双相情感障碍抑郁发作急性期治疗后残留症状及其影响因素

Residual symptoms after treatment of acute depressive episodes in patients with bipolar disorder andtheir influencing factors

目的探索双相障碍抑郁发作急性期治疗后的残留症状、功能损害及其影响因素。方法本研究为单中心、横断面研究,筛查2016 年2—12 月就诊于首都医科大学附属北京安定医院门诊或住院的双相障碍且最近一次是抑郁发作的患者130 例。通过标准化的问卷及访谈过程收集人口学资料、疾病临床特征。结果共纳入121 例受试者,其中有残留抑郁症状患者23.1%(28/121)。临床痊愈与残留抑郁症状两组在性别(χ^2=17.90,P< 0.01)、急性期伴有睡眠障碍(χ^2=7.37,P=0.01)、近2 年的发作次数(Z=-2.46,P=0.01)等方面差异有统计学意义,二分类Logistic 回归显示男性、急性期伴有睡眠障碍、近2 年发作次数多,均是急性期治疗后残留抑郁症状的独立危险因素。残留抑郁症状组各方面受损程度较临床痊愈组严重,且与抑郁程度呈正相关。结论双相障碍抑郁发作急性期治疗后部分患者仍然存在残留的抑郁症状,其中男性、急性期伴有睡眠障碍、近2 年发作次数多是其危险因素,残留的抑郁症状对患者影响严重,应该加强针对性治疗,以改善预后。

Objectives To explore the residual symptoms and its influencing factors after the treatment of bipolar disorder in the acute phase of depression.Methods This is a single center,cross-sectional study.Clinical data from the medical records of 130 outpatient or hospitalized patients with bipolar disorder(BD) whose last episode was depression and were treated in Beijing Anding Hospital between February and December 2016 was collected.A total of 121 cases were included in this study.Patients' demographic and clinical data were collected using a mix of standardized scales and interviews.Results A total of 121 patients were interviewed in this study.The proportion of patients with residual depressive symptoms was 23.1%(28/121).Gender(χ^2 =17.90,P < 0.01),acute phase with sleep disorders(χ^2 =7.37,P=0.01),episode times in the past two years (Z=-2.46,P=0.01) were significantly different between clinical remission group and residual symptom group.Multiple logistic regression analysis demonstrated that male,acute phase with sleep disorders,more episode times in the past two years were independently associated with residual depressive symptoms.Patients with residual depressive symptoms were more depressive and significantly more impaired than the remission group.Conclusions Residual depressive symptoms may occur in some patients after the acute phase of bipolar depression.Being male,more episode times in the past two years were significantly associated with residual depressive symptoms.Residual depressive symptoms have negatively impact on patients so we should strive to enhance treatment plans to improve the prognosis.