难治性抑郁症患者的4年随访研究  

Outcome investigation of treatment-resistant depression:a four-year follow-up study

作　　者：李霞[1] 陆峥[1] 刘晓鹏[1] 刘娜[1] 蔡军[1] 陈静[1] 朱敏捷[1] 肖世富[1] 

机构地区：[1]上海交通大学医学院附属上海市精神卫生中心老年科同济大学附属同济医院心身医学科,上海200030

出　　处：《内科理论与实践》2007年第6期428-431,共4页Journal of Internal Medicine Concepts & Practice

基　　金：上海市精神卫生中心青年人才培养计划资助(项目编号:QN1-9)

摘　　要：目的:横断面追踪调查难治性抑郁症(treatment-resistant depression)患者4年后转归与相关因素。方法:采用自编随访自评调查表,以电话和门诊访谈方式,对4年前诊断为难治性抑郁症的51例患者逐一随访。内容包括诊治情况、疾病结局和病程。随访资料与4年前基线资料包括人口学资料、病程、汉密顿抑郁量表17项(HAMD17)和汉密顿焦虑量表(HAMA)评分等进行相关分析。结果:①51例患者中,41例完成随访,6例失访,失访率11.7%,3例诊断更改,1例自杀死亡。随访组与失访组的基线资料无显著差异;②70.7%的患者坚持治疗从未中断,29.3%曾中断治疗或不再治疗,原因主要是病情好转和没有效果,88.5%的患者服用选择性5-羟色胺再摄取抑制剂,合并用药达77.1%,主要为苯二氮草卓类药、小剂量抗精神病药和情绪稳定剂;③完全康复、大部分症状消除、症状仅缓解了小部分和完全未缓解的患者分别占4.9%、51.2%、17.1%和26.8%;相应地,对疗效感觉满意或比较满意者为56.0%,感觉一般或不好者为44.0%;4年来病程波动变化者为75.5%;④病情转归与基线时HAMD17总分、HAMD17焦虑因子分、HAMA躯体焦虑因子与精神焦虑因子分相关。结论:即使服药依从性尚好,难治性抑郁症患者的总体转归仍不理想,并与焦虑症状可能相关。Objective To study the four-year outcome in patients with treatment-resistant depression, and its related factors. Methods Patients diagnosed as treatment-resistant depression four years before were followed-up by interview or telephone communication. The questionnaire included items associated with treatment, outcome and course of disease. The updated and the baseline information, including the data of demography, illness course, Hamilton rating scale for depression （HAMD,17 items） and Hamilton rating scale for anxiety（HAMA）, were analysed. Results （1）Of all the 51 enrolled cases, 41 completed questionnaire, 6 patients lost, 3 patients changed the diagnosis, and 1 patient died of suicide. There was no significant difference in the baseline evaluation in all enrolled patients. （2） Of all the 41 patients with complete follow-up information, 70.7% of them received medical treatment, while the other 29.3% discontinued at least one time due to disease recovery or progression. Eighty-eight point five percent took selective serotonin reuptake inhibitors as their antidepressants; among which 77.1% received combination treatment with benzodiazepine, low-dose antipsychotic or mood stabilizer. （3）The rates of complete recovery, mostly remission, small partly improvement and totally no response were 4.9%, 51.2%,17.1% and 26.8%, respectively. Accordingly, 56.0% of the patients were satisfied with their treatment, and 75.5% of them had fluctuated course during the past 4 years. （4） The outcome of patients with treatment- resistant depression was related with clinical characteristics including the total scores of HAMD, the anxiety factor of HAMD, the somatic anxiety factor and psychotic anxiety factor of HAMA. Conclusions Although most patients with treatment-resistant depression are compliant to the medical treatment, the outcome is not satisfactory. The poor outcome might relate with the symptom of anxiety.

关 键 词：难治性抑郁症 转归 焦虑症状 

分 类 号：R749.4[医药卫生—神经病学与精神病学]