慢性广泛性疼痛患者的临床特征、焦虑抑郁及述情障碍

Clinical Characteristics, Anxiety, Depression and Alexithymia in Patients with Chronic Widespread Pain

目的:观察医学上不能解释的和可解释的慢性广泛性疼痛(CWP)患者的临床特征、述情障碍、焦虑抑郁水平,探讨焦虑抑郁与述情障碍在CWP患者的相关性。方法:118例CWP患者作为研究对象,由疼痛科医师和心理科医师对其作出临床诊断,应用疼痛视觉模拟评分标尺(VAS)、多伦多述情量表(TAS-20)、Spielberger特质焦虑问卷(TAI)和Beck抑郁自评问卷(BDI-13)进行测量。结果:45例医学上不能解释的CWP(CWP-MUE)患者被诊断为躯体形式障碍、抑郁症、焦虑症和适应障碍。31例CWP患者存在述情障碍。CWP-MUE患者的TAS-20总分、TAI和BDI-13评分均显著高于医学上可解释的CWP患者。述情障碍CWP患者的TAS-20总分、BDI-13和VAS评分显著高于非述情障碍CWP患者。CWP患者的TAS-20总分及DIF、DDF因子评分与BDI-13评分显著相关(r=0.294、0.303和0.248,P<0.01)。结论:CWP-MUE存在相应的精神病学诊断,具有更高的述情障碍发生率和抑郁焦虑水平。

Objective： To investigate the Clinical characteristics of anxiety, depression and alexithymia in patients with chronic widespread pain（CWP） and the relationship between alexithymia and anxiety and depression. Methods： 118 pa- tients with CWP were enrolled and tested by the Visual Analogue Scale（VAS） for pain intensity, the 20-item Toronto Alexi- thymia Scale（TAS-20）, the Spielberger Trait Anxiety Inventory（TAI）, and the 13-item Beck Depression Inventory（BDI-13）. Results： 45 patients without medical accountings were diagnosed with somatoform disorder, depression, anxiety disorders and adjustment disorders. 31 patients with CWP were diagnosed as alexithymic. Compared to the CWP patients with medi- cal accountings, the patients without medical accountings showed significantly higher scores in the total score of TAS- 20, the TAI score and the BDI-13 score. Compared with the nonalexithymic patients with CWP, the alexithymic patients with CWP had significantly higher scores in the total score of TAS-20, the TAI score and the VAS score. The total score of TAS- 20, the factor DIF score and the factor DDF score were significantly related to the BDI- 13 score in patients with CWP（r= 0.294, 0.303 and 0.248 respectively, P〈0.01）. Conclusion： The CWP patients without medical accountings have higher prevalence of alexithymia and higher levels of anxiety and depression.