混合性焦虑抑郁障碍患者证候体质研究

Constitution and Clinical Syndromes of Patients with Mixed Anxiety-depressive Disorder

目的:探讨混合性焦虑抑郁障碍(MADD)患者中医证候及体质的分布及相关性。方法:利用医院焦虑抑郁量表(HADS)和患者健康问卷(PHQ-15),结合问诊收集符合MADD诊断患者61例,通过《中医体质分类与判定量表》与《抑郁症证候诊断量表》判定中医体质及证候,并做相关性分析。结果:MADD患者分布最多证型依次为肝郁脾虚证(55.7%)、痰浊内阻证(37.7%)及心肝火旺证(27.9%);60岁以上人群,肝郁脾虚证较其他年龄组有差异、肝肾阴虚证得分与45岁以下组间差异有统计学意义(P<0.05);MADD患者体质与证型无明显正相关,而气虚质与肝肾阴虚证、阳虚质与心肝火旺证负相关。结论:MADD主要证型分布与抑郁症大致相似,老年人中肝郁脾虚证分布较其他年龄段显著偏低,考虑与老年生理变化影响病机演变相关;MADD患者证候与体质无明显的正相关,临床辨病辨体辨证可能需区分。

Objective:To investigate the distribution and correlation of traditional Chinese medicine(TCM) syndromes and constitution in patients with mixed anxiety-depressive disorder(MADD).Methods:Sixty-one patients meeting the MADD diagnosis criteria were enrolled according to the Hospital Anxiety and Depression Scale(HADS),Patient Health Questionnaire 15(PHQ-15),and inquiry.The TCM constitution and syndromes were determined by the Traditional Chinese Medicine Constitution Classification and Determination Scale and Depression Syndrome Rating Scale, followed by the correlation analysis.Results:The top syndromes in MADD patients were liver depression and spleen deficiency(55.7%),phlegm turbidity and internal obstruction(37.7%),and effulgent fire in the heart and liver(27.9%).The scores of liver depression and spleen deficiency in people over 60 years old were different from those in other age groups, and their scores of yin deficiency in the liver and kidney were different from those in the age group below 45 years old(P<0.05).As revealed by the correlation analysis, there was no obvious positive correlation between constitution and syndromes, but there were negative correlations between qi deficiency and yin deficiency in the liver and kidney, and between yang deficiency and effulgent fire in the heart and liver.Conclusion:The distribution of major syndromes of MADD was roughly similar to that of depression, and the distribution of liver depression and spleen deficiency in the elderly was significantly lower than that in other age groups, which was presumably attributed to the pathogenesis affected by their physiological changes.No obvious positive correlation was found in the correlation analysis between syndromes and constitution of MADD patients.Clinical differentiation of disease, constitution, and syndrome needs to be distinguished.