双相抑郁症患者自杀行为的遗传方式

Genetic mode of suicidal behavior in patients with bipolar depressive disorder

目的:对双相抑郁症患者自杀行为的遗传方式进行分析,以探讨抑郁症患者自杀行为的遗传实质。方法:来源于1983-07-01/2003-06-01无锡市精神卫生中心门诊和住院诊断为抑郁症,无严重躯体疾病或脑器质性疾病,既往至少有一次躁狂发作的患者235例。359名对照组为患者的朋友、同事及领居,与研究对象无血缘关系。以双相抑郁症患者为先证者,采用自行编制的精神病家系调查表(内容主要包括患者及一级亲属所有成员社会人口学资料、疾病发作特点及次数、自杀情况),由两名主治医师或以上的研究人员对每一家系进行调查。由两名研究人员在互不知情的情况下按照中国精神障碍分类与诊断标准第3版(CCMD-3)抑郁发作及美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)双相抑郁标准对每一患者进行再诊断。对所有先证者及一级亲属中有自杀行为者进行面检(面检率>95%);对无自杀行为的一级亲属则进行信函调查(54%)及面检(46%)。已死亡及不能进行面检者的资料由一两名一级亲属提供有关情况填写调查表。观察双相抑郁症患者自杀行为的遗传方式。用医学遗传数学方法中分离分析和多基因阈值理论进行遗传方式的探讨。结果:完成家系调查的共209例,其中可纳入分析的共184例(男68例,女116例),对照组共359名(男134名,女225名)。经分离分析表明本组双相抑郁症自杀行为不符合单基因常染色体显性遗传,不符合单基因常染色体隐性遗传,亦不符合性连锁遗传;双相抑郁症自杀行为的加权平均遗传率及标准误为(50.15±9.7)%;一级亲属自杀行为预期发病率为1.38%,实际发病率为1.27%,两者差异无显著性意义(u=0.3056,P>0.05)。结论:双相抑郁症自杀行为遗传方式符合多基因遗传。根据多基因遗传因素所起的作用,应注意对有自杀行为的双相抑郁症患者及其亲属加以监测,以防止自杀的发生。

AIM： To analyze the genetic mode of suicidal behavior in patients with bipolar depressive disorder, so as to investigate the genetic essence of the suicidal behavior in patients with depressive disorder, METHODS： A total of 235 outpatients and inpatients with bipolar depression were selected from Wuxi Mental Health Center from July 1^st 1983 to June 1^st 2003, they all had at least one-time histories of manic episode, but all had no severe physical disease and brain organic disease, The subjects in the control group （n=359） were the friends, colleagues and neighbors of the patients, and they all had no blood relationship with the patients. The patients with bipolar depression were taken as the propositus, and they were assessed with the self-designed psychiatric family tree （including mainly the data of social demography of patients and their first-grade relatives, characters of disease onset, frequency of attack, history of suicide） under the instruction of 2 physicians-in-charge or more and filled up the self-made investigation form of psychiatric family tree, After rediagnosed by 2 another physicians-in-charge, according to CCMD-3 and DSM-Ⅳ, the interview （95%） was carried on for the patients and the first-grade relatives among the survivor. The interview （46%） and investigation with letter （54%） were carried on for the patients and first-grade relatives without suicidal behavior. The investigation forms of dead cases were provided and filled-up by one or two first-grade relatives, separation analysis in medical hereditary mathematic method and polygene threshold theory were applied to analyze the inheritance mode. RESULTS： Totally 209 cases finished the investigation of family tree, and 184 of them （68 males and 116 females） and 359 cases （134 males and 225 females） in the control group were involved in the analysis of results. By descriptive statistics, the study suggested that the suicidal behavior in patients with bipolar depressive disorder, neither accorded with the model of autosomal dominant inheritance, no accorded with autosomal recessive inheritance, or the model of sex-liked inheritance. By factual analysis, the weighted mean heritability and standard error of mean of suicidal behavior was （50.15±9.7）% in bipolar depressive patients; There was no significant difference between anticipative rate （1.38%） and actual rate （1.27%） in the first -grade relatives （u=0.305 6, P 〉 0.05）. CONCLUSION： Suicidal behavior in patients with bipolar depressive disorder has characteristics of polygenic mode. To avoid suicidal behavior in bipolar depressive patients and relatives, monitoring is needed according to the role of polygenic factors.