汉族女性癫痫患者性功能障碍发生率及其相关影响因素调查研究

Investigation on the incidence of sexual dysfunction and related factors in Han women with epilepsy

目的 调查本地区汉族女性癫痫患者(WWE)性功能障碍的发生率及相关影响因素。 方法 连续收集2015年1月至2017年12月扬州大学附属医院神经内科收治的112例汉族已婚WWE作为试验组,以同期120名年龄、受教育水平、职业状况相匹配的健康汉族已婚女性作为对照组。将112例WWE根据发作表现、脑电图特征分为局灶性或全面性癫痫,均接受抗癫痫药物(AEDs)治疗1年或以上。记录所有研究对象的一般资料,包括年龄、婚龄、学历、职业、家庭人均月收入、月经、生育等情况。记录WWE的疾病细节:发病年龄、病程、发作频率、AEDs情况。所用调查量表或问卷包括中文版女性性功能指数问卷(FSFI)、中文版Zung焦虑自评量表(SAS)、中文版Zung抑郁自评量表(SDS)、修订的8条目Morisky依从性量表(MMAS-8)和中文版国立癫痫发作严重程度量表(NHS3)。统计学方法包括χ^2验、t检验和二元Logistic回归分析。 结果 汉族WWE发生性功能障碍的比例高达70.5%(79/112),而对照组的比例为24.2%(29/120),差异有统计学意义(χ^2=50.061,P<0.01)。性功能障碍的各个维度发生率分别为:性欲低下85.7%(96/112),性唤醒障碍56.3%(63/112),阴道湿润障碍47.3%(53/112),性高潮障碍66.1%(74/112),性满意度障碍58.9%(66/112),性交疼痛障碍41.1%(46/112)。WWE合并焦虑比例为40.2%(45/112),抑郁比例为33.0%(37/112),服药依从性差比例为31.3%(35/112)。二元Logistic回归分析结果表明,与性功能障碍相关的独立因素包括家庭经济状况[家庭人均月收入<1 500元(OR=8.852,95%CI:1.469~53.346,P=0.017),家庭人均月收入1 500~2 500元(OR=6.438,95%CI:1.439~28.796,P=0.015)]、焦虑(OR=1.202,95%CI:1.050~1.375,P=0.008)、服药依从性(OR=0.371,95%CI:0.155~0.890,P=0.026)。 结论 WWE性功能障碍的发病率较高,与多因素相关。她们的焦虑水平较高,家庭经济状况和服药依从性较差。医务人员不仅要控制癫痫发作,还要重视评估和改善WWE的性功能,从而提高她们的生活质量。

Objective To investigate the incidence and related factors of sexual dysfunction in Chinese Han women with epilepsy (WWE).Methods A total of 112 cases of Han married WWE were continuously recruited from January 2015 to December 2017 in the Affiliated Hospital of Yangzhou University, and 120 matched non-epileptic healthy Han married women served as controls. The 112 WWE were classified as focal or comprehensive onset epilepsy and were treated with antiepileptic drugs (AEDs) for one year or more. Data collection was performed with a form inquiring about the participants′ demographic parameters, including age, duration of marriage, education level, employment, monthly family income per capita, history of infertility and irregular menses. Details of epilepsy in WWE were investigated, including age of onset, duration of illness, seizure frequency, medication adherence. All participants were submitted to relevant scales and questionnaires (Female Sexual Function Index, Zung Self-Rating Anxiety Scale and Zung Self-Rating Depression Scale). In addition, WWE were evaluated by the 8-Item Morisky Medication Adherence Scale and the National Hospital Seizure Severity Scale. Chi-square test, t test and binary Logistic regression were used for statistical analysis.Results A high rate (70.5%, 79/112) of sexual dysfunction was detected in WWE, whereas 24.2% (29/120) in controls (χ^2=50.061,P<0.01). Sexual dysfunction affected all dimensions: desire (85.7%, 96/112), arousal (56.3%, 63/112), lubrication (47.3%, 53/112), orgasm (66.1%, 74/112), satisfaction (58.9%, 66/112) and pain (41.1%, 46/112). Elevated rates of anxiety (40.2%, 45/112), depression (33.0%, 37/112) and poor medication adherence (31.3%, 35/112) were also found in WWE. Binary Logistic regression showed that family economic status (monthly family income per capita <1 500 Yuan (OR=8.852, 95%CI: 1.469-53.346, P=0.017), monthly family income per capita 1 500-2 500 Yuan (OR=6.438, 95%CI: 1.439-28.796, P=0.015)), anxiety (OR=1.202, 95%CI: 1.050-1.375, P=0.008) and medication adherence (OR=0.371, 95%CI: 0.155-0.890, P=0.026) were associated with sexual dysfunction.Conclusions The associated factors of sexual dysfunction in Chinese Han WWE are multifactorial. WWE have higher levels of anxiety, poor family economic status and poor medication adherence. Medical professionals should not only better control seizures, but also evaluate and improve patients′ sexual function, so as to improve the quality of life of WWE.