双极性指标对抑郁发作患者中双相障碍的识别效能：中国桥筛查研究

Recognition validity of bipolarity specifier for bipolar disorders among patients with major depressive episode：BRIDGE-China

目的 验证双极性指标对重性抑郁发作（major depressive episode,MDE）患者中双相障碍（bipolar disorder,BD）和双相Ⅱ型障碍（bipolar disorder typeⅡ,BDⅡ）的识别效能.方法 采用多中心、横断面诊断性研究,2008年3月至9月在20家精神专科医院连续性收录727例MDE患者,采用双极性指标、《美国精神障碍诊断与统计手册（第4版）》修改版（DSM-Ⅳ-TR）标准和临床诊断进行BD或BDⅡ筛查,比较二者筛检率,采用多因素回归分析分析BD相关危险因素.结果 双极性指标、DSM-Ⅳ-TR标准和临床诊断对MDE患者中BD检出率分别为39.9％（290/727）、14.4％（105/727）和31.9％ （232/727）,对BDⅡ检出率分别为30.8％（192/623）、9.5％（59/623）和20.5％（128/623）.与DSM-Ⅳ-TR标准相比,双极性指标筛检BD具备较高的灵敏度和特异度（100.0％和70.3％）；与临床诊断相比,双极性指标筛检BDⅡ具备良好的灵敏度和特异度（85.9％和83.4％）,较低的误诊率和漏诊率.双极性指标筛查BD阳性者共病边缘型人格障碍或焦虑障碍比例高于筛查阴性者.多因素回归分析显示,双极性指标识别BD的临床标记中,既往抗抑郁疗效转（轻）躁狂（OR=4.66）和抗抑郁治疗中出现情感发作（OR=3.68）为BD的高危因素；双极性指标和DSM-Ⅳ-TR标准识别BD的相同临床标记中,一级亲属存在躁狂或轻躁狂史（OR =3.58）、病程完全缓解（OR=2.54）和以往抗抑郁治疗出现易激惹（OR =2.40）为BD高危因素（均P＜0.01）.结论 初步证实双极性指标在MDE患者中筛检BD或BDⅡ型的识别效能良好,对BD亚类区分具有一定临床意义.

Objective To validate the recognition efficacy of bipolar disorders （BD） and BD type Ⅱ （BD Ⅱ） under bipolarity specifier among patients with major depressive episode（MDE）.Methods This is a multi-site,cross-sectional diagnostic study.727 consecutive subjects with major depressive episode （MDE） were screened for BD and BD Ⅱ under the bipolarity specifier,the DSM-Ⅳ-TR criteria and the clinical known diagnosis criteria at 20 psychiatric hospitals between March and September 2008,to compare the BD recognition rate and analyze factors related with BD using multi-factors regression analysis.Results Screened positive BD were 39.9%,14.4% and 31.9% under bipolarity specifier,DSM-Ⅳ-TR and clinical known diagnosis criteria,while screened positive BD Ⅱ were 30.8%,9.5% and 20.5% respectively.Compared with DSM-Ⅳ-TR,bipolarity specifier screened BD with relatively high sensitivity and specificity （100% and 70.3%）; while compared with clinical known diagnosis criteria,bipolarity specifier screened BD Ⅱ with very good sensitivity and specificity （85.9% and 83.4%）,plus relatively low under-diagnosis and over-diagnosis rate.Screened positive BD under bipolarity specifier combined with higher rate of borderline personality disorder （BPD）/anxiety disorder compared with negative ones.Multi-factors regression analysis found the OR value of two variables including switching during previous antidepressant treatment （OR =4.66） and mood episode during antidepressant treatment （OR =3.68） were relatively high under bipolarity specifier.These are also different from those under DSM-Ⅳ-TR.For the common markers under either bipolarity specifier or DSM-Ⅳ-TR,the OR value of three variables including relatives of first degree with mania/hypomania （OR =3.58）,illness course with free interval （OR =2.54） and irritability during previous antidepressant treatment （OR =2.40） were relatively high,thus indicates five high risk factors of BD with all the P value 〈 0.01.Conclusions This study initially validated well recognition efficacy of bipolarity specifier for both BD and BD Ⅱ] among patients with MDE.The results may also help for further subset classification of BD