焦虑、抑郁评分对白癜风治疗效果影响的前瞻性临床研究

A prospective clinical study on the effect of anxiety and depression scores on the treatment effect of vitiligo

目的:探讨焦虑、抑郁对白癜风患者药物治疗效果的影响。方法:培训过的医务处干事作为心理研究员依据汉密尔顿焦虑量表14项(HAMA-14)和汉密尔顿抑郁量表24项(HAMD-24)在白癜风患者治疗前对其进行焦虑、抑郁评分。皮肤科医师依据病情及患者治疗意愿对白癜风患者进行分组,分为单纯外涂药物治疗(外涂治疗组,n=72)和外涂药物+口服中药或西药联合治疗(联合治疗组,n=128)。将联合治疗组进一步分为联合活血合剂组(n=47)、联合甘草酸苷组(n=35)、联合活血合剂+甘草酸苷组(n=27)及联合泼尼松组(n=19)。活血合剂为复旦大学附属中山医院自制中药制剂,30 mL/次、每日2次口服;甘草酸苷50 mg/次,每日3次口服;泼尼松20 mg/次、每日1次口服。进行为期3个月的临床治疗观察,对各组进行疗效指数评估,分析焦虑、抑郁评分和疗效指数的相关性。结果:纳入200例,男性69例、女性131例。外涂治疗组稳定期65例,进展期7例;联合治疗组稳定期44例,进展期84例。200例患者均完成了为期3个月的临床观察,观察期内均未出现严重不良反应。Spearman相关系数分析结果显示,焦虑、抑郁与各治疗方法疗效指数均负相关(P<0.05)。结论:对于白癜风患者,无论是单纯应用外涂药物还是外涂药物联合口服中药或西药联合治疗,焦虑、抑郁状态均会降低疗效。

Objective:To explore the influence of anxiety and depression on the treatment efficiency in vitiligo patients.Methods:The Hamilton anxiety scale-14(HAMA-14)and Hamilton depression scale-24(HAMD-24)scores of patients with vitiligo were evaluated by a trained medical officer before treatment.The dermatologist treated patients with vitiligo according to condition and willingness of patients.Patients were divided into simple external drug treatment group(external drug group,n=72)and external drug application+oral Chinese or Western medicine combined treatment group(combined treatment group,n=128).Then the patients in the combined treatment group were divided into Huoxue mixture(n=47),glycyrrhizin(n=35),Huoxue mixture+glycyrrhizin(n=27),and prednisone(n=19)groups.Huoxue mixture was in-hospital medicine of Zhongshan Hospital,Fudan University,with 30 mL every time and bid orally,glycyrrhizin 50 mg every time and tid orally,and prednisone 20 mg qd orally.A 3-month clinical treatment observation was carried out,and the efficacy index of patients in the each treatment group was evaluated,and the correlation between anxiety and depression scores and treatment index was analyzed.Results:A total of 200 patients with vitiligo were included,with 69 males and 131 females.There were 65 patients in the stable stage and 7 patients in the advanced stage in the external drug group,and 44 patients in the stable stage and 84 patients in the advanced stage in the combined treatment group.All of the 200 patients completed the 3-month clinical observation,and none had serious adverse reactions during the treatment observation period.Spearman correlation coefficient analysis showed that anxiety and depression were all negatively correlated with the efficacy index of each treatment method.Conclusions:Whether it is the purely externally applied drug or the externally applied drug+oral Chinese or Western medicine combined treatment,the efficacy would be decreased by anxiety and depression.