抑郁症患者述情障碍与功能性躯体不适的关系

Somatization and alexithymia in patients with depressive disorder

目的了解抑郁症患者功能性躯体不适症状的特征,并探讨抑郁症患者述情障碍与功能性躯体不适症状之间的关系。方法选用多伦多述情障碍量表20项中文版（TAS-20）、患者健康问卷（PHQ-15）和汉密尔顿抑郁量表17项版本（HAMD-17）,对113例抑郁症患者（抑郁症组）和100例健康志愿者（对照组）进行评定。结果 （1）抑郁症组TAS-20总分及各因子分、PHQ-15总分及各条目分均显著高于对照组（均P〈0.05）;（2）根据PHQ总分将功能性躯体不适分为轻、中、重度,抑郁症组TAS-20总分、情感辨别不能因子分和外向性思维因子分均依次升高（P〈0.05）;（3）情感辨别不能因子主要与四肢躯干疼痛及疲劳症状呈正相关（r=0.211,r=0.434,均P〈0.05）,外向性思维因子与头部及消化系不适呈正相关（r=0.192,r=0.388,均P〈0.05）;（4）多元线性回归分析显示,情感辨别不能（β=0.220,95%CI 20.55-22.28）、外向性思维（β=0.216,95%CI 21.32-22.76）和HAMD-17总分（β=0.334,95%CI 21.54-23.79）为功能性躯体不适的影响因素（R^2=0.238）。结论抑郁症患者存在严重而广泛的功能性躯体不适症状,情感辨别不能和外向性思维可能对部分症状的产生具有影响。

Objective To examine the alexithymia features of patients with depressive disorder and to investigate the associations between alexithymia and somatization. Methods 113 patients with depressive disorder and 100 healthy controls were included. The Chinese version of the 20- item Toronto Alexithymia Scale（ TAS- 20）,Patient Health Questionnaire（ PHQ- 15）,and the 17- item Hamilton Depression Scale（ HAMD- 17） were applied for analysis. Results Compared with controls,patients with depressive disorder showed significantly higher scores in TAS- 20 and PHQ- 15（ P〈0. 05）. Among the scores of TAS- 20,Factor 1（ difficulty in identifying feelings） and Factor 3（ externally oriented thinking） were gradually increased as the increased severity of somatization（ P〈0. 05）. In all three factors of alexithymia,Factor 1 was strongly correlated with symptoms of pain on body（ including back and arms / legs / joints） and tire（ r =0. 211,r = 0. 434,P〈0. 05）,while Factor 3 was strongly correlated with discomfort of digestive system and head（ r =0. 192,r = 0. 388,P〈0. 05）. According to multiple linear regression,Factor 1（ β = 0. 220,95% CI 20. 55 - 22. 28）,Factor 3（ β = 0. 216,95% CI 21. 32 - 22. 76） and HAMD- 17 total scores（ β = 0. 334,95% CI 21. 54 - 23. 79） were the potential risk factors of somatic complains（ R^2= 0. 238）. Conclusion These results suggest that patients with depressive disorder have significant somatic amplifications. Alexithymia may be an affecting factor of the somatization symptoms of depression.