4. HBsAg carrying itself can not bring big impact on the original illness, but the most important influence of it is it can damage the liver and so threaten the patients’ health greatly, adding that GPT value is most meaningful in liver function test (13), so in this study we further discussed the relation between abnormal GPT value and HBsAg carrying, and taking Chi-Square Test as the analyzing method, with the result as no significant correlation exits, which was showed ain table 6. Moreover, the long term hospitalized schizophrenia patients need long-term psychiatric drugs treatment, while most psychiatric drugs is metabolised in the liver, adding that Alk-P is a very important test value index for drug related hepatitis (14), and that long term hospitalized schizophrenia patients especially the male have the habit of consuming beverages containing alcohol such as Baolida ect., and γ-GT value is relate to long term alcohol consumption behavior (15), so in this study we additionally analyzed the relations between γ-GT and Alk-P test value with abnormal GPT value, and the result showed that abnormal GPT value was significantly correlated with abnormal γ-GT (showed in table 7), but no significant correlation exists with abnormal Alk-P (showed in table 8). Then the data were sex classified, and Chi-Square Test were done to test abnormal GPT value with HBsAg carrying, abnormal γ-GT, and abnormal Alk-P value, with the finding as only male abnormal GPT value had significant correlation with abnormal γ-GT value, others had no significant correlation, as showed in table 6.
Table 6. Comparison of abnormal liver function with other blood biochemical values.
Discussion:
1. The study result of S.Chaudhury et al showed that chronic schizophrenia in-patients is a high risk group for hepatitis B infection (the HBsAg prevalence rate for chronic schizophrenia in-patients was 11%, which was far higher than control group as 2%), however, the result of this study was opposite to above observation, in which the HBsAg prevalence rate for chronic schizophrenia in-patients was insteadly significantly lower than that of common population. Although the HBsAg prevalence rate for chronic schizophrenia in-patients in that study was not very much more than that of this study which was 9.19%, the HBsAg prevalence rate for common people (13.98%) was far more higher than that of the control group in that study (2%), so we can reasonably deduced that the infection risk in this study had relatively increased much more. So the result of significant lowering HBsAg prevalence rate for chronic schizophrenia in-patients than common population showed that schizophrenia was not a risk factor for hepatitis B infection, and even can seen as a protection factor. The cause of higher HBsAg prevalence rate in chronic schizophrenia in-patients in the study made by S.Chaudhury et al might be that the quality of medication can influence the HBsAg prevalence rate including if disposible syringe can be used in all treatment during the patient’s life time, or if the patient had receive improper invasive traditional therapy, and if the shavers and tooth brushes were long term shared among patients etc., all of which can lead to the increase of HBsAg prevalence rate. So the HBsAg prevalence rate in long-term hospitalized patients can be lowered just with aseptic concept and good hygienic habit training, even that long-term hospitalization might be a protection factor for avoiding infceion.
2. We now further discuss why such differences happened, and can find that the main causation is the HBsAg prevalence rate for female patients was relatively low. According to that the infection pathway of hepatitis B can be vertical infection from mother to baby, blood communicating and body fluid infection including sexual behavior infection etc., and that the peculiarity of chronic psychiatric department female in-patients, and they are not easy to be favored by opposite sex for the matter of their illness, and that male and female patients were separated in different room, so the risk of sexual behavior infection is reduced, it can also said that generally the main pathway of hepatitis B infection for adult female is mostly from sex behavior, so if we want to effectively reduce the HBsAg carrying rate in the whole region, addition to hepatitis B prevention vaccination in infants and children now implemented, we can also do large scale prevention vaccination in birthing term females, surely apparent effect can be expected by doing this, because from doing this we can not only reduce the chance of horizontal infection of hepatitis B, but also the chance of vertical infection.
3. Be the carrier of hepatitis B or not itself has not special meaning in clinical, however, carrying of hepatitis B can bring damage to the liver, but in this study no significant correlation have been fund between hepatitis B carrying and abnormal liver function. Adding that psychiatric department patients accept long-term drug therapy with most psychiatric drugs metabolized via liver and Alk-P value has apparent correlation with drug related hepatitis, so from no meaningful correlation fund between these two after further probe the relation between abnormal GPT value and abnormal Alk-P value, it can be deduced that long term drug using is not really the cause of liver function impairing in non- psychiatric department patients, and this also offered an important supporting evidence for long term psychiatric drugs using.
In addition, some patients have the habit of alcohol consumption for the original disease of psychiatric department, so in this study we have also inspected the relation between abnormal γ-GT value and GPT value mostly related to alcoholic hepatitis, with the result showing significantly correlation between these two index, and further comparison with sex finding that the correlation between these two blood biochemical value mainly exist in male patients, which manifested that the abnormal liver function of male psychosis patients is mostly caused from long alcohol drinking habit, so restriction of the consumption amount of alcohol in male psychiatric patients will be able to reduce the incidence of liver diseases of male psychiatric patients.
We translated the Chinese document into English in 2002 for a doctor.
四．由于B型肝炎带原本身并不会造成病患重大影响，其最重要是会造成肝脏之损害，而对病患的健康有重大之威胁，且因肝功能检查中以GPT值最具意义(13)，所以本研究进一步探讨GPT值异常与B型肝炎带原之关系，并以卡方检定做为分析方法，检定后发现并没有有意义地相关如表六。另外因为长期住院之精神分裂症患者需接受长期精神科药物治疗，而大部份精神科用药是经由肝脏代谢，且因为Alk-P为药物引起肝炎的一个很重要的检验值指针(14)，加上有些长期住院之精神分裂症患者特别是男性，有习惯性饮用含有酒精成份的饮料（如保力达等），而γ-GT值与长期饮酒行为有关(15)故加做γ-GT和Alk-P两个检验值与GPT值异常之关系，结果发现GPT值异常与γ-GT异常呈现有意义地相关如表七，但与Alk-P异常则没有有意义地相关如表八。再以性别做分类进行GPT值异常与B型肝炎带原、γ-GT异常、Alk-P值异常进行卡方检定分析，发现只有男性之GPT值异常与γ-GT异常呈现有意义地相关，其它皆无有意义之相关性如表六。
表六　肝功能异常与其它血液生化值之比较
讨论
（一）依据S.Chaudhury et al的研究结论为慢性精神分裂症住院病人为感染B型肝炎的高危险族群（慢性精神分裂症住院病人之HBsAg盛行率11%远高于对照组2%），然而本研究结果则相反，反而是慢性精神分裂症住院病人HBsAg盛行率有意义地低于一般人口的盛行率，虽然该研究之精神分裂症病人HBsAg盛行率并未高于本研究精神分裂症病人HBsAg盛行率9.19%甚多，但本国一般民众之盛行率13.98%远高于其对照组之盛行率2%，因此也可以合理推论本研究之样本受到感染之机率也相对增高许多，因此，上述慢性精神分裂症住院病人g盛行率有意义地低于一般人口的盛行率的结果，显示罹患精神分裂症并非感染B型肝炎的危险因子，甚至可以说是一保护因子。而S.Chaudhury et al所做的研究中慢性精神分裂症住院病人HBsAg盛行率较高的结果，推断其原因有可能是因为医疗品质的高低，左右着B型肝炎的盛行率，包括是否在病人一生接受之所有治疗都能完全使用拋弃式注射针头，或是病患曾有接受过不当之侵入性民俗疗法，以及病患间长期共享刮胡刀及牙刷．．．等，都有可能造成盛行率的提高，所以只要有无菌的医疗观念，以及好的卫生习惯的训练，是可以降低长期住院病人HbsAg的盛行率，甚至可以说长期住院是避免感染的保护因子。
（二）进一步再探讨为何会造成如此之差异，可以发现到最主要原因是因为女性病患之HBsAg盛行率较低。根据B型肝炎的感染途径有可能经由母子垂直感染、血液感染、以及体液感染包括性行为感染．．．等，针对慢性精神科女性住院病患的特性来论，其因为患病的关系造成其较不受到异性之青睐，且住院后男女分房，故也降低了从性行为感染的机率，因此可以说一般女性其成年后的B型肝炎感染途径，有大部分是来自于性行为，如果想要有效降低全国B型肝炎带原率，除了现行之婴幼儿全面施打B型肝炎预防注射外，可以从有生育能力之女性做大规模之预防注射，预期将会有明显之效果，因为如此不仅可以降低B型肝炎水平传染之机会，也可以降低B型肝炎垂直传染之机会。
（三）是否为B型肝炎带原本身在临床上并没有特别的意义，主要是B型肝炎带原可能会对肝脏产生危害，然而在本研究中发现B型肝炎带原与肝功能异常并没有有意义地相关。且因为精神科病患长期接受药物治疗，精神科药物又大部份经由肝脏代谢，而Alk-P值与药物性肝炎有明显相关，于是进一步探讨GPT值异常与Alk-P值异常的关系后，发现两者并没有有意义地相关，故推论长期服用药物并非精神科病患有肝脏机能损害之原因，故也给予长期使用精神科药物的安全性一个重要的支持证据。
另外由于精神科病患因本身疾病之因素，其部份之病患有喝酒之习惯，因此本研究也检视与酒精性肝炎最有相关性的γ-GT值异常与GPT值异常之关系，结果发现两者呈现有意义之相关，再以性别做比对，更可发现到主要是男性的血液生化值中两者有相关，显示男性精神病患肝功能异常可能大部份是因长期喝酒习惯所引起的，因此限制男性精神病患的饮酒量，将可减低男性精神病患的肝疾患发生率。