情感障碍家族史对抑郁症患者临床特征及疗效的影响

The effect of family history with mood disorder on clinical features and efficacy in patients with depression

目的:探讨情感障碍家族史对抑郁症患者临床特征及抗抑郁药疗效的影响。方法:根据有无情感障碍家族史,将抑郁症患者分为阳性家族史组(n=80)和阴性家族史组(n=80)。采用度洛西汀或舍曲林治疗8周,在基线及第2、4、6、8周末评定汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)、抗抑郁药副反应量表(SERS)、快感缺失量表(SHAPS)、愉快情绪体验量表(TEPS)、贝克抑郁自评问卷(BDI)。以HAMD-17减分率作为疗效判定标准。结果:两组在起病年龄、总病程上有统计学意义(P均<0.01)。阳性家族史组中更多处于单身状态。基线时两组HAMA总分及因子分、SHAPS、TEPS、BDI总分差异有统计学意义(P<0.05或P<0.01)。经8周治疗,两组有效率和临床治愈率差异无统计学意义。Logistic回归分析显示,家族史、发病年龄、总病程、发作次数、药物等与疗效无相关性。结论:具有阳性家族史的抑郁症患者起病年龄早、总病程长、快感缺失及焦虑症状更严重,且更倾向于单身状态;经药物治疗后,躯体焦虑仍明显,但总体疗效与阴性家族史患者相当。

Objective:To explore the clinical characteristics of depressive patients with mood disorder family history and impact on the efficacy of antidepressant medication.Method:According to the family history of mood disorder,patients with depression were divided into positive family history group(n=80)and negative family history group(n=80).Both two groups were treated with duloxetine or sertraline for 8 weeks.Patients were assessed with the Hamilton Depression Scale(HAMD-17),Hamilton Anxiety Scale(HAMA),Rating Scale for Side Effects(SERS),Snaith-Hamilton Pleasure Scale(SHAPS),Temporal Experience of Pleasure Scale(TEPS)and Beck depression rating scale(BDI)at baseline and at the end of the 2th,4th,6th,and 8th week.The reduction rate of HAMD-17 score was adopted as the criterion for curative effect.Results:There were statistically significant differences on the age of onset and total course of the disease between the two groups(all P<0.01).Most patients in the positive family history group were single.At baseline,there were statistically significant differences in the total and factor scores of HAMA,and total scores of SHAPS,TEPS and BDI between the two groups(P<0.05 or P<0.01).After 8 weeks of treatment,there were no significant differences in the efficiency and clinical curative ratio between the two groups.Logistic regression analysis showed that family history,age of onset,total duration of illness,number of episodes,drugs and other factors had no significant effect on efficacy.Conclusion:Depressive patients with positive family history of mood disorder present some clinical characteristics such as early age of onset,long total duration of illness,more severe anhedonia and anxiety symptoms,and are more inclined to be single.After drug treatment,the symptoms of somatic anxiety were still obvious,but the overall efficacy is equivalent to patients with negative family history.