中华精神科杂志
中華精神科雜誌
중화정신과잡지
CHINESE JOURNA OF PSYCHIATRY
2013年
4期
212-216
,共5页
施慎逊%张明园%陆峥%吴文源%周天骍%张海音%刘义兰%赵靖平%孙学礼
施慎遜%張明園%陸崢%吳文源%週天骍%張海音%劉義蘭%趙靖平%孫學禮
시신손%장명완%륙쟁%오문원%주천성%장해음%류의란%조정평%손학례
抑郁症%焦虑%共病现象%复发%随访研究
抑鬱癥%焦慮%共病現象%複髮%隨訪研究
억욱증%초필%공병현상%복발%수방연구
Depressive disorder%Anxiety%Comorbidity%Recurrence%Follow-up studies
目的 观察抑郁症共病焦虑障碍患者1年(12个月)随访结果及复发相关因素.方法 本研究为前瞻性、多中心、队列随访研究；采用17项汉密尔顿抑郁量表(HAMD17)和汉密尔顿焦虑量表(HAMA)对594例抑郁症患者进行3、6、12个月随访评估,比较抑郁症共病焦虑障碍(共病组,344例)与非共病焦虑障碍(非共病组,250例)的临床痊愈率、复发率、自杀念头、服药依从性、联合治疗的差异；采用logistic逐步回归分析复发相关因素.结果 3、6、12个月3个时点随访到的患者分别为482、441、301例.3个月时,共病组临床痊愈率(53.7％,153/285)低于非共病组(68.0％,134/197),差异有统计学意义(P＜0.01).3个月和6个月时,共病组HAMD总分[(8.80±6.49)、(6.86±7.07)分]和HAMA总分[(6.35±4.64)、(4.88±4.63)分]均高于非共病组[HAMD:(7.20 ±5.97)、(5.33±5.86)分,HAMA:(4.77±4.26)、(3.38 ±3.69)分],12个月时共病组HAMA总分[(3.98±4.01)分]高于非共病组[(2.97±3.95)分],差异均有统计学意义(P＜0.05或P＜0.01).3、6、12个月3个时点共病组与非共病组的复燃率分别为6.7％(19/285) vs 5.6％(11/197),13.3％ (36/270)vs 8.2％ (14/171),14.9％ (30/202) vs 9.1％ (9/99),2组比较差异无统计学意义(P均＞0.05)；但生存分析显示,2组1年复发率差异有统计学意义(X2=4.487,P＜0.05).2组自杀念头、转躁率、服药依从性和社会功能差异均无统计学意义(P均＞0.05).共病组和非共病组分别有50.5％和43.4％的患者在1年随访时仍合用苯二氮(卓)类药.Logistic多元回归分析显示,6个月时自杀念头[OR=32.258,95％可信区间(CI) 7.092 ～ 142.857,P＜0.01]和服药依从性(OR=0.564,95％ CI0.363～0.877,P＜0.05)与复发有关.结论 共病焦虑障碍的抑郁症患者较非共病者近期疗效差,年复发率高；共病与非共病焦虑障碍抑郁症患者的1年总体疗效和临床痊愈率相近；合用苯二氮(卓)类药较普遍；自杀念头是复发的危险因素,服药依从性是复发的保护因素.
目的 觀察抑鬱癥共病焦慮障礙患者1年(12箇月)隨訪結果及複髮相關因素.方法 本研究為前瞻性、多中心、隊列隨訪研究；採用17項漢密爾頓抑鬱量錶(HAMD17)和漢密爾頓焦慮量錶(HAMA)對594例抑鬱癥患者進行3、6、12箇月隨訪評估,比較抑鬱癥共病焦慮障礙(共病組,344例)與非共病焦慮障礙(非共病組,250例)的臨床痊愈率、複髮率、自殺唸頭、服藥依從性、聯閤治療的差異；採用logistic逐步迴歸分析複髮相關因素.結果 3、6、12箇月3箇時點隨訪到的患者分彆為482、441、301例.3箇月時,共病組臨床痊愈率(53.7％,153/285)低于非共病組(68.0％,134/197),差異有統計學意義(P＜0.01).3箇月和6箇月時,共病組HAMD總分[(8.80±6.49)、(6.86±7.07)分]和HAMA總分[(6.35±4.64)、(4.88±4.63)分]均高于非共病組[HAMD:(7.20 ±5.97)、(5.33±5.86)分,HAMA:(4.77±4.26)、(3.38 ±3.69)分],12箇月時共病組HAMA總分[(3.98±4.01)分]高于非共病組[(2.97±3.95)分],差異均有統計學意義(P＜0.05或P＜0.01).3、6、12箇月3箇時點共病組與非共病組的複燃率分彆為6.7％(19/285) vs 5.6％(11/197),13.3％ (36/270)vs 8.2％ (14/171),14.9％ (30/202) vs 9.1％ (9/99),2組比較差異無統計學意義(P均＞0.05)；但生存分析顯示,2組1年複髮率差異有統計學意義(X2=4.487,P＜0.05).2組自殺唸頭、轉躁率、服藥依從性和社會功能差異均無統計學意義(P均＞0.05).共病組和非共病組分彆有50.5％和43.4％的患者在1年隨訪時仍閤用苯二氮(卓)類藥.Logistic多元迴歸分析顯示,6箇月時自殺唸頭[OR=32.258,95％可信區間(CI) 7.092 ～ 142.857,P＜0.01]和服藥依從性(OR=0.564,95％ CI0.363～0.877,P＜0.05)與複髮有關.結論 共病焦慮障礙的抑鬱癥患者較非共病者近期療效差,年複髮率高；共病與非共病焦慮障礙抑鬱癥患者的1年總體療效和臨床痊愈率相近；閤用苯二氮(卓)類藥較普遍；自殺唸頭是複髮的危險因素,服藥依從性是複髮的保護因素.
목적 관찰억욱증공병초필장애환자1년(12개월)수방결과급복발상관인소.방법 본연구위전첨성、다중심、대렬수방연구；채용17항한밀이돈억욱량표(HAMD17)화한밀이돈초필량표(HAMA)대594례억욱증환자진행3、6、12개월수방평고,비교억욱증공병초필장애(공병조,344례)여비공병초필장애(비공병조,250례)적림상전유솔、복발솔、자살념두、복약의종성、연합치료적차이；채용logistic축보회귀분석복발상관인소.결과 3、6、12개월3개시점수방도적환자분별위482、441、301례.3개월시,공병조림상전유솔(53.7％,153/285)저우비공병조(68.0％,134/197),차이유통계학의의(P＜0.01).3개월화6개월시,공병조HAMD총분[(8.80±6.49)、(6.86±7.07)분]화HAMA총분[(6.35±4.64)、(4.88±4.63)분]균고우비공병조[HAMD:(7.20 ±5.97)、(5.33±5.86)분,HAMA:(4.77±4.26)、(3.38 ±3.69)분],12개월시공병조HAMA총분[(3.98±4.01)분]고우비공병조[(2.97±3.95)분],차이균유통계학의의(P＜0.05혹P＜0.01).3、6、12개월3개시점공병조여비공병조적복연솔분별위6.7％(19/285) vs 5.6％(11/197),13.3％ (36/270)vs 8.2％ (14/171),14.9％ (30/202) vs 9.1％ (9/99),2조비교차이무통계학의의(P균＞0.05)；단생존분석현시,2조1년복발솔차이유통계학의의(X2=4.487,P＜0.05).2조자살념두、전조솔、복약의종성화사회공능차이균무통계학의의(P균＞0.05).공병조화비공병조분별유50.5％화43.4％적환자재1년수방시잉합용분이담(탁)류약.Logistic다원회귀분석현시,6개월시자살념두[OR=32.258,95％가신구간(CI) 7.092 ～ 142.857,P＜0.01]화복약의종성(OR=0.564,95％ CI0.363～0.877,P＜0.05)여복발유관.결론 공병초필장애적억욱증환자교비공병자근기료효차,년복발솔고；공병여비공병초필장애억욱증환자적1년총체료효화림상전유솔상근；합용분이담(탁)류약교보편；자살념두시복발적위험인소,복약의종성시복발적보호인소.
Objective To observe one year outcome of patients with depression comorbidity with anxiety disorders and predictor factors to recurrence.Method Totally 594 patients from 17 hospitals,met with the diagnosis criteria of DSM-Ⅳ for depression,were prospectively evaluated using the 17-item Hamilton Rating Scale for Depression (HAMD17) and Hamilton Rating Scale for Anxiety (HAMA) at the end of 3,6and 12 months since they were enrolled the study.The conditions of remission,relapse,suicide idea,compliance with medicine and combined therapy were compared between depression comorbidity with (344cases) or without(250 cases) anxiety disorder.Logistic regression analysis was performed to investigate the recurrent predictors of depression.Results There were 482,441 and 301 patients at the three following points separately.The rate of remission in 3 month was significantly lower in comorbidity group (CG) than that in without comorbidity group (WCG) (53.7％ vs.68.0％,P =0.002).The scores of HAMD[(8.80 ±6.49),(6.86 ± 7.07)] and HAMA [(6.35 ± 4.64),(4.88 ± 4.63)] both were significantly higher in CG than those [HAMD:(7.20 ± 5.97),(5.33 ± 5.86),HAMA:(4.77 ± 4.26),(3.38 ± 3.69)] in WCG.And only HAMA score (3.98 ± 4.01) in CG was marked higher than that (2.97 ± 3.95) in WCG (P ＜ 0.05 or P ＜ 0.01).In three different following points,the rates of relapse / recurrence were 6.7％ vs.5.6％,13.3％vs.8.2％,and 14.9％ vs.9.1％ separately,no significant differences between two groups (P ＞ 0.05).But the Kaplan-Meier survival analysis showed the higher recurrent rate in CG (x2 =4.487,P ＜ 0.05).The rate of suicide idea converting mania,compliance with medicine and social function were no significant differences within two groups (P ＞0.05).About half of patients (50.5％ in CG and 43.4％ in WCG) were still using benzodiazepines after one year.Logistic regressive analysis showed that suicide idea and compliance with medicine in 6 month point were associated with one year recurrence in this study.Conclusions The results indicate that short outcome in CG is less than WCG,higher recurrent rate also in CG,and supporting the views outside.The one year outcome may be similar in two groups,nearly 4/5 patients obtained remission after they are treated with antidepressants.It should be concerned that about half of patients still take benzodiazepine for long time.The suicide idea is the predictor factor and the compliance with medicine is the protector factor to the recurrence of depression.
