慢性鼻-鼻窦炎患者心理障碍及相关因素分析

Psychiatric disorders in patients with chronic rhinosinusitis and its associated factor analysis

目的 初步探讨慢性鼻-鼻窦炎（chronic rhinosinusitis,CRS）患者的精神心理特点以及相关因素分析.方法 对2012年9月至2014年2月大连大学附属中山医院收治的80例CRS患者的精神心理状态与中国常模进行对照研究,利用症状视觉模拟量表评分法（visual analogue scale,VAS）、Lund-Mackay评分法、Lund-Kennedy评分法三种检查方法,并结合症状自评量表（self-reporting inventory 90,SCL-90）分析CRS患者主观症状、客观检查与精神心理障碍的特点及关系.以SPSS 19.0软件对数据进行统计学分析.结果 CRS患者中心理有轻度损害的50名（62.50％）,轻-中度损害的5名（6.25％）,患者的躯体化（=4.46,P=0.00）、强迫症状（t=4.78,P=0.00）、人际关系敏感（t=2.42,P =0.02）、焦虑（t=2.47,P=0.02）、精神病性（t=3.01,P=0.01）和其他（睡眠、饮食,t=6.31,P=0.00）共六项因子分高于中国常模,差异具有统计学意义.强迫症状、人际关系敏感、焦虑、精神病性对病情的影响显著;女性人际关系敏感评分高于男性（Z=-3.04,P=0.00）;病程更长者,其躯体化（Z=-3.42,P=0.00）、强迫症状（Z=-2.42,P=0.01）、人际关系敏感（Z=-3.46,P=0.00）和总均分（Z=-2.11,P=0.04）得分更高,且差异具有统计学意义;年龄更小者,恐怖评分高于常模,差异具有统计学意义（Z=-2.25,P=0.02）;吸烟频繁的患者,躯体化评分更高,差异具有统计学意义（Z=-3.11,P=0.00）;文化程度和手术史对SCL-90各评分无影响（P值均＞0.05）.结论 CRS患者有轻度到轻-中度心理健康损害,强迫症状、人际关系敏感、焦虑、精神病性障碍随着病情的加重而严重.女性、病程长和有吸烟史可加重CRS患者的心理障碍.

Objective To investigate the characteristics of psychiatric comorbidity in patients with chronic rhinosinusitis.Methods The psychological investigation and evaluation were done in 80 patients with chronic rhinosinusitis by using self-reporting inventory 90 （SCL-90）,visual analogue scale （VAS）,Lund-Mackay score and Lund-Kennedy score.The results were compared with healthy Chinese population,including factors of age,gender,educational level,course of disease,the number of operation and smoking history（using rank-sum test analysis,SPSS 19.0）.Results Mild and mild-to-moild levels of psychosis were noted in 68.75％ with high score for somatization （t =4.46,P =0.00）,obsession （t =4.78,P =0.00）,interpersonal sensitivity（t =2.42,P =0.02）,anxiety （t =2.47,P =0.02）,psychoticism （t =3.01,P =0.01） and other（t =6.31,P =0.00） compared with control group.The factor scores of relation sensibility in female group were higher than male group （Z =-3.04,P =0.00）.The factor scores of Somatization （Z =-3.42,P =0.00）,Obsession （Z =-2.42,P =0.01）,Interpersonal Sensitivity （Z =-3.46,P =0.00）,General Symptomatic Index （Z =-2.11,P =0.04） in long course group were higher than short course group.The factor scores of panic in junior group were higher than senior group （Z =-2.25,P =0.02）.The factor scores of somatization in smoking group were higher than less-smoking group（Z =-3.11,P =0.00）.There was no difference in score of SCL-90 with educational background and surgical history （all P ＞ 0.05）.Conclusions Psychiatric disorders are prevalent in patients with CRS.CRS patients＇ psychological status was worse than that of the healthy person.