采用90项症状自评量表分析成都市变应性鼻炎患者心理健康情况

Analysis of mental state of allergic rhinitis patients in Chengdu city by symptom check list 90(SCL-90) scale

目的探讨成都市变应性鼻炎(allergic rhinitic,AR)患者的心理健康情况.方法选择2013年7月至2018年1月在四川大学华西医院、四川省人民医院、成都中医药大学附属医院、四川省中西医结合医院、四川省第二中医医院就诊的1536例AR患者,根据纳入和排除标准筛选出827例纳入研究组.采用90项症状自评量表(symptom check list 90,SCL-90)按照性别、体质量指数、年龄、婚否、月薪、病程、居住环境、文化程度、工作环境共9种分类方法,对患者的精神心理状态进行评分,并作组内比较.将研究组和中国常模组进行组间比较,提取心理障碍的阳性因子.采用视觉模拟量表(visual analogue scale,VAS)对研究组的鼻痒、喷嚏、清水样涕、鼻塞4个症状进行评分.用SPSS19.0软件行统计学分析.采用多元回归统计方法,对阳性因子和症状评分作偏相关分析.结果研究组的SCL-90总均分为(2.64±0.25)分(x±s,下同),符合轻中度心理健康损害.827例AR患者中,无心理健康损害者124例(15.0%),轻度损害者176例(21.3%),轻中度损害者474例(57.3%),中重度损害者41例(5.0%),重度损害者12例(1.4%).组内比较结果显示,差异项目数位居前3位的分类是居住环境、性别和工作环境:城居患者的躯体化、强迫症状、人际关系敏感、抑郁、焦虑、精神病性、其他(睡眠、饮食)、总均分均高于乡居患者[(3.29±0.61)分比(2.65±0.50)分,(2.81±0.77)分比(2.05±0.38)分,(3.10±0.19)分比(2.49±0.67)分,(3.40±0.84)分比(2.49±0.70)分,(3.04±0.64)分比(2.33±0.51)分,(3.02±0.55)分比(2.40±0.77)分,(3.40±0.41)分比(2.52±0.77)分,(2.91±0.11)分比(2.29±0.40)分,Z值分别为4.88、5.25、4.57、5.91、5.09、4.63、5.55、-4.55,P值均<0.05];女性的躯体化、人际关系敏感、抑郁、其他(睡眠、饮食)评分高于男性[(2.66±0.51)分比(2.00±0.45)分,(3.37±0.47)分比(2.63±0.51)分,(3.44±0.57)分比(2.85±0.52)分,(3.47±0.36)分比(2.76±0.45)分,Z值分别为-5.10、-5.51、-4.86、-5.28,P值均<0.05];户内工作组的躯体化、人际关系敏感、精神病性、其他(睡眠、饮食)评分高于户外工作组[(3.49±0.64)分比(2.78±0.46)分,(3.33±0.30)分比(2.56±0.68)分,(3.28±0.60)分比(2.67±0.31)分,(3.50±0.85)分比(2.85±0.37)分,Z值分别为5.31、5.79、4.89、5.00,P值均<0.05].户外工作组的强迫症状、焦虑、敌对评分均高于户内工作组[(3.44±0.40)分比(2.83±0.35)分,(3.40±0.50)分比(2.57±0.93)分,(3.34±0.88)分比(2.69±0.56)分,Z值分别为4.96、6.22、5.08,P值均<0.05].组间比较发现抑郁、焦虑、精神病性、其他(睡眠、饮食)可作为4个阳性因子与VAS评分进行偏相关分析.偏相关分析结果提示:抑郁与喷嚏、清水样涕呈正相关趋势,焦虑与鼻痒、鼻塞呈正相关趋势,精神病性与鼻痒、喷嚏呈正相关趋势,其他(睡眠、饮食)与清水样涕、鼻塞呈正相关趋势.结论成都市AR患者存在轻中度心理健康损害,与AR症状存在相关性.

Objective To analyse the mental state of patients with allergic rhinitis (AR) in Chengdu. Methods One thousand five hundred and thirty-six AR patients from Sichuan Provincial Integrated Traditional Chinese and Western Medicine Hospital, West China Hospital of Sichuan University, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan People's Hospital, Sichuan Second Hospital of Traditional Chinese Medicine were selected from July 2013 to January 2018. Eight hundred and twenty-seven patients were screened into study group by inclusion and exclusion standards. The symptom check list 90 (SCL-90) was used to group and score the mental state of these patients according to nine classification criteria: gender, BMI, age, marital status, monthly salary, disease duration, living environment, education level and working environment. Then, the scores were compared within groups. Inter-group comparison was made between the study group and the Chinese norm, and the positive factors for psychological disorders were extracted. Four symptoms in the study group, i.e. nasal itching, sneezing, clear discharge and nasal congestion, were scored on the visual analogue scale (VAS). SPSS 19.0 software was used to carry out statistical analysis. Partial correlation analysis was performed between the positive factors and the symptom scores by multiple regression statistical method. Results The total score of SCL-90 in the study group was 2.64±0.25, which was accorded with mild to moderate mental health impairment. There were 124 (15.0%) without mental health damage, 176 (21.3%) with mild damage, 474 (57.3%) with mild to moderate damage, 41 (5.0%) with moderate to severe damage and 12 (1.4%) with severe damage. The in-group comparison showed that the top three categories of different items were the living environment, gender and working environment. The scores of somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, psychosis, other (sleep, diet) and total average score of urban residents were higher than that of country residents (3.29±0.61 vs 2.65±0.50, 2.81±0.77 vs 2.05±0.38, 3.10±0.19 vs 2.49±0.67, 3.40±0.84 vs 2.49±0.70, 3.04±0.64 vs 2.33±0.51, 3.02±0.55 vs 2.40±0.77, 3.40±0.41 vs 2.52±0.77, 2.91±0.11 vs 2.29±0.40, Z value was 4.88, 5.25, 4.57, 5.91, 5.09, 4.63, 5.55,-4.55, respectively, all P<0.05). Women scored higher than man for somatization, interpersonal sensitivity, depression and others (2.66±0.51 vs 2.00±0.45, 3.37±0.47 vs 2.63±0.51, 3.44±0.57 vs 2.85±0.52, 3.47±0.36 vs 2.76±0.45, Z value was -5.10,-5.51,-4.86,-5.28, respectively, all P<0.05). The scores of somatization, interpersonal sensitivity, psychosis and other (sleep, diet) were higher in the indoor group than those in the outdoor group (3.49±0.64 vs 2.78±0.46, 3.33±0.30 vs 2.56±0.68, 3.28±0.60 vs 2.67±0.31, 3.50±0.85 vs 2.85±0.37, Z value was 5.31, 5.79, 4.89, 5.00, respectively, all P<0.05). The outdoor group scored higher on obsessive-compulsive symptoms, anxiety and hostility (3.44±0.40 vs 2.83±0.35, 3.40±0.50 vs 2.57±0.93, 3.34±0.88 vs 2.69±0.56, Z value was 4.96, 6.22, 5.08, respectively, all P<0.05). The inter-group comparison found that depression, anxiety, psychosis and other (sleep, diet) could be partially correlated with VAS scores as 4 positive factors. The results of partial correlation analysis showed that depression was positively correlated with sneezing and nasal runny discharge, anxiety was positively correlated with nasal itching and nasal obstruction, psychosis was positively correlated with nasal itching and sneezing, and other (sleep, diet) was positively correlated with nasal runny discharge and nasal obstruction. Conclusion AR patients have mild to moderate mental health impairments, which are correlated with AR symptoms.