重性抑郁障碍患者失眠严重程度与急性期疗效相关性研究

The relationship between the severity of insomnia and the curative effect in acute stage in patients with major depressive disorder

目的探讨重性抑郁障碍患者失眠严重程度与急性期疗效的相关性。方法对57例重性抑郁障碍患者用失眠严重程度指数(insomnia severity index,ISI)评估失眠程度并分组,匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评估睡眠质量,用24项汉密尔顿抑郁量表(Hamilton depression scale,HAMD_(24))评估患者抑郁症状,并用其减分率反映急性期治疗(4～6周)效果,比较不同失眠程度患者疗效。结果经急性期治疗,伴有轻度、中度和重度失眠的3组重性抑郁障碍患者急性期痊愈率(21/21 vs. 19/21 vs. 9/15)存在统计学差异(χ~2=22.34,P<0.01),患者治疗前PSQI评分与HAMD减分率呈负相关(r=-0.44,P<0.01)。治疗后,重度失眠组的HAMD总分及焦虑/躯体化、阻滞、绝望感因子分高于中度和轻度失眠组,差异有统计学意义(P<0.01)。结论重性抑郁障碍患者失眠严重程度可能预测急性期疗效;经急性期治疗后,伴有重度失眠的重性抑郁障碍患者残留焦虑/躯体化、阻滞、绝望感等症状较轻中度失眠患者更明显。

Objective To investigate the relationship between the severity of insomnia and the curative effect in acute stage in patients with major depressive disorder(MDD).Methods The Insomnia Severity Index(ISI)was used to evaluate and group the severity of insomnia in the 57 patients with MDD.The Pittsburgh Sleep Quality Index(PSQI)was used to assess sleep quality.The 24-item Hamilton Depression Scale(HAMD24)was used to evaluate depressive symptoms,and the effect of acute stage(4~6 weeks)was evaluated with its reduction rate.The difference of curative effect was compared among patients with different insomnia levels.Results There was a significantly different recovery rate in acute stage in 3 groups of patients with mild,moderate and severe insomnia(χ^2=22.34,P<0.01).The severity of insomnia in patients with MDD(PSQI)was negatively correlated with the curative effect of acute stage(r=-0.44,P<0.01).The total score,anxiety/somatization factor score,retardant factor score and despair factor score were significantly higher in severe insomnia group than in the moderate and mild insomnia groups after acute treatment(P<0.01).Conclusion The severity of insomnia in patients with MDD can predict the curative effect in acute stage.The depressive patients with severe insomnia have residual anxiety/somatization,retardant,feelings of despair and other symptoms more obvious than mild and moderate insomnia patients after acute treatment.