妊娠早期自主神经功能检查联合负面情绪评估对产后抑郁症的预测价值分析

Predictive value of autonomic nerve function test combined with negative emotion assessment during first trimester for postpartum depression

目的探讨妊娠早期自主神经功能检查联合负面情绪评估对产后抑郁症(postpartum depression,PPD)的预测价值。方法选取2015年1月至2017年7月于本院行产前检查并分娩的398例孕妇为研究对象,产后6周根据爱丁堡产后抑郁量表(Edinburgh postnatal depression scale,EPDS)评分将其分为PPD组和非PPD组。比较两组孕妇妊娠第10周的自主神经功能检查和负面情绪评估结果,采用Pearson相关性分析评价孕妇妊娠早期各指标与EPDS评分的相关性,采用接受者操作特征曲线(receiver operator characteristic,ROC)的曲线下面积(area under curve,AUC)评价妊娠早期各指标对PPD的预测价值。结果随访结果表明55例孕妇在产后6周出现PPD,发生率为13.8%。PPD组孕妇妊娠早期的平均心率、机体压力指数(physical stressindex,PSI)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评分、汉密尔顿抑郁量表(Hamilton depression acale,HAMD)评分均显著高于非PPD组(P_均<0.05),心率变异标准偏差(standard deviation of NN intervals,SDNN)、自主神经系统活性、每搏输出量、微分脉搏指数、血管弹性均显著低于非PPD组(P_均<0.05)。Pearson相关性分析表明,EPDS总分与SDNN、每搏输出量、微分脉搏指数均呈显著负相关(P_均<0.05),与PSI、HAMA评分呈显著正相关(P_均<0.05)。ROC曲线分析表明,SDNN、PSI、每搏输出量、微分脉搏指数、HAMA评分对PPD的发生具有中等预测价值(AUC为0.7～0.9),其中SDNN的预测价值最高。结论妊娠早期自主神经功能检查联合负面情绪评估对PPD具有一定的预测价值,尤其是SDNN、PSI、每搏输出量、微分脉搏指数、HAMA评分,可能有助于早期筛查PPD。

Objective To explore the predictive value of autonomic nerve function test combined with negative emotion assessment during first trimester for postpartum depression(PPD).Method 398 pregnant women receiving antenatal examination and delivery in our hospital from January 2015 to July 2017 were enrolled for the study,and divided into PPD group and non-PPD group according to Edinburgh postpartum depression scale(EPDS)score in 6 weeks after childbirth.Results of autonomic nervous function test and negative emotional assessment were compared between the two groups at 10 weeks of gestation.Pearson correlation analysis was used to analyze the correlation between all indicators in first trimester and EPDS scores.Area under curve(AUC)of eceiver operator characteristic(ROC)was performed to evaluate the predictive value of these indicators in first trimester for PPD.Result Follow-up results showed that 55 pregnant women suffered from PPD in 6 weeks after childbirth,whose incidence was 13.8%.The mean heart rate,physical stress index(PSI),Hamilton anxiety scale(HAMA)and Hamilton depression acale(HAMD)scores in PPD group were significantly higher than those in non-PPD group(Pall<0.05),and the activity of the standard deviation of NN intervals(SDNN),autonomic nervous system activity,stroke volume,differential pulse index and vascular elasticity were significantly lower than those in non-PPD group(Pall<0.05).Pearson correlation analysis showed that EPDS score was negatively correlated with SDNN(Pall<0.05),stroke volume and differential pulse index,and positively correlated with PSI and HAMA score(Pall<0.05).ROC analysis showed that SDNN,PSI,stroke volume,differential pulse index and HAMA score had moderate predictive value for occurrence of PPD(AUC 0.7~0.9),among them SDNN had the highest value.Conclusion Autonomic nerve function test combined with negative emotion assessment during first trimester have a certain predictive value for PPD,especially for SDNN,PSI,stroke volume,differential pulse index and HAMA score,which may help early screening of PPD.