伴焦虑症状的抑郁症患者认知功能研究

The cognitive impairment in depression patients with anxiety symptom

目的 探讨伴焦虑症状的抑郁症患者认知功能的特点及其影响因素.方法 对458名首发抑郁症患者使用汉密尔顿焦虑量表（HAMA）评定焦虑程度,根据量表得分划分为无焦虑症状组（n=76）和伴焦虑症状组（n=266）,并使用威斯康星卡片分类测验（WCST）、Stroop色-词关联测验、可重复性成套神经心理状态测验（RBANS）评定其认知功能.结果 （1）无焦虑症状组在完成分类数、学习到学会、即刻记忆、视觉广度、注意、延时记忆上的得分[分别为（2.88±2.14）分,（64.16±24.20）分,（81.78±17.16）分,（84.08±15.41）分,（106.45±20.72）分,（86.12± 13.06）分]高于伴焦虑症状组[分别为（2.07±1.98）分,（54.33±27.05）分,（70.47±17.61）分,（79.76±14.63）分,（98.25±17.11）分,（79.97±16.10）分],差异有统计学意义（P＜0.01或P＜0.05）;无焦虑症状组在在错误应答数、持续错误百分比、单色时间、字义干扰时、颜色干扰时上的得分[分别为（61.21±21.50）分,（17.11±6.10）分,（19.04±6.57）分,（15.01±9.11）分,（2.79±2.82）分]低于伴焦虑症状组[分别为（67.20±21.87）分,（19.21±7.18）分,（21.03±7.69）分,（17.92±10.64）分,（3.86±5.61）分],差异有统计学意义（P＜0.05）.（2）受教育年限、年龄、躯体性焦虑、精神性焦虑共同解释了即刻记忆28.1％的变异量（F=25.015,P＜0.01）;受教育年限和精神性焦虑共同解释了延时记忆19.8％的变异量（F=31.625,P＜0.01）;年龄和精神性焦虑共同解释了字义干扰时13.6％的变异量（F=20.293,P＜0.01）.结论 伴焦虑症状的抑郁症在执行功能、认知加工速度、记忆及注意上的损伤比无焦虑症状的抑郁症更为严重,受教育年限、年龄、精神性焦虑及躯体性焦虑是其影响因素.

Objective To investigate the cognitive impairment in depression with anxiety symptom and its influencing factors.Methods 458 first-episode depression patients were assessed with Hamilton Anxiety Scale （HAMA）.According to the score of HAMA,the patients with depression were divided into with anxiety symptom group （n=266） and without anxiety symptom group （n=76）.Using Wisconsin Card Sorting Test （WCST）,Stroop Color-Word Test,Repeatable Battery for the Assessment of Neuropsychological Status （RBANS） to assess neuropsychological function.Results （1）The group without anxiety symptom had higher scores on categories completed （2.88 ± 2.14）,learning to learned （64.16 ± 24.20）,immediately memory（81.78± 17.16）,visual span（84.08± 15.41）,attention（106.45±20.72） and delayed memory （86.12 ±13.06） than the group with anxiety symptom had （（2.07± 1.98）,（54.33±27.05）,（70.47± 17.61）,（79.76± 14.63）,（98.25± 17.11）,（79.97± 16.10） respectively）,and all these differences were significant （P〈0.01or P〈0.05）.The group without anxiety symptom had lower scores on response error（61.21±21.50）,perseverative error percentage（17.11±6.10）,monochrome time （19.04±6.57）,time of meaning interference （15.01 ±9.11） and time of color interference （2.79 ± 2.82） than the group with anxiety symptom had （（67.20 ±21.87）,（19.21±7.18）,（21.03±7.69）,（17.92± 10.64）,（3.86±5.61） respectively）,and all these differences were significant （P〈0.05）.（2）The combination of educational years,age,somatic anxiety and psychic anxiety explained the 28.1% variances of immediately memory（F=25.015,P〈0.01）;the combination of educational years and psychic anxiety explained the 19.8% variances of delayed memory（F=31.625,P〈0.01）;and the combination of age and psychic anxiety explained the 13.6% variances of time of meaning interference （F=20.293,P〈0.01）.Conclusion Depression with anxiety symptom has more severe impairment on executive function,processing speed,memory and attention.Educational years,age,psychic anxiety and somatic anxiety are influencing factors.