突发性聋患者焦虑、抑郁与病情阶段的关系及影响因素分析

Relationship of anxiety and depression with illness stage in patients with sudden hearing loss and its influencing factors

目的探讨突发性聋患者焦虑、抑郁与病情阶段的关系,并分析焦虑及抑郁发生的影响因素。方法于2016年1月至2017年1月纳入急性期突发性聋患者45例(急性期组)、慢性期突发性聋患者71例(慢性期组)、健康志愿者30例(对照组),进行问卷调查。应用汉密尔顿焦虑(HAMA)及抑郁(HAMD)量表测评并对比各组焦虑及抑郁发生情况。统计患者一般资料、发病及治疗相关资料,通过回归树分析测评患者发生焦虑、抑郁的影响因素。结果急性期组HAMA、HAMD得分及焦虑、抑郁发生率明显高于慢性期组和健康对照组(与慢性期组对比,Z=-9.100,P<0.001;Z=-9.091,P<0.001;χ~2=31.209,P<0.001;χ~2=35.845,P<0.001;与健康对照组对比,Z=-7.336,P<0.001;Z=-7.324,P<0.001;χ~2=21.674,P<0.001;χ~2=23.148,P<0.001);慢性期组HAMA、HAMD得分及焦虑、抑郁发生率与健康对照组对比,差异无统计学意义(Z=-1.018,P=0.308;Z=-0.042,P=0.967;P=0.671;P=0.722)。发生焦虑或抑郁患者中,急性期患者占比更高(χ~2=31.209,P<0.001;χ~2=35.845,P<0.001),耳聋轻度、耳鸣无或轻度患者占比更低(χ~2=12.650,P<0.001;χ~2=18.629,P<0.001),发生抑郁患者中,男性患者占比更低(χ~2=4.424,P=0.035),差异有统计学意义。疾病阶段、就诊时耳聋程度是患者发生焦虑及抑郁的主要影响因素。慢性期组中无效患者发生焦虑或抑郁患者占比更高,差异有统计学意义(Z=-2.445,P=0.014;Z=-2.815,P=0.005)。结论急性期突发性聋患者焦虑及抑郁发生率较高;疾病阶段、就诊时耳聋程度是患者发生焦虑及抑郁的主要影响因素;慢性期组患者疗效越好,焦虑及抑郁风险越低。

Objective To investigate the relationship of anxiety and depression with illness stage in patients with sudden hearing loss,and to analyze the factors influencing anxiety and depression.Methods Forty-five patients with sudden hearing loss in the acute stage（acute group）,71 subjects with sudden hearing loss in the chronic stage（chronic group）,and 30 healthy subjects（control group）were enrolled from January 2016 to January 2017.The degrees of anxiety and depression in each group were evaluated using the Hamilton Anxiety（HAMA） and Hamilton Depression（HAMD） scales.General information and data of illness and treatment were recorded,and the factors influencing anxiety and depression were analyzed using the classification and regression tree.Results The HAMA and HAMD scale scores and the incidence rates of anxiety and depression in the acute group were much higher than those in the chronic and control groups（compared with the chronic group,Z=-9.100,P〈0.001;Z=-9.091,P〈0.001;χ2=31.209,P〈0.001;χ2=35.845,P〈0.001.compared with the control group,Z=-7.336,P〈0.001;Z=-7.324,P〈0.001;χ2=21.674,P〈0.001;χ2=23.148,P 0.001）.These indexes were similar between the chronic and control groups,although the differences were not statistically significant（Z=-1.018,P=0.308;Z=-0.042,P=0.967;P=0.671;P=0.722）.In the patients with anxiety or depression,the proportion of those with acute illness was higher（χ2=31.209,P〈0.001,χ2=35.845,P〈0.001）,and the proportions of those with mild deafness and no or mild tinnitus were lower（χ2=12.650,P〈0.001;χ2=18.629,P〈0.001）.In the patients with depression,the proportion of males was lower（χ2=4.424,P=0.035）.These differences were statistically significant.The disease stage and degree of deafness were the main factors influencing anxiety and depression in all the patients.In the chronic group,the patients with poor prognosis had a higher prevalence of anxiety or depression;the differences were statistically significant（Z=-2.445,P=0.014;Z=-2.815,P=0.005）.Conclusion In this study,the patients with acute sudden hearing loss had high prevalence rates of anxiety and depression.Disease stage and degree of deafness were the main factors influencing anxiety and depression.The patients with chronic illnesses who received treatment with better efficacy had lower risks of anxiety and depression.