多发性硬化患者情感障碍研究

The Study of Affective Disorder in Patients with Multiple Sclerosis

目的初步探讨多发性硬化(multiple sclerosis,MS)患者情感障碍的发生频率、特点和发生机制,以及情感障碍对MS患者生活质量的影响。方法选取37例复发-缓解型MS患者,并均经脑MRI、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、临床功能障碍评分(EDSS)、生活质量评价〔包括基本生活能力(ADL)和操作性生活能力(IADL)〕检查。分析MS患者情感障碍发生情况及其与其他临床表现的相关关系,以及各因素对情感障碍的影响。结果所有MS患者发生抑郁占43.2%(16/37),焦虑占37.8%(14/37),抑郁伴焦虑占35.1%(13/37)。患者中有、无抑郁组间比较临床表现差异无统计学意义,焦虑组EDSS和IADL评分高于无焦虑组(P<0.05),低收入者焦虑发生率较高(P<0.05)。抑郁和焦虑与EDSS、ADL及IADL得分呈正相关,经回归分析发现EDSS评分对抑郁、焦虑的影响有统计学意义。糖皮质激素治疗对患者情感无显著影响。结论情感障碍对MS患者日常生活功能造成不利影响,在某种程度上可能较运动或感觉障碍更影响患者的工作和社会生活能力。

Objective To discuss the frequence, characteristic and machanism of affective disorder in patients with multiple sclerosis（MS）. Methods Thirty seven patients with remitting-relapsing MS were recruited. All of them underwent MRI scan and had HAMD, HAMA, EDSS, ADL and IADL to assess the degree of affective disorder. We observed the incidence rate of affective disorder and analyzing their correlation with the clinical manifestation. Results Patients with depression and with anxiety separately were 16 （43.2%） and 14 （37.8%）, and both of them were 13（35.1%）. Clinical manifestation had no significance difference between with and without anxiety patients, and it also had no significant between with and without depression patients. There were high EDSS and IADL score in anxiety patients （P〈0.05）. The proportion of anxiety was high in low incoming patients （P〈0.05）. There were high EDSS, ADL and IADL score in depression/anxiety patients. EDSS had a significant difference in depression/anxiety patients. Whether using methylprednisolone （oral or infusion） therapy had no significant influence to the degree of affective disorder. Conclusions Affective disorder have adverse influence for MS patients＇ daily life, which have a more significant influence on working and social life than motor or sensory disturbance does.