早发型双相障碍健康相关危险行为的危险因素病例对照研究

A case-control study of risk factors of health-related risky behaviors in early-onset bipolar disorder

目的：了解早发型双相障碍健康相关危险行为特点及危险因素.方法：采用病例对照研究设计,纳入符合疾病和有关健康问题的国际统计分类第十次修订本（ICD-10）双相障碍标准的起病年龄＜18岁的患者78例（抑郁发作38例,躁狂发作28例,混合状态2例,缓解期10例）及正常对照100例,用青少年健康相关危险行为自评问卷（AHRBI）评估双相障碍患者的健康相关危险行为.从性别、年龄等人口学资料及起病年龄、总病程、使用抗精神病药治疗史等临床特征方面探讨双相障碍患者健康相关危险行为的危险因素.结果：双相障碍组AHRBI总分与攻击暴力、健康妥协、破坏纪律、无保护性行为、自杀自伤及吸烟饮酒等6项因子评分均高于正常对照组[如总分,55 （38,119） vs.46 （38,65）,P＜0.05].有自杀自伤行为患者与无自杀自伤行为患者相比,起病年龄较大[14.0 （10.0,17.0） vs.14.0 （9.0,16.0）],总病程较短[12.0 （1.0,65.0） vs.26.0 （1.0,103.0）]（均P＜0.05）.Logistic回归分析显示自杀自伤与起病年龄（OR=1.92,95％CI：1.20～3.02）、性别（OR=5.92,95％ CI：1.48～23.52）、抗精神病药治疗史（OR=0.14,95％CI：0.02～0.66）、吸烟饮酒（OR=3.88,95％ CI：1.40 ～ 10.84）、破坏纪律（OR =4.16,95％CI：1.08 ～ 16.08）等因素关联;破坏纪律与攻击暴力（OR=26.74,95％ CI：4.16～171.68）、健康妥协（OR =6.66,95％CI：1.08 ～41.10）关联（均P＜0.05）.结论：早发型双相障碍患者总体健康相关危险行为多于正常对照,患者在6个维度均存在明显增多的健康相关危险行为.起病晚、女性、吸烟喝酒、破坏纪律是自杀自伤行为的危险因素,抗精神病药物治疗史是保护性因素.健康妥协和攻击暴力是破坏纪律行为的危险因素.

Objective： To investigate the characteristics of health-related risky behaviors and the risk factors of early-onset bipolar disorder. Methods： Seventy-eight patients fulfilled the ICD-10 criteria for bipolar disorder with onset-age 〈 18 years-old [ depressive state （38）, manic state （28）, mixed state （2）, remission （10）] and 100 healthy matched controls were recruited. Their health-related risky behaviors were assessed using the Questionnaire for Ado-lescents Health-Related Risky Behavior Inventory （AHRBI）. Logistic regression was performed to evaluate risk fac- tors associated with health-related risky behaviors among patients with bipolar disorder. Results： The bipolar group had higher AHRBI scores in the total scale and six subscales than controls, including Aggression and Violence （AV）, Health-Compromising Behavior （HCB）, Rule Breaking （RB）, Unprotected Sex （US）, Self-injury and Sui- cide （SS）, and Smoking and Drinking （SD） [ e. g., total scores, 55 （38, 119）vs. 46（38, 65） ;P 〈 0. 05]. Compared to patients without SS, the patients with SS had older onset-age [ 14.0（10. 0, 17. 0）vs. 14. 0（9. 0, 16.0）] and shorter duration[ 12. 0（1.0, 65.0） vs. 26.0（ 1.0, 103.0） ] （Ps 〈 0. 05）. Logistic regression analysis showed that SS were associated with onset-age （OR = 1.92, 95% CI： 1.20 - 3.02）, gender （ OR = 5.92, 95% CI： 1.48 - 23.52）, history of antipsychotics use （OR = 0. 14, 95% CI： O. 02 - 0. 66）, SD（ OR = 3.88, 95% CI： 1.40 - 10. 84） and RB （ OR = 4. 16, 95% CI： 1.08 - 16.08） （Ps 〈 0. 05）. RB were significantly associated with scores of AV（ OR = 26. 74, 95% CI： 4. 16 - 171.68） and HCB （ OR = 6. 66, 95 % CI： 1.08 -41.10） （Ps 〈 0. 05）. Conclusion： The early-onset bipolar disorder may have more health-related risky behaviors than general population. Older onset-age, female, smoking and drinking, and rule breaking are the risk factors of self-injury and suicide, while antipsychotics use is the protec- tive factor. Aggression and violence and health-compromising behavior are the risk factors of rule breaking.