单双相重度抑郁临床特征及无抽搐电休克治疗临床疗效的对照研究

The controlled clinical trial of unipolar and bipolar major depression for clinical characteristics and clinical efficacy of Modified electric convulsive therapy

目的探讨单双相重度抑郁的临床特征及无抽搐电休克治疗(MECT)的临床疗效差异。方法采用回顾性研究的方法,回顾性地抽取2015年6月~2018年6月于徐州医科大学附属东方医院住院治疗患者中单相重度抑郁患者250例(单相组)及双相重度抑郁症患者92例(双相组)的病案资料,对两组一般资料进行对照分析,以汉密尔顿抑郁量表(HAMD-17)总分、5项因子分及减分率来评定MECT前后两组患者临床症状及临床疗效差异。结果双相组治愈率高于单相组,双相组的HAMD-17总分减分率高于单相组,两组差异显著(P<0.01)。单相组阻滞因子减分率更高,双相组躯体焦虑化因子及认知障碍因子减分率更高,差异显著(P<0.05)。双相组MECT起效次数及治疗总次数均高于单相组,差异显著(P<0.01)。结论 (1)与单相重度抑郁相比,双相重度抑郁患者的发病年龄更早,就诊年龄更小,文化程度更高,家族史阳性率更高,病程更长,阻滞症状更重;(2)单双相抑郁的发病机制可能不同,MECT可能更加适用于阻滞症状更加明显的单相重度抑郁患者和躯体焦虑症状及认知障碍更加明显的双相重度抑郁患者;(3)MECT治疗单双相重度抑郁时均有显著疗效;与单相重度抑郁相比,MECT治疗双相重度抑郁起效更慢,治疗疗程更长,治愈率更高。

Objective To investigate the differences of clinical features and clinical curative efficacy of modified electric convulsive therapy(MECT)between unipolar and bipolar major depression.Methods This study adopts the method of retrospective study,and retrospectively extracted the medical records of hospitalized patients from June 2015 to June 2018 in Oriental hospital affiliated to Xuzhou medical university.A total of 250 patients with unipolar major depression(unipolar group)and 92 patients with bipolar major depressive disorder(bipolar group)were included in our study.We contrastly analysis general information and evaluate clinical symptoms and clinical curative effect differences of MECT with Hamilton depression rating scale(HAMD-17)total score points,five factors points and ratio of points for unipolar and bipolar major depression.Results The cure rate for bipolar group was significantly higher than unipolar group(P<0.01).Bipolar group of HAMD-17 ratio of points is superior to unipolar group,with significant statistical differences(P<0.01).The ratio of points for unipolar group of retardation factor points was higher than bipolar group,however somatic anxiety and cognitive impairment points of bipolar group is higher than unipolar group,with statistical differences(P<0.05).Both the average numberand total number of MECT for bipolar groupwere higher than in unipolar group,the difference has statistical significance(P<0.01).Conclusion(1)Compared with unipolar major depression,bipolar major depression patients with earlier onset age,younger treatment,higher educational level,family history of higher positive rate,longer duration,and heavier retardation symptom.(2)The pathogenesis of bipolar and unipolar major depression were different,and may also prompt that MECT is more suitable for retardation Symptoms of unipolar major depression and somatic anxiety symptoms or cognitive impairment of bipolar major depression.(3)The significant clinical curative effect of MECT treatment is distinct for both unipolar and bipolar major depression.Compared with unipolar major depression,MECT treatment for bipolar major depression work slower,treatment duration is longer,but clinical curative effect is better.