抑郁症临床治愈的指标及其有效性研究

The operational criterion and its validity of remission of major depressive disorder

目的 探讨界定抑郁症临床治愈的17项HAMD（HAMD17）评分的临界值,并检验其有效性.方法 对251例经治疗症状得到明显改善的抑郁症患者评定HAMD17、大体评定量表、生活质量综合评定问卷,并应用受试者工作特征曲线法分析临界值.结果 抑郁症患者经过急性期治疗,HAMD17≤7分时,92.3％（203/220）的被试者存在至少一种阈下症状,48.6％ （107/220）的患者心理社会功能未恢复正常.HAMD17评分0～3分组患者心理功能、社会功能、躯体功能评分[分别为（60.1±15.4）、（62.0±l1.2）、（60.5±14.3）分],高于4～ 14分组患者[分别为（52.0±12.3）、（54.0±11.0）、（52.7±10.2）分],差异具有统计学意义（t=3.307、4.119、3.626,均P＜0.01）.0～3分组心理社会功能恢复正常的比例（74.2％,92/124）高于4～ 14分组患者（12.6％,16/127;χ2=97.103,P＜0.01）.结论 抑郁症患者经过急性期治疗,HAMD17评分0～3分的患者心理社会功能更好,当HAMD17评分＞3分时,患者可能存在较多的阈下症状,临床上应予以重视.

Objective To explore the optimal cutoff point defining remission on 17-item Hamilton Depression Scale （HAMD17） for major depressive disorder （MDD）,and examine the validity of this cutoff point.Method We interviewed 251 MDD responders with the HAMD17,Global Assessment of Functioning,Generic Quality of Life Inventory.Results After acute phase treatment for MDD,even the HAMD17 scored 7 or less,92.3% （203/220） of remitters had at least one subthreshold depressive symptoms,48.6% （107/220） of them also experienced functioning impairment,when psychosocial functioning taken into account,a cutoff of ≤ 3 might be the operational criterion of MDD remission.Compared to MDD patients scoring 4-14 on HAMD17,patients scoring 0-3 had significantly better psychological functioning,social functioning and physical functioning （separately 60.1 ± 15.4 vs.52.0 ± 12.3,62.0 ± 11.2 vs.54.0 ± 11.0,60.5±14.3vs.52.7±10.2; t=3.307,4.119,3.626,all P〈0.01）.Compared to4-14 score group,the rate of ones with psychosocial functioning being normal in 0-3 score group was higher （74.2% vs.12.6% ; χ2 =97.10,P 〈 0.01）.Conclusion The results indicate that patients with MDD whose score of ≤3 on HAMD17 after the acute phase treatment may have better psychosocial functioning than those whose score of 〉 3,suggesting this criterion be valid.