慢性紧张型头痛伴焦虑抑郁的相关影响因素分析

Analysis for the related factors influencing chronic tension headache with anxiety and depression

目的探探讨慢性紧张型头痛伴焦虑抑郁的现状及其相关影响因素。方法慢性紧张型头痛患者121例患者,由1名专业的神经内科医生和1名专业精神科医师分别对其进行汉密尔顿焦虑量表和汉密尔顿抑郁量表评测,并对其年龄、性别、体重指数、躯体疾病、睡眠质量、头痛严重程度、病程及是否长期服用止痛药等进行相关因素分析。结果121例中慢性紧张型头痛伴焦虑抑郁患者63例,患病率为52.07%。其中男20例,患病率40.0%;女43例,患病率为60.6%,女性患病率显著高于男性(P=0.026)。年龄在18~45岁、46~69岁、≥70岁焦虑抑郁患病率分别是20.8%,59.2%及61.5%,差异有统计学意义(P=0.003)。BMI正常及超重/肥胖者焦虑抑郁患病率为5.7%及70.9%,差异有统计学意义(P=<0.001)。有躯体疾病者更易发生焦虑抑郁症(P<0.001)。睡眠质量PSQI≤7分和>7分的焦虑抑郁患病率为15.0%和70.4%,差异有统计学意义(χ^2=32.894,P<0.001)。头痛VAS评分1~3分、4~6分及7~10分者发生焦虑抑郁的患病率分别是7.1%、60.0%及100%,差异有统计学意义(P<0.001)。病程在1年以内及>1年者发生焦虑抑郁的患病率为17.8%及72.4%,差异有统计学意义(P<0.001)。长期否认服用止痛药及明确服用止痛药的焦虑抑郁患病率为35.7%及60.8%,差异有统计学意义(χ^2=6.982,P=0.009)。Logistics回归分析显示:性别、BMI、睡眠质量(PSQI)、头痛严重程度评分(VAS评分)及长期服用止痛药物是慢性紧张型头痛并发焦虑抑郁的独立危险因素(P<0.05)。其中女性是男性的4倍,超重/肥胖患者是正常体重的25倍,睡眠质量差是睡眠质量好患者的6倍,头痛程度越严重者发生焦虑抑郁的风险越高,长期服用止痛药者伴发焦虑抑郁风险也高。结论慢性紧张型头痛患者中,女性、超重/肥胖、睡眠障碍、头痛较严重及长期服用止痛药物者更易发生焦虑抑郁。临床应以上述人群为重点人群,尽早干预,提高患者的生活质量。

Objective To investigate the related factors influencing chronic tension headache with anxiety and depression.Methods A total of 121 patients with chronic tension headache who were admitted and treated in our hospital from January 2018 to August 2019 were enrolled in the study,who were evaluated by a professional neurologist and a professional psychiatrist by means of Hamilton Anxiety Scale and Depression Scale.Moreover the related factors including patient’s age and sex,body mass index,physical illness,sleep quality,severity of headache,duration of disease,and long-term use of painkillers were analyzed.Results Among the 121 patients,there were 63 cases of chronic tension headache complicated by anxiety and depression,with the prevalence rate being 52.07%,of whom,20 cases were males,with the prevalence rate being 40.0%,and 43 cases were females,with the prevalence rate being 60.6%,and the female prevalence rate was significantly higher than that of males(P<0.05).The prevalence of anxiety and depression in 18~45 age group,46~69 age group,70 and above age group were 20.8%,59.2%and 61.5%,respectively,there were significant differences among the three age groups(P<0.01).The prevalence of anxiety and depression in normal weight patients and overweight/obese patients was 5.7%and 70.9%,there was significant difference between them(P<0.01).The patients with physical illness were more likely to develop anxiety and depression(P<0.01).The prevalence of anxiety and depression in the patients with sleep quality PSQI≤7 or>7 was 15.0%and 70.4%,respectively,there was significant difference between them(P<0.01).The prevalence of anxiety and depression in patients with headache VAS scores of 1~3,4~6 and 7~10 was 7.1%,60.0%and 100%,respectively,there was significant difference among the three groups(P<0.01).The prevalence of anxiety and depression in the patients with a disease duration of less than 1 year or more than 1 year was 17.8%and 72.4%,respectively,there was significant difference between them(P<0.01).Logistics regression analysis showed that gender,BMI,sleep quality(PSQI),headache severity score(VAS score)and long-term use of analgesic drugs were independent risk factorsof chronic tension-type headache complicated by anxietyand depression(P<0.05).Among these patients,female patients were four times as many as male patients,and the patients with overweight/obese were 25 timesas many as normal weight subjects,and the patientswith poor sleep quality were six times as many as thosewith good sleep quality.The more severe theheadache,the higher the risk of anxiety and depression,and the patients who had long-term use of painkillers had the higher risk of anxiety and depression.Conclusion Among patients with chronic tension-type headache,women,overweight/obesity,sleep disorders,severe headaches,and long-term use of analgesics are more likely to develop anxiety and depression.Clinically,the population mentioned above are the key population,it is necessary to carry out intervention as soon as possible to improve the life quality of patients.