首发躁狂患者1年内复发的影响因素及与疾病转归和功能预后的关系

Influencing factors of recurrence within one year in patients with first-episode mania and correlation between disease outcome and functional prognosis

目的探讨首发躁狂患者第1年内复发的影响因素及与7年后疾病转归和功能预后的关系。方法纳入2011年10月至2013年10月首次躁狂发作患者147例,收集首发时人口学、疾病特征、生化指标和治疗情况等资料。通过7年随访,了解间期疾病复发、治疗情况及7年后现况人口学、整体功能水平。结果完成7年随访101例。复发组(第1年内复发者)首发时伴攻击特征者比例、接受维持期治疗者比例、YMRS外表因子分、对支持利用度分低于未复发组(第1年内未复发者);复发组体质指数、甘油三酯、伴精神性症状者比例高于未复发组(均P<0.05)。复发组7年间总发作次数高于未复发组(P<0.05)。两组间7年后整体功能评定量表分差异无统计学意义(P>0.05)。多因素logistic回归分析,首发时伴攻击特征(OR=0.300)、接受维持期治疗(OR=0.314)、对支持利用度(OR=1.370)、伴精神病性症状(OR=7.696)与第1年内复发相关。结论首次躁狂患者伴精神病性症状、对支持利用度低增加了第1年内复发风险,伴攻击特征、接受维持期治疗者复发风险相对低。第1年内复发者后期疾病复发次数多。

Objective first-episode mania,and the correlation between disease outcome and functional prognosis after 7 years.Methods A total of 147 patients with first-episode mania from October 2011 to October 2013 were enrolled.The data were collected at the first episode including demography,disease characteristics,biochemical indicators,treatment,etc.The relapse and treatment of the disease in the next 7 years would be investigated,as well as the current situation of demography and global assessment Function after 7 years.Results Patients with aggressive characteristics,the maintenance phase treatment,the appearance factor inYMRS and the support Utilization Score in the recurrent group(recurrence in the first year)were lower than those in the nonrecurrent group(non-recurrence in the first year).Patients with body Mass Index(BMI),triglyceride,and the proportion of patients with psychotic symptoms were higher than those in the non-relapse Group(P<0.05).The total seizure frequency in the recurrence group was higher than that in the non-recurrence group in 7 years(P<0.05).There was no significant difference in Global Assessment Function between the two groups(P>0.05).Multivariate logistic regression analysis showed that aggressive characteristics(OR=0.300),the maintenance phase treatment(OR=0.314),to the support Utilization Score(OR=1.370),psychotic symptoms(OR=7.696)at first onset were associated with recurrence of manic in a year.Conclusion symptoms and low utilization of support increased the risk of recurrence in the first year,while those with aggressive characteristics and maintenance treatment had relatively low risk of recurrence in the first year.The patients who relapsed within one year would relapse more frequently.