脑胶质瘤患者手术前后近期心境障碍的临床研究

Clinical study of pre- and post-operative recent mood disorders in glioma patients

目的 探讨脑胶质瘤患者手术前后近期出现心境障碍的临床特点.方法 回顾性纳入2015年7月至2017年6月西南医科大学附属医院神经外科行手术治疗的76例脑胶质瘤患者,术前2～3d及术后5～7d对所有患者行汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）及倍克-拉范森躁狂量表（BRMS）评分.采用多元线性逐步回归方法分析影响脑胶质瘤患者HAMD评分的临床因素.结果 与术前比较,76例脑胶质瘤患者术后HAMD评分显著下降[分别为（13.5±3.2）分、（9.8±1.5）分,t=3.010,P＜0.05];术后出现抑郁的患者比例显著下降[分别为42.1％（32/76）、15.8％ （12/76）,x2=12.795,P＜0.01].术后HAMA评分[分别为（10.1±2.8）分、（12.8±4.6）分]及出现焦虑的患者比例[分别为38.2％（29/76）、50.0％（38/76）]均较术前下降,但差异均无统计学意义（均P＞0.05）.术后BRMS评分[分别为（7.5±2.1）分、（8.7±2.5）分]及出现躁狂的患者比例[分别为2.6％（2/76）、3.9％ （3/76）]较术前下降,但差异均无统计学意义（均P＞0.05）.比较不同病理级别、肿瘤部位及肿瘤侧别的脑胶质瘤患者手术前后HAMD评分,结果显示病理高级别组、额颞叶组及右侧组术后HAMD评分显著低于术前（均P＜0.05）.多元线性逐步回归分析显示,家庭收入是术前HAMD评分的影响因素（β=-0.573,t=-3.427,P＜0.01）,且家庭收入高低与术前HAMD评分高低呈负相关.结论 部分脑胶质瘤患者手术前后存在不同程度及类型的心境障碍,抑郁可能与脑胶质瘤的生长部位密切相关,家庭收入是影响术前HAMD评分的独立危险因素.

Objective To discuss the prevalence and clinical features of pre-and post-operative mood disorders in patients with gliomas.Methods A retrospective analysis was conducted on 76 patients of gliomas who underwent surgical resection between July 2015 and June 2017 at Neurosurgery Department of the Affiliated Hospital of Southwest Medical University.Hamilton depression scale （HAMD）,Hamilton anxiety scale （HAM-A） and Bech-Rafaelsen Mania rating scale （BRMS） were used for evaluation at 2-3 days before surgery and 5-7 days post surgery.Results Compared with the pre-operative conditions of 76 patients with gliomas,their postoperative HAMD scores were significantly decreased （13.5 ± 3.2 vs.9.8 ± 1.5,t =3.010,P 〈 0.05）.Significant reduction was seen in the proportion of patients with postoperative depression [42.1% （32/76） vs.15.8% （12/76）,x2 =12.795,P 〈 0.01].There was no significant difference between pre-and post-operative HAMA scores （10.1 ± 2.8 vs.12.8 ± 4.6） or between pre-and post-operative proportions of patients with anxiety [38.2% （29/76） vs.50.0% （38/76）] （both P 〉 0.05）.No significant difference was observed between pre-and post-operative BRMS score （7.5 ± 2.1 vs.8.7 ± 2.5） or pre-and post-operative proportions of patients with mania [2.6% （2/76） vs.3.9% （3/76）] （both P 〉0.05）.The results showed that postoperative HAMD scores in pathologically high level group,frontal and temporal lobes group and right side group were significantly lower than those prior to surgery （all P 〈 0.05）.Multiple linear stepwise regression analysis showed that household income was vital to preoperative HAMD scores of glioma patients （β =-0.573,t =-3.427,P 〈 0.01） and was negatively correlated with preoperative HAMD scores.Conclusions Some glioma patients may present with mood disorders of varying extent and types both before and after surgery.Depression seems to be closely related to the location of glioma.Family income could be an independent influencing factor for preoperative HAMD score.