• <tr id="yyy80"></tr>
  • <sup id="yyy80"></sup>
  • <tfoot id="yyy80"><noscript id="yyy80"></noscript></tfoot>
  • 99热精品在线国产_美女午夜性视频免费_国产精品国产高清国产av_av欧美777_自拍偷自拍亚洲精品老妇_亚洲熟女精品中文字幕_www日本黄色视频网_国产精品野战在线观看 ?

    Fatigue in patients with inflammatory bowel disease in Eastern China

    2021-04-01 09:15:18ShanShanGongYiHongFanBinLvMieQingZhangYiXuJingZhao
    World Journal of Gastroenterology 2021年11期
    關(guān)鍵詞:整群生物醫(yī)學(xué)建筑學(xué)

    Shan-Shan Gong, Yi-Hong Fan, Bin Lv, Mie-Qing Zhang, Yi Xu, Jing Zhao

    Abstract

    Key Words: Inflammatory bowel disease; Fatigue; Quality of life; Work productivity; Risk factors; Eastern China

    INTRODUCTION

    Inflammatory bowel disease (IBD) is a chronic, nonspecific inflammation of the gastrointestinal tract with an unknown etiology that can be classified as ulcerative colitis (UC) and Crohn's disease (CD)[1]. IBD has a high prevalence in young adults and is characterized by a long course, high recurrence rate, and severe complications (such as toxic megacolon, intestinal perforation, intestinal obstruction, intestinal bleeding, and cancer)[2]. Mucus-bloody stools, diarrhea, abdominal pain, weight loss, and anemia are the main clinical manifestations of IBD[3], which seriously impact the quality of life (QoL) of patients and increase the financial burden.

    Fatigue is expressed as an overwhelming experience of mental and/or physical exhaustion that affects daily living and is unrelieved by rest or sleep[4,5]. Studies in several countries have shown that fatigue is common in patients with IBD[6-10]. Some studies have found that fatigue is associated with active enteritis[11], especially with mucosal healing in patients with IBD[12]. In addition, fatigue also has a negative psychological impact on patients with IBD, exacerbating clinical symptoms and promoting disease progression[13]. Even as a result of fatigue, IBD patients have to adjust their daily activities and work, and some even choose to resign, which seriously affects their QoL[14]and increases their financial burden[15]. Fatigue is a very common but relatively neglected problem in IBD patients, especially in China. The prevalence rate of IBD in China is the highest in Asia[16], but there is little research on fatigue in patients with IBD. In addition, the relationship between fatigue and QoL and work productivity (WP) in Chinese IBD patients has not been reported.

    In this study, we aimed to investigate the prevalence and risk factors for fatigue in patients with IBD in Eastern China through a cross-sectional study. We also determined the relationships between fatigue and QoL and WP to evaluate the impact of fatigue on IBD patients in Eastern China.

    MATERIALS AND METHODS

    Study population

    This cross-sectional study was conducted at the First Affiliated Hospital of Zhejiang Chinese Medical University, a Regional Tertiary IBD Diagnostic and Treatment Center in Eastern China, from February 2018 to August 2020. The inclusion criteria were a confirmed diagnosis of IBD and signed informed consent. The diagnostic criteria for IBD were based on the Chinese consensus on the diagnosis and treatment of IBD[17]. The exclusion criteria were the inability to understand or complete the questionnaires, refusal to give written informed consent before participation, and concomitant diseases with fatigue as the main symptoms, such as cancer, heart disease, or liver cirrhosis. This study was registered at the Chinese Clinical Trials Registry (ChiCTR1900025890).

    Ethics

    This study was approved by the ethics committee of the First Affiliated Hospital of Zhejiang Chinese Medical University, and informed consent was obtained from all participants. Patients under the age of 16 were admitted to our study with consent from their parents or guardians.

    Clinical and sociodemographic data

    The demographic characteristics of the patients were collected, including age, sex, body mass index (BMI), course of the disease, current smoking habits, IBD-related surgery (such as colectomies, other bowel surgery, and perianal surgery), disease activity, type of IBD, location of disease, and current medications. Blood samples were collected (within one week before and after completion of the questionnaires) and analyzed for hemoglobin, albumin, and erythrocyte sedimentation rate.

    Definitions

    Disease activity and severity were assessed using the following clinical indices: Harvey-Bradshaw activity index[18]was used for CD. Mayo score and Truelove and Witts criteria[19]were used for UC. Anemia was defined as hemoglobin < 130 g/L for males and < 120 g/L for females. Hypoalbuminemia was defined as albumin < 35 g/L. BMI was based on the Chinese criteria of weight for adults[20]. Underweight was defined as BMI < 18.5 kg/m2; normal weight was defined as 18.5 kg/m2≤ BMI < 24.0 kg/m2; overweight was defined as 24.0 kg/m2≤ BMI < 28.0 kg/m2; and obesity was defined as BMI ≥ 28.0 kg/m2.

    The significance level of coefficients is indicated only when they reach the 0.001 criterion. The following cutoffs were used to define the magnitude of the correlation coefficients: < 0.25, low correlation; 0.25 to 0.5, fair correlation; 0.5 to 0.75, moderate-togood correlation; and > 0.75, good-to-excellent correlation[21].

    Questionnaires

    Fatigue was analyzed using the multidimensional fatigue inventory (MFI; ranging from 20 to 100, with higher scores indicating more severe fatigue). This questionnaire, previously validated in Chinese and for IBD patients[22], comprises 20 items divided into five subscales: General fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue[23]. The definition of fatigue was complicated by a lack of clear cutoff scores. Several studies have found that scales of general fatigue are more psychometrically useful than the use of numerical rating scales, so the MFI of general fatigue can be called "fatigue"[24-26]. Combining the values reported in a domestic study[27]and foreign studies[28-30]on the MFI, fatigue was defined as general fatigue score ≥ 12.

    Depression was analyzed using the Patient Health Questionnaire-9 (PHQ-9), which has been validated in Chinese IBD patients[31]. The PHQ-9 scores each of the 9 DSM-IV criteria on a scale ranging from "0" (not at all) to "3" (nearly every day). The total PHQ-9 score that categorizes depression is as follows: Nondepression as 0 ≤ PHQ-9 ≤ 4, mild depression as 5 ≤ PHQ-9 ≤ 9, moderate depression as 10 ≤ PHQ-9 ≤ 14, moderatesevere depression as 15 ≤ PHQ-9 ≤19, and severe depression as 20 ≤ PHQ-9 ≤ 27[32].

    The generalized anxiety disorder 7-item scale was completed to measure symptoms of anxiety and has been validated in Chinese patients with IBD[31]. The generalized anxiety disorder 7-item scale is a 7-item self-report instrument that is scaled from 0–3 (not at all, several days, more than half the days, and nearly every day), with total scores ranging from 0 to 21, and it is interpreted as follows: The absence of anxiety (0-4), mild anxiety (5-9), moderate anxiety (10-14), and severe anxiety (15-21)[33].

    問卷調(diào)查采用分層整群抽樣方法,選擇工程學(xué)院電氣工程與自動化、電子信息科學(xué)與技術(shù)、生物醫(yī)學(xué)工程、建筑學(xué)和物理學(xué)5個專業(yè)共20個自然班的學(xué)生作為調(diào)研對象,于2017年4月隨機(jī)抽取樣本發(fā)放問卷進(jìn)行調(diào)查。

    The Short Inflammatory Bowel Disease Questionnaire (SIBDQ) was used to assess IBD-specific QoL[34]. The SIBDQ includes 10 items, each with a score from 1 (worst) to 7 (best), with the total score ranging from 10 to 70 (the higher the score, the better the QoL). Furthermore, the SIBDQ has four domains: Bowel symptoms, systemic symptoms, emotional function, and social function.

    The work productivity and activity impairment general health questionnaire[35]measures time missed from work and work impairment because of IBD in the past week. The work productivity and activity impairment general health questionnaire includes four items: Work time missed (absenteeism), impaired productivity at work (presenteeism), overall work impairment (OWI; combined absenteeism and presenteeism), and impairment in non-work-related activities due to health problems (activity impairment). Absenteeism was calculated as [hours missed due to health problems/ (hours missed due to health problems + hours worked)] × 100; presenteeism was calculated as (degree health affected productivity while working/10) × 100; OWI was calculated as absenteeism + [(1-absenteeism) × presenteeism]; and (4) daily activity impairment was calculated as (degree of health affected daily activities/10) × 100.

    Statistical analysis

    Quantitative variables are expressed as the mean ± SD or as medians and interquartile range (IQR), and qualitative variables are expressed as frequencies and percentages. After transforming fatigue from a quantitative to a qualitative variable (with/without fatigue), logistic regression analyses were performed. Variables with P < 0.05 in the univariate analysis were included in the multivariate analysis, and the results are expressed as odds ratios (ORs) with their corresponding 95% confidence intervals (CIs). Correlations between fatigue and QoL and WP were measured with Spearman's rank correlation coefficient. Statistical analyses were performed using Statistic Package for Social Science 24 (Statistic Package for Social Science Inc., Chicago, IL, United States), and P < 0.05 was considered statistically significant.

    RESULTS

    IBD patients’ demographic and clinical characteristics

    A total of 311 IBD patients, including 168 CD and 143 UC patients, were enrolled in this study. The participants had a median age of 42 (IQR: 31-53) years. Most of the participants had health insurance (90.35%, n = 281) and were married (74.28%, n = 231). There were 212 (68.17%) patients who had a job, of whom 208 (66.88%) were working full-time. Regarding the duration of disease, the participants reported a median of 5 (IQR: 2-12) years. A total of 51.45% of IBD patients were in the active phase of the disease, and 32.80% of participants had IBD-related surgery. The demographic and clinical characteristics of IBD patients are summarized in Table 1.

    Prevalence and score of fatigue in patients with IBD

    The prevalence of fatigue in patients with IBD was 60.77%, including 71.88% in patients with active IBD and 49.01% in patients in remission. The median fatigue total score was 43 (IQR: 33-59) in IBD patients, and the median general fatigue, physical fatigue, mental fatigue, reduced activity, and reduced motivation scores were 12 (IQR: 9-15), 8 (IQR: 6-12), 9 (IQR: 6-12), 7 (IQR: 4-9), and 7 (IQR: 4-12), respectively (Figure 1).

    Factors associated with fatigue

    The univariate analysis showed that disease activity (P < 0.001, OR = 2.659; 95%CI: 1.663-4.253), depression (P < 0.001, OR = 13.722; 95%CI: 7.608-24.749), anxiety (P < 0.001, OR = 8.134; 95%CI: 4.351-15.204), anemia (P < 0.001, OR = 3.792; 95%CI: 2.232-6.440), and IBD-related surgery (P < 0.05, OR = 1.654; 95%CI: 1.004-2.727) were associated with the presence of fatigue (Figure 2A).

    Multivariate logistic regression analysis indicated that depression (P < 0.001, OR = 8.078, 95%CI: 4.113-15.865), anxiety (P = 0.028, OR = 2.373, 95%CI: 1.100-5.119), anemia (P = 0.007, OR = 2.498, 95%CI: 1.290-4.834), and IBD-related surgery (P = 0.027, OR =2.035, 95%CI: 1.084-3.819) were related to fatigue in IBD patients (Figure 2B).

    Table 1 Demographic and clinical characteristics of inflammatory bowel disease patients

    CD: Crohn's disease; UC: Ulcerative colitis; IBD: Inflammatory bowel disease; 5-ASA: 5-aminosalisylic acid; IQR: Interquartile range; IS: Immunosuppressant.

    Figure 1 Fatigue score in the inflammatory bowel disease patients. The solid line indicates the median, and the dotted line indicates the interquartile range. The small insert within the graphs in Figure 1 enlarges the scores of the five subscales of multidimensional fatigue inventory (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue) in the inflammatory bowel disease patients.

    Fatigue and QoL

    The median QoL total score was 53 (IQR: 44-62), and the median scores of bowel symptoms, social function, emotional function, and systemic symptoms were 17 (IQR: 13-20), 12 (IQR: 9-13), 9 (IQR: 6-12), 15 (IQR: 11-19), and 11 (IQR: 10-13), respectively (Figure 3). Fatigue was negatively correlated with QoL (r = - 0.831; P < 0.0001), particularly with emotional function (r = -0.721; P < 0.0001) (Figure 4A). Further analysis revealed that general fatigue (r = -0.785; P < 0.0001) showed a good-toexcellent correlation with negative QoL, and reduced activity (r = -0.731; P < 0.0001) and psychological fatigue (r = -0.704; P < 0.0001) showed a moderate-to-good correlation with negative QoL (Figure 4B).

    Fatigue and WP

    Figure 2 Factors associated with the presence of fatigue. A: Univariate analysis; B: Multivariate analysis. OR: Odds ratio; IBD: Inflammatory bowel disease.

    Figure 3 Quality of life score in the inflammatory bowel disease patients. The solid line indicates the median, and the dotted line indicates the interquartile range. The small insert within the graphs in Figure 3 enlarges the scores of the four domains of short inflammatory bowel disease questionnaire (bowel symptoms, systemic symptoms, emotional function, and social function) in the inflammatory bowel disease patients.

    There were 208 (66.88%) patients who were working full-time, and their prevalence of fatigue was 58.65%. Further analysis found that their median total fatigue score was 41 (IQR: 32.25-58), with median general fatigue, physical fatigue, mental fatigue, reduced activity, and reduced motivation scores of 12 (IQR: 9-15), 9 (IQR: 7-12), 9 (IQR: 6-11), 6 (IQR: 4-9), and 6 (IQR: 4-11), respectively (Figure 5). Fatigue had the strongest positive correlation with OWI (r = 0.605; P < 0.0001), followed by activity impairment (r = 0.566; P < 0.0001), presenteeism (r = 0.543; P < 0.0001), and absenteeism (r = 0.480; P < 0.0001) (Figure 6A). Compared with physical fatigue, mental fatigue, reduced activity, and reduced motivation, general fatigue was the most strongly associated with WP loss (OWI: r = 0.552, P < 0.0001; activity impairment: r = 0.549, P < 0.0001; presenteeism: r = 0.519, P < 0.0001; absenteeism: r = 0.442, P < 0.0001) (Figure 6B).

    Figure 4 Fatigue and quality of life. A: Correlation between total fatigue scores and quality of life scores (total quality of life scores: Spearman’s r = -0.831, P < 0.0001; emotional function: Spearman’s r = -0.721, P < 0.0001) in the inflammatory bowel disease patients; B: Correlation between total quality of life scores and fatigue (general fatigue: Spearman’s r = -0.785, P < 0.0001; reduced activity: Spearman’s r = -0.731, P < 0.0001; psychological fatigue: Spearman’s r = -0.704, P < 0.0001) in the inflammatory bowel disease patients.

    Figure 5 Fatigue score in inflammatory bowel disease patients with full-time jobs. The solid line indicates the median, and the dotted line indicates the interquartile range. The small insert within the graphs in Figure 5 enlarges the scores of the five subscales of multidimensional fatigue inventory (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue) in the inflammatory bowel disease patients.

    DISCUSSION

    In the present study, we found that the prevalence of fatigue in patients with IBD in Eastern China was 60.77%, including 71.88% in the active stage and 49.01% in the remission stage. Major factors associated with fatigue were depression, anxiety, anemia, and IBD-related surgery. Female sex, disease activity, and hypoalbuminemia do not increase the risk of fatigue. In addition, fatigue had a negative impact on QoL and was positively correlated with WP loss.

    Figure 6 Fatigue and work productivity. A: Correlation between total fatigue scores and work productivity loss [overall work impairment: Spearman’s r = 0.605, P < 0.0001; activity impairment: Spearman’s r = 0.566, P < 0.0001; presenteeism: Spearman’s r = 0.543, P < 0.0001; absenteeism: Spearman’s r = 0.480, P < 0.0001] in inflammatory bowel disease patients with full-time jobs; B: Correlation between general fatigue and work productivity loss (overall work impairment: Spearman’ s r = 0.552, P < 0.0001; activity impairment: Spearman’s r = 0.552, P < 0.0001; presenteeism: Spearman’s r = 0.552, P < 0.0001; absenteeism: Spearman’s r = 0.552, P < 0.0001) in inflammatory bowel disease patients with full-time jobs. OWI: Overall work impairment.

    Multifactorial analysis showed that depression and anxiety were risk factors for fatigue, and depression, in particular, is the strongest risk factor for fatigue. Several previous studies are consistent with our findings[36-38]. In chronic diseases, fatigue and psychiatric disorders such as depression and anxiety coexist[39,40], including IBD[41]. The immune-inflammatory pathway and gut-brain axis may be possible pathways for the coexistence of fatigue and psychological disorders in IBD[39-42]. One of the reasons for such a high prevalence of fatigue and psychiatric comorbidity in patients with IBD in Eastern China may be due to limited therapeutic drug options. The use of biologics as an effective treatment for IBD in China is very limited. First, the options are limited, with only infliximab entering the Chinese market. When IBD patients fail to respond to infliximab therapy, they are faced with the situation of either having no drugs available or using hormones with more side effects. Second, it is expensive, as only CD is reimbursed by health insurance, which increases the financial burden of patients. The limited availability of medication, the recurrence of disease symptoms, the side effects of hormone therapy, and the heavy financial burden contribute to the development of fatigue and psychiatric disorders in Chinese patients with IBD. Anemia is the most common extraintestinal manifestation of IBD, which occurs in up to 20% of outpatients and up to 68% of inpatients with IBD[43,44]. The major causes of anemia in IBD are iron[45], vitamin B12, and folic acid deficiency[46]. The side effects or complications of some drugs for IBD are anemia. For example, methotrexate can lead to folic acid deficiency and megaloblastic anemia[47]. One of the side effects of azathioprine and 6-mercaptopurine is myelosuppression[48]. Sulfadiazine and 5-aminosalicylate have rare hemolytic complications[49,50]. The relationship between fatigue and IBD-related surgery has rarely been reported. In our study, IBD-related surgery was found to be a risk factor for fatigue in IBD patients, which may be related to postoperative complications, postoperative pain, fear of stoma care, environmental (especially family) reactions, and acceptance of new conditions[29,51,52]. However, a clinical study in Poland that included 60 IBD patients concluded that surgical treatment reduced fatigue symptoms[53], which was contrary to the findings of our study. The difference may be due to different sample sizes, and our study has a larger sample size. In addition, the study in Poland compared the fatigue scores at one day before surgery and three months after surgery. The clinical symptoms of patients at 3 mo after operation were improved, but the postoperative complications were not fully exposed. Our study included not only patients at 3 mo after the operation but also patients many years after operation and repeated surgery. Postoperative complications, disease activity, the annoyance of anastomotic care, and fear of reoperation were fully exposed. All of these factors will lead to fatigue in IBD patients. Surprisingly, female sex, disease activity, and hypoalbuminemia did not significantly increase fatigue among IBD patients in Eastern China. In previous studies[37,54], female sex was found to be a strong predictor of fatigue, but no good explanation for this association was found. Our study, however, found that female sex was not a risk factor for fatigue. This may have been because of the small sample size in our study. The association between fatigue and disease activity in IBD is controversial. Fatigue scores were higher and more frequent among IBD patients with active disease than in the reference population and among those with quiescent IBD, but contrasts with the findings of others[9,36,55]. In this study, univariate analysis showed that disease activity was a risk factor for fatigue but not in multivariate analyses. Therefore, more research is needed to clarify the relationships between female sex and disease activity and fatigue in Chinese patients with IBD. The common symptom of hypoalbuminemia is fatigue, but our findings suggest that it is not a risk factor for fatigue in patients with IBD in Eastern China. This may have been because of the small number of patients affected (29.3% of all those studied) or because fatigue was strongly associated with other factors, such as depression, anemia, anxiety, or IBD-related surgery.

    Risk factors for fatigue, such as depression, anxiety, anemia, and IBD-related surgery, were found to decrease QoL in IBD patients in previous studies[56-59], which explained why fatigue also leads to a decrease in QoL in IBD patients. Our further analysis found that psychological factors are particularly important in the relationship between fatigue and QoL. To improve the QoL of patients with IBD, the risk factors for fatigue should be identified and corrected in time to prevent the occurrence of fatigue. In addition to the impact on the QoL of the patient, fatigue can also lead to WP loss or even unemployment, which has significant economic consequences. Our study found that fatigue had an impact on the OWI, activity impairment, presenteeism, and absenteeism, among which general fatigue had the strongest impact. The appeal conclusion showed that the effect of fatigue on WP loss was also the result of a comprehensive effect, in which physical and psychological factors played an important role.

    Although fatigue and its negative consequences are common in patients with IBD, the issue is rarely discussed in China. The underlying cause may be fatigue, especially during remission, which is considered a difficult and frustrating symptom, and the risk factors for fatigue are unclear, so there is little opportunity to help patients. Indeed, in China, there are few studies on the relationship between IBD and fatigue, which cannot provide clinical guidance. It is hoped that our findings will draw the attention of clinicians and patients to the role of fatigue in patients with IBD, improve the QoL of patients with IBD, and reduce the loss of WP by intervening in risk factors that contribute to fatigue. For example, in clinical practice, the joint management of patients' fatigue and psychological disorders is very important. Patients with depression and anxiety should pay close attention to their fatigue through targeted psychological counseling and intervention, such as health lectures, psychological counseling, individual counseling, and other ways to reduce patients' depression and anxiety, improve patients' fatigue, promote patients' health, and improve their QoL. IBD patients with anemia should correct their anemia in time. For IBD patients who have undergone surgery, postoperative complications, postoperative pain, and patients' fear of colostomy nursing should be properly addressed.

    There are several limitations to our study. First, the size of the study sample was too small. Further large sample size studies are warranted for a more accurate estimation of the prevalence of fatigue and definitive identification of risk factors for fatigue. Second, our study was a single-center clinical study, which cannot represent the overall situation of IBD patients in China.

    CONCLUSION

    In conclusion, we have shown that the prevalence of fatigue is considerably high in patients with IBD in Eastern China, even in clinical remission, and the risk factors for fatigue are depression, anxiety, anemia, and IBD-related surgery. Female sex, disease activity, and hypoalbuminemia do not increase the risk of fatigue. In addition, fatigue reduces the QoL of IBD patients in Eastern China and damages WP. The results of our study provide a scientific basis for effectively preventing and improving fatigue in IBD patients.

    ARTICLE HIGHLIGHTS

    ACKNOWLEDGEMENTS

    The authors would like to thank the study participants.

    猜你喜歡
    整群生物醫(yī)學(xué)建筑學(xué)
    階梯整群隨機(jī)試驗(yàn)
    芻議“生物醫(yī)學(xué)作為文化”的研究進(jìn)路——兼論《作為文化的生物醫(yī)學(xué)》
    基于整群隨機(jī)樣本評估的簡單隨機(jī)抽樣精度探討
    靈長類生物醫(yī)學(xué)前沿探索中的倫理思考
    高層建筑設(shè)計(jì)中生態(tài)建筑學(xué)的應(yīng)用分析
    建筑學(xué)中綠色建筑設(shè)計(jì)的發(fā)展趨勢分析
    建筑學(xué)與建筑設(shè)計(jì)現(xiàn)狀淺析
    見山樓的建筑學(xué)意味
    國外生物醫(yī)學(xué)文獻(xiàn)獲取的技術(shù)工具:述評與啟示
    為什么整群豬圍攻一頭豬
    久久综合国产亚洲精品| 波野结衣二区三区在线| 亚洲自拍偷在线| 免费播放大片免费观看视频在线观看| 国精品久久久久久国模美| 亚洲精品成人av观看孕妇| 天堂网av新在线| 尾随美女入室| 91久久精品电影网| 777米奇影视久久| 久久99热这里只有精品18| 黄色怎么调成土黄色| 热99国产精品久久久久久7| 国产乱人偷精品视频| 色5月婷婷丁香| 99视频精品全部免费 在线| 永久免费av网站大全| 我的老师免费观看完整版| 亚洲电影在线观看av| 国产老妇女一区| 欧美三级亚洲精品| 人人妻人人澡人人爽人人夜夜| 成人午夜精彩视频在线观看| 老师上课跳d突然被开到最大视频| 在线免费观看不下载黄p国产| 97精品久久久久久久久久精品| 日本欧美国产在线视频| 少妇猛男粗大的猛烈进出视频 | 又大又黄又爽视频免费| 免费观看av网站的网址| 人妻制服诱惑在线中文字幕| 亚洲丝袜综合中文字幕| 特大巨黑吊av在线直播| 日韩亚洲欧美综合| 国产黄片视频在线免费观看| 欧美另类一区| 亚洲欧美精品专区久久| h日本视频在线播放| 波多野结衣巨乳人妻| av专区在线播放| 80岁老熟妇乱子伦牲交| 午夜视频国产福利| 国产乱人偷精品视频| 晚上一个人看的免费电影| 国产精品99久久99久久久不卡 | 伦理电影大哥的女人| 一级毛片aaaaaa免费看小| 人妻系列 视频| 男人和女人高潮做爰伦理| 午夜免费鲁丝| 97在线视频观看| 日韩中字成人| 国产成人精品久久久久久| 精品国产一区二区三区久久久樱花 | 在线精品无人区一区二区三 | 男人狂女人下面高潮的视频| 亚洲欧美一区二区三区国产| 成人毛片60女人毛片免费| 亚洲人成网站高清观看| 国产亚洲一区二区精品| 精品少妇久久久久久888优播| 九色成人免费人妻av| 亚洲一级一片aⅴ在线观看| 日本午夜av视频| 成人毛片a级毛片在线播放| 尾随美女入室| 免费看不卡的av| 中文字幕亚洲精品专区| 国产精品99久久99久久久不卡 | 日韩视频在线欧美| 国产探花在线观看一区二区| 亚洲国产精品国产精品| 下体分泌物呈黄色| 日日摸夜夜添夜夜爱| 激情 狠狠 欧美| 精品午夜福利在线看| 色视频在线一区二区三区| 色婷婷久久久亚洲欧美| 婷婷色综合www| 嫩草影院新地址| 久久久精品欧美日韩精品| 色视频在线一区二区三区| 免费观看性生交大片5| 亚洲aⅴ乱码一区二区在线播放| 激情 狠狠 欧美| 高清日韩中文字幕在线| 国产高潮美女av| 国产男女超爽视频在线观看| 联通29元200g的流量卡| 老女人水多毛片| 极品教师在线视频| 成人鲁丝片一二三区免费| 美女高潮的动态| 狂野欧美白嫩少妇大欣赏| av女优亚洲男人天堂| 久久久久网色| 综合色丁香网| 噜噜噜噜噜久久久久久91| 日韩大片免费观看网站| 黄片wwwwww| 欧美日韩视频精品一区| 亚洲精品亚洲一区二区| 国产精品久久久久久久电影| 麻豆成人av视频| 成人一区二区视频在线观看| 中文字幕人妻熟人妻熟丝袜美| 久久精品国产亚洲av天美| 热99国产精品久久久久久7| 高清欧美精品videossex| 一二三四中文在线观看免费高清| 69av精品久久久久久| 免费观看无遮挡的男女| 欧美激情在线99| 啦啦啦中文免费视频观看日本| 亚洲最大成人av| 97在线视频观看| 综合色av麻豆| 超碰av人人做人人爽久久| 国产成人精品婷婷| 久久人人爽人人爽人人片va| 一边亲一边摸免费视频| 男女下面进入的视频免费午夜| 久久精品人妻少妇| 国内少妇人妻偷人精品xxx网站| 精品视频人人做人人爽| 国产成人免费无遮挡视频| 国产男人的电影天堂91| 亚洲综合色惰| 一级毛片黄色毛片免费观看视频| 成人亚洲欧美一区二区av| 亚洲欧美精品自产自拍| 成人毛片60女人毛片免费| 日韩欧美 国产精品| 免费看a级黄色片| 最新中文字幕久久久久| 亚洲天堂av无毛| 亚洲av日韩在线播放| 天堂中文最新版在线下载 | 交换朋友夫妻互换小说| 99精国产麻豆久久婷婷| 伦理电影大哥的女人| 亚洲成色77777| 肉色欧美久久久久久久蜜桃 | 午夜免费鲁丝| 欧美日韩视频高清一区二区三区二| 日日摸夜夜添夜夜爱| 在线观看免费高清a一片| 美女xxoo啪啪120秒动态图| 99久久中文字幕三级久久日本| 看非洲黑人一级黄片| 亚洲av男天堂| 国产精品女同一区二区软件| 国产国拍精品亚洲av在线观看| 少妇被粗大猛烈的视频| 中文欧美无线码| 少妇人妻一区二区三区视频| 少妇丰满av| 精品久久久久久久久av| 国产亚洲午夜精品一区二区久久 | 欧美xxxx黑人xx丫x性爽| 狂野欧美激情性xxxx在线观看| 最新中文字幕久久久久| 精品国产三级普通话版| 亚洲av.av天堂| 日韩三级伦理在线观看| 亚洲伊人久久精品综合| 一级毛片电影观看| 色视频在线一区二区三区| 日韩成人av中文字幕在线观看| 一级毛片电影观看| 青春草亚洲视频在线观看| 国产高清有码在线观看视频| 国产精品久久久久久av不卡| 噜噜噜噜噜久久久久久91| 男女国产视频网站| 欧美另类一区| 成人特级av手机在线观看| 久久久久久国产a免费观看| a级毛片免费高清观看在线播放| 亚洲国产精品成人综合色| 毛片一级片免费看久久久久| 王馨瑶露胸无遮挡在线观看| 老司机影院成人| 美女高潮的动态| 国产欧美日韩一区二区三区在线 | 69av精品久久久久久| 一个人观看的视频www高清免费观看| 一二三四中文在线观看免费高清| 精品一区二区三区视频在线| 亚洲精品日本国产第一区| 啦啦啦啦在线视频资源| 国产成人a区在线观看| 青春草视频在线免费观看| 一级毛片aaaaaa免费看小| 免费av观看视频| 国产黄片美女视频| 麻豆久久精品国产亚洲av| 国产 一区精品| 国产成年人精品一区二区| 国产欧美另类精品又又久久亚洲欧美| 国产精品三级大全| 男女边吃奶边做爰视频| 听说在线观看完整版免费高清| 亚洲欧美日韩卡通动漫| 亚洲av免费高清在线观看| 熟女人妻精品中文字幕| 天堂俺去俺来也www色官网| 中文字幕免费在线视频6| 国产高清三级在线| 国产伦理片在线播放av一区| 91久久精品电影网| 亚洲欧美日韩无卡精品| 国产精品久久久久久精品电影| av免费在线看不卡| 欧美少妇被猛烈插入视频| 在线观看美女被高潮喷水网站| 欧美日韩国产mv在线观看视频 | 黄色怎么调成土黄色| 一本久久精品| 成人二区视频| 久久精品国产亚洲av涩爱| 久久久午夜欧美精品| 久久久久精品久久久久真实原创| 亚洲av福利一区| 能在线免费看毛片的网站| 超碰97精品在线观看| 国产 一区 欧美 日韩| 高清视频免费观看一区二区| 麻豆久久精品国产亚洲av| xxx大片免费视频| 亚洲,一卡二卡三卡| 春色校园在线视频观看| 少妇 在线观看| 亚洲精品一区蜜桃| 国产精品人妻久久久久久| 国产男女超爽视频在线观看| 自拍偷自拍亚洲精品老妇| 美女主播在线视频| 丰满人妻一区二区三区视频av| 一级毛片久久久久久久久女| 春色校园在线视频观看| 直男gayav资源| 欧美高清成人免费视频www| 九草在线视频观看| 九九在线视频观看精品| 日韩av不卡免费在线播放| 免费看a级黄色片| 七月丁香在线播放| 国产精品久久久久久精品古装| 三级国产精品片| 亚洲精品一区蜜桃| 欧美+日韩+精品| 精品熟女少妇av免费看| 神马国产精品三级电影在线观看| 99热国产这里只有精品6| 国产男女内射视频| 亚洲精品影视一区二区三区av| 国产精品熟女久久久久浪| 人妻系列 视频| 欧美97在线视频| 亚洲最大成人中文| 免费观看在线日韩| av国产免费在线观看| 亚洲av福利一区| 色播亚洲综合网| 免费黄色在线免费观看| 国产欧美日韩精品一区二区| www.av在线官网国产| 久久久亚洲精品成人影院| 日日啪夜夜撸| 亚洲av.av天堂| 激情 狠狠 欧美| 一级黄片播放器| 国产久久久一区二区三区| 久久久久久久大尺度免费视频| 亚洲人成网站在线观看播放| 肉色欧美久久久久久久蜜桃 | 久久97久久精品| 丝袜脚勾引网站| 亚洲不卡免费看| 99re6热这里在线精品视频| 国产高潮美女av| 国产精品av视频在线免费观看| 少妇裸体淫交视频免费看高清| 亚洲欧美一区二区三区国产| av在线老鸭窝| 人人妻人人澡人人爽人人夜夜| 91aial.com中文字幕在线观看| 七月丁香在线播放| 欧美成人一区二区免费高清观看| 国产乱人偷精品视频| 人人妻人人爽人人添夜夜欢视频 | 777米奇影视久久| 女人十人毛片免费观看3o分钟| 最近手机中文字幕大全| 蜜桃亚洲精品一区二区三区| 国产探花在线观看一区二区| 成人毛片a级毛片在线播放| 黑人高潮一二区| 日韩亚洲欧美综合| 在线观看人妻少妇| 久久久久久久久久成人| 日产精品乱码卡一卡2卡三| 激情 狠狠 欧美| 熟女人妻精品中文字幕| 久久久a久久爽久久v久久| 国产熟女欧美一区二区| 国产一区二区在线观看日韩| 综合色av麻豆| 日韩 亚洲 欧美在线| 丝瓜视频免费看黄片| 日韩在线高清观看一区二区三区| 在线天堂最新版资源| 免费av毛片视频| 禁无遮挡网站| 天堂网av新在线| 纵有疾风起免费观看全集完整版| 18禁裸乳无遮挡动漫免费视频 | 最近最新中文字幕大全电影3| 伊人久久精品亚洲午夜| 国内少妇人妻偷人精品xxx网站| 黑人高潮一二区| 97精品久久久久久久久久精品| 可以在线观看毛片的网站| 欧美亚洲 丝袜 人妻 在线| 久久影院123| 久久久久久久大尺度免费视频| 日本熟妇午夜| 国产成人免费观看mmmm| 简卡轻食公司| 国产伦在线观看视频一区| 美女国产视频在线观看| 51国产日韩欧美| 色综合色国产| 久久久精品94久久精品| 直男gayav资源| 欧美三级亚洲精品| 美女xxoo啪啪120秒动态图| 国产欧美日韩一区二区三区在线 | 欧美三级亚洲精品| 男女国产视频网站| 国产精品蜜桃在线观看| 99视频精品全部免费 在线| 国产一区二区亚洲精品在线观看| 香蕉精品网在线| 国产熟女欧美一区二区| 我要看日韩黄色一级片| 久久精品国产a三级三级三级| 22中文网久久字幕| 亚洲精品影视一区二区三区av| 免费看光身美女| 色视频在线一区二区三区| 色5月婷婷丁香| 在线观看国产h片| 亚洲精华国产精华液的使用体验| 偷拍熟女少妇极品色| kizo精华| 日韩成人av中文字幕在线观看| 人妻一区二区av| 99九九线精品视频在线观看视频| 亚洲性久久影院| 久久人人爽av亚洲精品天堂 | 黄片无遮挡物在线观看| 欧美成人精品欧美一级黄| 亚洲精品日韩av片在线观看| 99热这里只有精品一区| 草草在线视频免费看| 别揉我奶头 嗯啊视频| 亚洲国产av新网站| 国产色爽女视频免费观看| 亚州av有码| 国产日韩欧美在线精品| 啦啦啦在线观看免费高清www| 夜夜爽夜夜爽视频| 2018国产大陆天天弄谢| 久久久精品免费免费高清| 欧美少妇被猛烈插入视频| 少妇的逼水好多| 国产熟女欧美一区二区| 丝袜美腿在线中文| 三级男女做爰猛烈吃奶摸视频| 王馨瑶露胸无遮挡在线观看| 一级毛片黄色毛片免费观看视频| 久久久久网色| 婷婷色麻豆天堂久久| 最近的中文字幕免费完整| 91午夜精品亚洲一区二区三区| 国产中年淑女户外野战色| 亚洲激情五月婷婷啪啪| 欧美3d第一页| 视频区图区小说| 直男gayav资源| 国产成人免费观看mmmm| 中文字幕久久专区| 亚洲最大成人av| 麻豆成人av视频| 啦啦啦中文免费视频观看日本| 国产成人精品福利久久| 丰满少妇做爰视频| 国产女主播在线喷水免费视频网站| 国产 精品1| 亚洲精品自拍成人| 蜜桃亚洲精品一区二区三区| 亚洲国产av新网站| 男女那种视频在线观看| 国产黄a三级三级三级人| 成人欧美大片| 免费大片18禁| 99久久九九国产精品国产免费| 王馨瑶露胸无遮挡在线观看| 国产成人精品久久久久久| 好男人在线观看高清免费视频| 两个人的视频大全免费| 秋霞在线观看毛片| 欧美日韩视频精品一区| 久久久久久久久久久丰满| 日韩大片免费观看网站| 日韩欧美一区视频在线观看 | 免费av毛片视频| 老师上课跳d突然被开到最大视频| 亚洲伊人久久精品综合| 欧美一级a爱片免费观看看| 欧美精品国产亚洲| 少妇的逼水好多| 国产高清国产精品国产三级 | 神马国产精品三级电影在线观看| 人妻系列 视频| 亚洲精品视频女| 成人鲁丝片一二三区免费| 三级男女做爰猛烈吃奶摸视频| 欧美一区二区亚洲| 丝袜喷水一区| 国产黄频视频在线观看| 欧美xxxx性猛交bbbb| 人体艺术视频欧美日本| 国产成年人精品一区二区| 女的被弄到高潮叫床怎么办| 黄色一级大片看看| 国产精品人妻久久久影院| 欧美日韩亚洲高清精品| 1000部很黄的大片| 久久韩国三级中文字幕| 亚洲在线观看片| 亚洲真实伦在线观看| 国产成人免费无遮挡视频| 老女人水多毛片| 国产真实伦视频高清在线观看| 国产成人免费无遮挡视频| 男女无遮挡免费网站观看| 亚洲综合色惰| 免费看日本二区| 国产精品一区二区性色av| 免费观看无遮挡的男女| 日韩电影二区| 亚洲综合色惰| 秋霞在线观看毛片| 插逼视频在线观看| 久久综合国产亚洲精品| 国产高清三级在线| 精品久久久久久久久亚洲| 亚洲国产精品成人久久小说| 女人久久www免费人成看片| 夫妻午夜视频| 久久精品国产亚洲av天美| 国产免费一级a男人的天堂| 综合色丁香网| 国产欧美日韩精品一区二区| 美女高潮的动态| 最近中文字幕高清免费大全6| 国产伦精品一区二区三区四那| 国产伦精品一区二区三区视频9| 三级国产精品片| 永久免费av网站大全| 亚洲aⅴ乱码一区二区在线播放| 国产又色又爽无遮挡免| 亚洲av.av天堂| 美女高潮的动态| 亚洲精品日韩在线中文字幕| 亚洲高清免费不卡视频| 午夜视频国产福利| 美女国产视频在线观看| 亚洲精品中文字幕在线视频 | 两个人的视频大全免费| 天天躁日日操中文字幕| 亚洲性久久影院| 亚洲精品色激情综合| 欧美日韩亚洲高清精品| 午夜福利高清视频| 99久国产av精品国产电影| av福利片在线观看| 欧美zozozo另类| 99久久九九国产精品国产免费| 日本爱情动作片www.在线观看| 80岁老熟妇乱子伦牲交| www.色视频.com| 婷婷色av中文字幕| 中文天堂在线官网| 在线 av 中文字幕| 国产白丝娇喘喷水9色精品| 欧美少妇被猛烈插入视频| 最近最新中文字幕大全电影3| 国产 一区精品| 国产美女午夜福利| 在线a可以看的网站| 午夜免费鲁丝| 人妻一区二区av| 99九九线精品视频在线观看视频| 国产又色又爽无遮挡免| 亚州av有码| 亚洲精品乱码久久久v下载方式| 日日啪夜夜撸| 国产老妇伦熟女老妇高清| 女人久久www免费人成看片| 亚洲精品国产成人久久av| 老女人水多毛片| 亚洲美女视频黄频| 久久精品久久久久久久性| 亚洲国产高清在线一区二区三| 一区二区三区四区激情视频| 看黄色毛片网站| 中文精品一卡2卡3卡4更新| 直男gayav资源| 97人妻精品一区二区三区麻豆| 青春草国产在线视频| 天堂中文最新版在线下载 | 亚洲精品国产av成人精品| 最近中文字幕2019免费版| 婷婷色综合www| 亚洲av欧美aⅴ国产| 一本一本综合久久| 老司机影院毛片| 午夜福利视频精品| 精品酒店卫生间| 校园人妻丝袜中文字幕| 黄色日韩在线| 少妇人妻久久综合中文| 亚洲精品中文字幕在线视频 | 国产亚洲一区二区精品| 美女主播在线视频| 男人狂女人下面高潮的视频| 国产免费福利视频在线观看| 嫩草影院入口| 亚洲成色77777| 欧美zozozo另类| 天天一区二区日本电影三级| 久久ye,这里只有精品| 精品久久久噜噜| 亚洲av免费在线观看| 久久久a久久爽久久v久久| 日日撸夜夜添| 内地一区二区视频在线| eeuss影院久久| 少妇人妻精品综合一区二区| 两个人的视频大全免费| 高清欧美精品videossex| 欧美日韩综合久久久久久| 亚洲高清免费不卡视频| 人妻制服诱惑在线中文字幕| 少妇裸体淫交视频免费看高清| 日韩在线高清观看一区二区三区| 狂野欧美激情性xxxx在线观看| 国产精品人妻久久久久久| 男女边吃奶边做爰视频| 国产在线一区二区三区精| 亚洲国产精品专区欧美| 国产色婷婷99| 国产精品爽爽va在线观看网站| 欧美+日韩+精品| 色播亚洲综合网| 高清午夜精品一区二区三区| 99久国产av精品国产电影| 男女啪啪激烈高潮av片| 干丝袜人妻中文字幕| 欧美日韩在线观看h| 一级黄片播放器| av播播在线观看一区| 国产欧美日韩一区二区三区在线 | 日韩中字成人| 亚洲图色成人| 亚洲怡红院男人天堂| 涩涩av久久男人的天堂| 亚洲一级一片aⅴ在线观看| 涩涩av久久男人的天堂| 少妇人妻久久综合中文| 99久久人妻综合| 日本wwww免费看| av黄色大香蕉| 日韩伦理黄色片| 成年av动漫网址| 精品一区二区免费观看| 欧美高清性xxxxhd video| 一区二区av电影网| 免费看av在线观看网站| 亚洲自拍偷在线| 国产v大片淫在线免费观看| 成人黄色视频免费在线看| 嘟嘟电影网在线观看| 亚洲成人中文字幕在线播放| 极品教师在线视频| 精品久久久久久电影网| 亚洲不卡免费看| 视频区图区小说| 国产成人aa在线观看| 亚洲激情五月婷婷啪啪| 免费在线观看成人毛片| 中文欧美无线码| 嘟嘟电影网在线观看| 精品国产乱码久久久久久小说| 国产爽快片一区二区三区| 久久久久久久久大av| 国产 一区 欧美 日韩| 大片电影免费在线观看免费| 午夜视频国产福利| 久久人人爽av亚洲精品天堂 | 精品一区二区三卡|