抑郁障碍患者筛查及1年随访研究

Biphasic screening and 1-year follow-up study of patients with depression

目的:对抑郁障碍患者的疗效进行开放性、前瞻性研究,以期为临床早诊断提供筛查依据。方法:选取专科医院住院的符合ICD-10诊断标准诊断为抑郁障碍的患者。出院前1天进行自制一般情况调查表、汉密顿抑郁量表(HAMD)、心境障碍问卷(MDQ)评定。将MDQ量表评分≥7分定义为筛查阳性,视为高危组,其余视为低危组。出院后1年对两组患者进行随访,内容包括症状评估、社会功能状况、是否更改诊断为双相情感障碍等。结果:共入组168例患者,出院后1年共脱落3例,脱落率1.7%。高危组入组年龄、首次发病年龄均小于低危组(t=-4.28,-6.02;P<0.05)。低危组1年临床疗效优于高危组(χ~2=2.11,P<0.05)。高危组更改为双相障碍诊断例数显著高于低危组(χ~2=17.00,P<0.05)。出院1年疗效与首次发病年龄(P=0.047,OR=0.89,B=0.12)、更改诊断(P=-0.063,OR=0.91,B=0.16)、MDQ评分(P=-0.037,OR=0.78,B=0.11)关系密切。更改诊断与首次发病年龄(P=0.067,OR=0.91,B=0.12)、MDQ评分(P=-0.077,OR=0.81,B=0.19)关系密切。结论:首次发病年龄越早远期疗效越差。MDQ量表在抑郁障碍早期应用作为常规筛查工具值得在临床中推广使用。

Objective:To study the efficacy of depression patients in an open and prospective way,in order to provide a screening basis for early clinical diagnosis.Methods:The patients who met the ICD-10 diagnostic criteria and were hospitalized in a special hospital were selected.One day before discharge,the general condition questionnaire,HAMD and MDQ were assessed.MDQ score ≥ 7 was defined as screening positive,which was regarded as high-risk group and the rest as low-risk group.Two years after discharge,two groups of patients were followed up,including symptom evaluation,social function status,whether to change the diagnosis of bipolar disorder.Results:A total of 168 patients were enrolled in the group.3 patients were dropped off 1 years after discharge,with a drop rate of 1.7%.The age of admission and the age of first onset in high-risk group were lower than those in low-risk group(t=-4.28,-6.02;P<0.05).The 2-year clinical effect of low-risk group was better than that of high-risk group(χ~2=2.11,P<0.05).The number of patients with bipolar disorder in high risk group was significantly higher than that in low risk group(χ~2=17.00,P<0.05).Two years after discharge,the curative effect was closely related to the age of first onset(P=0.047,OR=0.89,B=0.12),MDQ positive(P=-0.063,OR=0.91,B=0.16)and diagnosis change(P=-0.037,OR=0.78,B=0.11).The change of diagnosis was closely related to the age of first onset(P=0.067,OR=0.91,B=0.12)and MDQ positive(P=-0.077,OR=0.81,B=0.19).Conclusion:The earlier the age of the first onset,the worse the long-term effect.MDQ as a routine screening tool in the early stage of depression is worth popularizing in clinical practice.