儿童双相障碍住院患者诊断稳定性及相关因素分析

The clinical characteristics and diagnostic consistency in pediatric inpatients with bipolar disorders

目的回顾性分析儿童双相障碍住院患者诊断稳定性及相关因素。方法对北京安定医院2007年7月至2012年6月出院时年龄〈18岁、入院时或出院时曾经诊断双相障碍患者的诊断稳定性及相关因素进行分析，采用“向前条件”方法进行二分类多因素logistic回归分析。结果5年间曾诊断为双相障碍患者共342例，总住院次数400次，共有800项诊断（包括入院诊断和出院诊断）；342例患者双相障碍诊断的总体一致率为66．7％（228例）；Logistic回归分析结果显示，双相障碍诊断稳定性与住院次数[OR=4．912，95％可信区间（CI）2．520—9．577，P=0．000]、幻觉妄想症状（OR=2．841，95％CI1．670～4．836，P=0．000）、躁狂状态（OR=0．365，95％CI 0．215～0．619，P=0．000）显著相关。结论儿童双相障碍症状不典型，伴有精神病性症状较常见，诊断稳定性主要受住院次数、幻觉妄想症状及躁狂状态影响。

Objective To retrospectively analyze diagnostic consistency in pediatric patients with bipolar disorders. Methods Data was collected from the information of pediatric inpatients （ 〈 18 years） discharged from Beijing An-ding hospital affiliate of Capital Medical University during July 1,2007 and June 30, 2012, who were diagnosed as bipolar disorders at admission and （or） discharge. Multivariate binary logistic regression was employed to analyze influencing factors of the diagnostic stability. Results 342 cases were selected during the five years, the total frequency of hospitalization was 400 times with 800 main hospital diagnoses （both at admission and at discharge）, 66. 7% cases were all diagnosed as bipolar disorders at every admission and discharge, and were considered as diagnostic stable ones. Statistically significant variables remaining in the final logistic regression model suggested that more frequent hospitalization （ OR = 4. 912, 95% CI 2. 520 - 9. 577, P = 0. 000） and the presence of hallucinations or delusions （ OR = 2. 841,95% CI 1. 670 - 4. 836, P = 0. 000） and the absence of mania （ OR = 0. 365, 95% CI O. 215- 0. 619, P = 0. 000） in cover page of medical records might be higher possibility of diagnostic inconsistency. Conclusion The presentation of childhood bipolar disorder is often atypical with higher possibility of diagnostic inconsistency.