abstract

Rezumat Tabloul clinic în hepatitele cronice (HC) virale deseori este asimptomatic sau cu simptome minimale, care pot avea un spectru variat. Deseori este dificil de apreciat în ce măsură simptomul este rezultatul acțiunii patogenetice a virusului sau este unul asociat bolii de bază și se dezvoltă prin mecanisme adiționale, inclusiv psihosomatice. Scopul cercetării a fost de a studia prevalența tulburărilor de somn, a simptomelor de refl ux și dispeptice la bolnavii cu hepatite cronice virale în funcție de activitatea procesului hepatic și de prezența depresiei. În studiu au fost incluși 147 pacienți cu HC virale (B, C; D) și 29 persoane sănătoase în calitate de lot martor (LM). Toți participanții au fost examinați clinic și paraclinic. Chestionarele au conținut întrebări despre existența simptomelor de reflux (pirozis, regurgitații) și dispeptice (durere epigastrică, sindromul postprandial) la momentul examinării și în perioada antediagnostică. Statutul depresiv și formele de insomnie s-au determinat cu ajutorul testului Hamilton-21. Scoruri depresive au acumulat 85% din pacienți versus 14% în LM. Rezultatele au arătat o prevalență semnifi cativ mai mare a simptomelor de reflux și dispeptice după diagnosticarea HC virale comparativ cu perioada antediagnostică, în special din contul persoanelor depresive. Prevalența simptomelor gastrointestinale și a tulburărilor de somn în HC virale a fost superioară la pacienții depresivi versus cei nondepresivi și nu depinde de activitatea transaminazelor. Aceste rezultate tind să confi rme ipoteza că simptomele de reflux și dispeptice, la fel ca și tulburările de somn, sunt, într-o măsură mai mare, influențate de factorii psihosociali după depistarea bolii, decât să reprezinte manifestări extrahepatice datorate mecanismelor patogenetice ale hepatitei virale.

The clinical picture in chronic viral hepatitis (ChVH) could be often asymptomatic or presenting minimal, but very diverse symptoms. Sometimes it is difficult to determine whether the symptom is caused by viral infection pathogenic mechanisms or by manifestation of associated conditions, developed by additional psychosomatic mechanisms. The aim of this research was to study the prevalence of sleep disorders, reflux and dyspeptic symptoms in patients with ChVH, in dependence on the activity of the hepatic process and on the presence of depression. There were examined 147 patients with ChVH (B, C, D) and 29 healthy subjects served as a control group (CG). A clinical and paraclinical examination was conducted. The questionnaires contained questions about the presence of reflux symptoms (heartburn, regurgitation) and dyspepsia (epigastric pain, postprandial syndrome) at the time of the study and in the period prior to detection of hepatitis. Depression was assessed by the help of the Hamilton-21 scale, which contains information on various types of sleep disorders. The depression positive scales were found in as much as 85% of hepatitis patients and only 14% in CG. The results showed a significantly higher prevalence of reflux and dyspeptic symptoms after diagnosis of ChVH in comparison with the pre-diagnostic period, mainly in depressive patients. The prevalence of gastrointestinal symptoms and sleep disorders in ChVH was higher in depressed patients versus non-depressive ones; the activity of transaminases did not affect the frequency of these symptoms. These results tend to confirm the hypothesis that reflux and dyspeptic symptoms as well as sleep disorders are more likely influenced by psychosocial factors following the detection of the disease than being extrahepatic manifestations due to pathogenetic mechanisms of viral hepatitis.

Течение хронических вирусных гепатитов (ХВГ) часто протекает асимптоматично, или же болезнь протекает с минимальными, но весьма разнообразными симптомами. Часто бывает сложно определить насколько симптом обусловлен патогенетическими механизмами вирусной инфекции или же является проявлением сопутствующих основному заболеванию состояний, развивающихся по дополнительным механизмам, в том числе психосоматическим. Целью данного исследования было изучение частоты нарушений сна, симптомов рефлюкса и диспепсии у больных с ХВГ, в зависимости от активности печеночного процесса и от наличия депрессии. Обследовано 147 пациентов с ХВГ (D, C, D) и 29 здоровых человека в качестве контрольной группы (КГ). Было проведено клиническое и параклиническое обследование. Опросники содержали вопросы о наличии симптомов рефлюкса (изжога, регургитации) и диспепсии (эпигастральная боль, постпрандиальный синдром) к моменту исследования и в период до обнаружения гепатита. Депрессию оценивали по шкале Гамильтона-21, в которой содержится информация о различных типах нарушений сна. Депрессия обнаружена у 85% пациентов с ХВГ в сравнении с 14% в КГ. Результаты указывают значительно более высокую частоту симптомов рефлюкса и диспепсии после обнаружения ХВГ в сравнении с пре диагностическим периодом, в основном за счет депрессивных больных. Частота нарушений сна выше при депрессии, в сравнении с ее отсутствием при ХВГ. Активность трансаминаз не повлияла на частоту симптомов. Данные результаты говорят в пользу подтверждения гипотезы о главенствующей роли психосоматических механизмов в возникновении симптомов рефлюкса, диспепсии и нарушений сна после выявления ХГВ и в меньшей степени они являются следствием непосредственного патогенеза ХВГ.

The clinical picture in chronic viral hepatitis (ChVH) could be often asymptomatic or presenting minimal, but very diverse symptoms. Sometimes it is difficult to determine whether the symptom is caused by viral infection pathogenic mechanisms or by manifestation of associated conditions, developed by additional psychosomatic mechanisms. The aim of this research was to study the prevalence of sleep disorders, reflux and dyspeptic symptoms in patients with ChVH, in dependence on the activity of the hepatic process and on the presence of depression. There were examined 147 patients with ChVH (B, C, D) and 29 healthy subjects served as a control group (CG). A clinical and paraclinical examination was conducted. The questionnaires contained questions about the presence of reflux symptoms (heartburn, regurgitation) and dyspepsia (epigastric pain, postprandial syndrome) at the time of the study and in the period prior to detection of hepatitis. Depression was assessed by the help of the Hamilton-21 scale, which contains information on various types of sleep disorders. The depression positive scales were found in as much as 85% of hepatitis patients and only 14% in CG. The results showed a significantly higher prevalence of reflux and dyspeptic symptoms after diagnosis of ChVH in comparison with the pre-diagnostic period, mainly in depressive patients. The prevalence of gastrointestinal symptoms and sleep disorders in ChVH was higher in depressed patients versus non-depressive ones; the activity of transaminases did not affect the frequency of these symptoms. These results tend to confirm the hypothesis that reflux and dyspeptic symptoms as well as sleep disorders are more likely influenced by psychosocial factors following the detection of the disease than being extrahepatic manifestations due to pathogenetic mechanisms of viral hepatitis.