强迫症临床特征对药物疗效的影响

The clinical features of obsessive-compulsive disorder and its impact on pharmacotherapeutic effect

目的 探讨强迫症患者的临床特征对药物疗效的影响.方法 选取符合DSM-Ⅳ中强迫症诊断标准的87例强迫症患者进行评估,采用Y-BOCS评估强迫症状严重程度,强迫症状分类量表修订版（Obsessive-Compulsive Inventory-Revised,OCI-R）评估对强迫症状的痛苦感受,贝克抑郁量表第2版、贝克焦虑量表评估抑郁、焦虑症状,儿童期创伤经历问卷评估儿童期创伤水平,并进行为期16周的药物治疗随访,以Y-BOCS减分率评估治疗是否有效.采用Pearson相关分析临床特征与疗效的相关关系,并采用二分类Logistic进行逐步回归分析.结果 总体治疗有效率为65.3％（47/72）,晚发强迫症患者（n=47）OCI-R中检查评分高于早发强迫症患者[n=40,（6.3±3.7）分与（3.7±3.3）分;t=-2.50,P=0.016],高创伤强迫症患者（n=52）的OCI-R中强迫思维评分以及贝克抑郁量表第2版评分均高于低创伤强迫症患者[n=23,（6.8±3.3）分与（4.5±3.5）分,t=-2.14,P=0.038;（23.8±12.1）分与（15.6±5.8）分,t=-3.08,P=0.003].强迫症患者的首次发病年龄与Y-BOCS减分率呈正相关（r=0.25,P＜O.05）.Logistic逐步回归分析显示,首次发病年龄进入回归方程（OR=1.15,P＜0.05）.结论 强迫症患者的童年创伤经历越多,强迫思维越严重,首次发病年龄越早,疗效越差.

Objective To explore the relation of clinical characteristics and drug therapeutic effect in patients with obsessive-compulsive disorder （OCD）.Methods Totally 87 patients meeting the DSM-Ⅳ criteria for OCD were recruited.They were assessed with the Y-BOCS and Obsessive-Compulsive Inventory-Revised （OCI-R）to evaluate the degree of obsessive-compulsive symptoms and distress,and Beck Depression Inventor-Ⅱ and Beck Anxiety Inventory to evaluate the degree of depression and anxiety,Childhood Trauma Questionnaire was used to measure the childhood trauma,and the patients were arranged to complete the follow-up of 16 weeks,the reductive rate of Y-BOCS was used to assess efficacy.Pearson correlation and binary logistic stepwise regression were used to analysis the relationship between clinical characteristics and therapeutic effect.Results The total effective rate of treatment was 65.3% （47/27）.Compared with early-onset OCD patients （n=40）,late-onset OCD patients （n=47） showed higher checking scores of OCI-R （3.7±3.3 vs.6.3±3.7;t=-2.50,P〈0.05）.Higher-trauma OCD patients （n=52） scored higher than lower-trauma OCD patients （n=23） in obsession and Beck Depression Inventor-Ⅱ scores （6.8 ± 3.3 vs.4.5±3.5,t=-2.14,P=0.038;23.8± 12.1 vs.15.6±5.8,t=-3.08,P=0.003）.The age at onset of OCD was positively correlated with the reductive rate of Y-BOCS （r=0.25,P〈0.05）.Logistic regression analysis reported that age of onset entered into the regression model （OR=1.15,P〈0.05）.Conclusions It suggests that OCD patients with more childhood trauma experience may exhibit more severe obsession,and those with earlier age of onset may exhibit the worse therapeutic effect.