中文版双极性指数评估表临床信效度研究

Study of reliability and validity of Chinese version of the bipolarity index in clinic

目的：评价中文版双极性指数评估表的信度和效度，确定抑郁障碍和双相障碍合适的划界分。方法选择首都医科大学附属北京安定医院的108例双相障碍患者和68例抑郁障碍患者。采用横断面研究，以中文版简明国际神经精神访谈（MINI）作为“金标准”，使用情感障碍评估表（ADE）进行检查，并得出双极性指数评估表分值。对结果使用ROC曲线分析，确定适合的抑郁障碍和双相情感障碍的划界分。结果双相障碍患者的BPX总分为（60.15±12.00）分，临床发作特征因子分为（16.39±4.37）分，首次发病年龄因子分为（15.74±3.34）分，病程因子分为（11.52±4.19）分，治疗反应因子分为（15.19±4.48）分，均高于抑郁障碍患者[分别为（26.21±12.00±）、（2.82±2.79）、（9.85±4.32）、（4.46±2.62）、（6.72±4.82）分]，差异均有统计学意义（P〈0.05）。而家族史因子分两者之间差异无统计学意义（P〉0.05）。 BPX的评定者之间总分配对一致性Kappa值为1.00，内部5个因子配对一致性Kappa均为1.00。重测一致性结果为BPX总分相关系数为0.982（P〈0.05），各因子分相关系数为0.982-1.000。反映内部一致性的Cronbach＇sα系数为0.789，每个项目的均值范围在1.61-13.47，总量表均值是46.93（SD=20.49）。通过ROC曲线对双极性指数评估表用于区分双相障碍和抑郁障碍进行分析，以44分为划界分时，对双相障碍的诊断显示了高水平的灵敏度（0.92）、特异度（0.93）、阳性预测值（0.95）和阴性预测值（0.88）。结论中文版双极性指数评估表具有较高的信效度，确定的抑郁障碍和双相障碍划界分，能够对双相障碍的早期识别提供帮助，为精神科临床提供新的评估工具。

Objective To evaluate the reliability and validity of the Chinese version of bipolarity index （BPX）, and de-termine the cut-off score between major depressive disorder （MDD） and bipolar disorder （BPD）. Methods 108 patients with BPD and 68 patients with MDD were employed from the Beijing Anding Hospital Affiliated to Capital Medical U-niversity. The cross-sectional research was performed in this study. The Chinese version of Mini-international neu-ropsychiatric interview （MINI） was used as“gold standard”and the affective disorder evaluation （ADE） was used to in-terview patients, thus the bipolarity index score was obtained. The ROC curve analysis was used to determine the cut-off score between MDD and BPD. Results Total score of the BPX [（60.15±12.00） scores], the factor score of clinical episode character [（16.39±4.37） scores], the factor score of episode age [（15.74±3.34） scores], the factor score of course character [（11.52±4.19） scores] and the factor score of treatment response [（15.19±4.48） scores] of subjects with BPD were higher than those of the patients with MMD [（26.21±12.00）, （2.82±2.79）, （9.85±4.32）, （4.46±2.62）, （6.72±4.82） scores respectively],the differences were all statistically significant （P〈0.05）, but there was no significant difference in the factor score of family history （P〉 0.05）. The consistency （Kappa） of total score between the raters was 1.00, the consistency （Kappa） of 5 internal factors between the raters were all 1.00. The result of re-measurement consistency showed that the correlation index of BPX total score was 0.982 （P〈0.05）, and the correlation index of each factor was between 0.982 and 1.000. The Cronbach＆#39;sα index which reflected the internal consistency was 0.789. The mean value of every ca tegory ranged from 1.61 to 13.47, and the mean value of scale was 46.93 （SD=20.49）. Through the ROC curve analysis and Bipolarity index （BPX） which was us ed to differentiate MDD and BPD, 44 scores＆amp;nbsp;was obtained as cut-off score. BPX showed high sensitivity （0.92）, specificity （0.93）, positive predicted value （0.95） and negative predicted value （0.88）. Conclusion The Chinese version of BPX scale has high reliability and validity. With defined cut-off score, it can help early recognition of BPD and provide a new evaluation tool for clinical psychiatry.