双相障碍重性抑郁发作患者自杀未遂行为的危险因素

Clinical risk factors of suicide attempts in bipolar disorder patients with current major depressive episode

目的:基于社会人口学特征和临床特征确定双相障碍(BD)重性抑郁发作患者自杀未遂行为的风险因素。方法:采用横断面研究的方法对BD重性抑郁发作的住院患者共390例,依据此次抑郁发作有无自杀未遂行为患者分为伴自杀未遂BD组(SA组,n=149)和不伴自杀未遂BD组(NSA组,n=241);分别比较两组间社会人口学特征、生化、血液学、免疫学和心理学等指标的差异。以组间存在差异的变量作为自变量进行多因素Logistic回归分析BD重性抑郁发作自杀未遂行为的风险因素。在SA组,应用Pearson相关分析风险因素与患者目前自杀风险(依据护士用自杀风险评估量表总分)的相关性。结果:相对于NSA组,SA组年龄、首发年龄、血清三酰甘油浓度、中性粒细胞/淋巴细胞比值及血红蛋白浓度明显降低,血IgA浓度、单身(包括离异)和伴混合特征比例偏高(P<0.05或P<0.01)。多因素Logistic回归分析显示较低的年龄(O R=0.962,P<0.05)及较高的IgA浓度(OR=1.864,P<0.001)是BD重性抑郁自杀未遂行为的风险因素。SA组自杀风险与年龄呈负相关(r=-0.36,P<0.001),与IgA浓度呈正相关(r=0.42,P<0.001。结论:较低的年龄及较高的血IgA水平是BD重性抑郁发作患者自杀未遂行为的风险因素,这两个特征可为临床自杀风险早期识别提供客观信息。

Objective:To identify risk factors associated with suicide attempt in bipolar disorder patients with current major depressive episode.Method:Totally 390 were enrolled by cross-sectional study,including 149 BD patients with suicide attempts during a recent depressive episode(SA group),241 BD patients without prior suicide attempts(NSA group).The demographic characteristics and clinical features including biochemical,haematological,immunological and psychological parameters were compared between SA and NSA groups.The risk factors of suicide attempts in BD major depressive patients were analyzed by multiple Logistic regression.Pearson correlation between the clinical features and the suicide risk(total scores of the Nurses'Global Assessment of Suicide Risk,NGASR)was analyzed in the SA patients.Results:Compared to the NSA group,the SA group showed decreased age,age of onset,serum triglyceride concentration,hemoglobin concentration and the neutrophil/lymphocyte ratio,and increased concentration of IgA,the percentage of single people and with mixing characteristics(P<0.05 or P<0.01).The multiple Logistic regression analysis demonstrated that lower age(OR=0.962,P<0.05)and higher concentration of IgA were risk factors of suicide attempt(OR=1.864,P<0.001).Additionally,the age was significantly negatively correlated with NGASR(r=-0.36,P<0.001)and the concentration of IgA was significantly positively correlated with NGASR in the SA group(r=0.42,P<0.001).Conclusion:The major risk factors for suicide attempts in BD patients with major depressive episode were lower age and higher concentration of IgA,which could provide objective indication for early clinical identification.