抑郁症急性期治疗结局对残留症状变化的影响:一项来自全国、多中心的随访调查研究

Effects of treatment outcome in acute phase of depression on residual symptoms in a 6-month follow-up: a national, multicenter study

目的:探讨抑郁症急性期是否达完全缓解对残留症状变化的影响。方法:本研究为多中心、前瞻性、非干预性研究,在中国13个城市的16家医院开展,研究时间为2016年5月至2017年10月,纳入急性期抗抑郁药治疗8~12周后治疗有效的抑郁症患者,在基线收集患者的人口学及临床资料,采用抑郁症状快速评估量表(Brief 16-item Quick Inventory of Depressive Symptomatology Self-Report,QIDS-SR 16)、广泛性焦虑自评量表(Generalized Anxiety Disorder Scale,GAD-7)、亚利桑那性体验量表(Arizona Sexual Experience Scale,ASEX)、数字广度和符号编码测验分别评估患者的抑郁、焦虑、性功能与认知功能,于1个月末、3个月末和6个月末完成3次随访评估。采用重复测量线性混合效应模型和广义估计方程进行组间各指标的比较和分析。结果:共428例抑郁症患者符合入组标准纳入分析,基线时179例(41.8%,179/428)达完全缓解纳入完全缓解组,249例(58.2%,249/428)部分缓解纳入部分缓解组,2组基线人口学资料、疾病特征、治疗方面差异均无统计学意义。完全缓解组食欲增加、体重增加、自杀意念、坐立不安的发生率随时间变化差异无统计学意义(Z=-1.62~1.34,均P>0.003),部分缓解组睡眠过多、食欲增加、体重增加的发生率随时间变化差异无统计学意义(Z=-2.43~-1.26,均P>0.003),2组其余症状在6个月末相对于基线时的发生率差异有统计学意义(Z=-10.77~-2.46,均P<0.003),而2组之间差异无统计学意义(Z=0.37~3.26,均P>0.003)。2组在各访视点GAD-7总分差异有统计学意义(χ^(2)=24.68~113.80,均P<0.01),完全缓解组焦虑症状改善优于部分缓解组(F=8.39,P<0.01)。2组ASEX总分在各访视点组间差异无统计学意义(F=-1.93~-0.68,均P>0.05),组内差异亦无统计学意义(F=0.01~0.17,均P>0.05)。基线时2组数字广度测验、数字符号测验总分差异无统计学意义(F=-1.23、-1.14,P>0.05),校正基线时总分后,随访期间数字符号测验总分组间差异亦无统计学意义(F=-1.14~-0.91,均P>0.05)。结论:急性期的治疗结局对抑郁症的残留症状变化具有影响,达完全缓解对于焦虑症状的改善具有积极意义,但对于性功能障碍、认知症状的改善无显著影响。

Objective To explore the effect of the acute treatment outcome on the trajectory of residual symptoms for major depressive disorder(MDD).Method This is a multicenter,prospective,non-intervention study.The MDD patients who self-reported an improvement after received an 8-12 weeks antidepressant treatment were included.Social-demographic and clinical characteristics were collected at the baseline.Brief 16-item Quick Inventory of Depressive Symptomatology Self-Report(QIDS-SR16),Generalized Anxiety Disorder Scale(GAD-7),Arizona Sexual Experience Scale experience(ASEX),Digital Span Test(DST)and Digit Symbol Substitution Test(DSST)were used to assess the symptoms.Patients were followed up at month 1,3 and 6.Mix effect model and generalized estimating equation were used to analysis changes over visits of symptoms within or between groups.Result Totally,428 eligible patients were included in this study.At baseline,179 patients achieved remission(41.8%,179/428)and 249 achieved partial remission(58.2%,249/428).There were no significant differences in demographics,clinical characteristics and treatment between the two groups.The proportion of increased appetite,weight gain,suicidal ideation,and restlessness in the remission group did not change significantly over time(Z=-1.62-1.34,all P>0.003),meanwhile,the proportion of hypersomnia,increased appetite,and weight gain in the partial remission group did not change significantly over the course of the assessments(Z=-2.43--1.26,all P>0.003).The proportion of other residual symptoms changed significantly from baseline to 6-month follow-up in both groups(Z=-10.77--2.46,all P<0.003),nevertheless,there was no significant difference between the two groups(Z=0.37-3.26,all P>0.003).The total score of GAD-7 of the two groups were significantly different at each assessment timepoint(χ^(2)=24.68-113.80,P<0.01),and the improvement of anxiety in the remission group was better than that in the partial remission group(F=8.39,P<0.01).There were no significant differences in the total ASEX scores between the two groups at each visit(F=-1.93--0.68,all P>0.05),and there were no significant difference within the group(F=0.01-0.17,P>0.05).There was no significant difference in the total scores of DST and DSST between the two groups at baseline(F=-1.23,-1.14,all P>0.05),and also no significant differences were found during all follow-up visits after control for score at baseline(F=-1.14--0.91,all P>0.05).Conclusions The treatment outcome of the acute phase has an impact on the residual symptoms of MDD.Remission has a positive effect on the improvement of anxiety,but has no significant effect on the improvement of sexual dysfunction and cognitive function.