心境障碍问卷和32项轻躁狂症状清单在单相抑郁障碍和双相障碍患者中的应用  

Application of mood disorder questionnaire and 32-item hypomania checklist in patients with unipolar depressive disorder and bipolar disorder

作　　者：付兆燕 毛珍 孙悦 李峰 李田[1,2] 王传跃 薄奇静 Fu Zhaoyan;Mao Zhen;Sun Yue;Li Feng;Li Tian;Wang Chuanyue;Bo Qijing(The National Clinical Research Center for Mental Disorders&Beijing Key Laboratory of Mental Disorders&Beijing Institute for Brain Disorders Center of Schizophrenia,Beijing Anding Hospital,Capital Medical University,Beijing 100088,China;Advanced Innovation Center for Human Brain Protection,Capital Medical University,Beijing,100069,China)

机构地区：[1]首都医科大学附属北京安定医院,国家精神心理疾病临床医学研究中心,精神疾病诊断与治疗北京市重点实验室,北京脑重大疾病研究院精神分裂症研究所,100088 [2]首都医科大学人脑保护高精尖创新中心,北京100069

出　　处：《神经疾病与精神卫生》2022年第9期652-659,共8页Journal of Neuroscience and Mental Health

基　　金：国家自然科学基金项目(81901355);北京市自然科学基金面上项目(7192081)。

摘　　要：目的比较心境障碍问卷(MDQ)和32项轻躁狂症状清单(HCL-32)在单相抑郁障碍和双相障碍患者中的应用效果。方法纳入2014年9月至2015年12月于首都医科大学附属北京安定医院就诊的212例心境障碍患者,其中单相抑郁障碍组患者107例,双相障碍组患者105例。采用主成分分析法对2个量表进行因子分析。采用Cronbach’sα系数评估2个量表的内部一致性信度,采用Spearman相关分析2个量表各条目得分与总分的相关性,比较两组患者2个量表的阳性应答率及得分。采用受试者工作特征(ROC)曲线分析2个量表的筛查性能并比较ROC曲线下面积。结果MDQ为两因子结构,特征值分别为5.39、1.47,对总方差的累积贡献率为52.81%;HCL-32为三因子结构,特征值分别为12.61、2.87、1.84,对总方差的累积贡献率为54.11%。MDQ和HCL-32的Cronbach’sα系数分别为0.88(95%CI:0.85~0.90)、0.95(95%CI:0.94~0.96)。MDQ、HCL-32各条目与总分之间的相关系数分别为0.50~0.72(P<0.01)、0.16~0.78(P<0.05)。双相障碍组MDQ所有条目的阳性应答率均高于单相抑郁障碍组;除条目32外,双相障碍组HCL-32各条目的阳性应答率均高于单相抑郁障碍组。单相抑郁障碍组的MDQ总分为3.00(0,5.00)分,HCL-32总分为9.00(1.00,17.00)分,低于双相障碍组的5.00(1.50,9.00)、17.00(12.00,23.50)分,差异有统计学意义(Z=-4.03、-5.02;P<0.01)。MDQ区分单相抑郁障碍和双相障碍的ROC曲线下面积为0.66(95%CI:0.59~0.73,P<0.001),与HCL-32的0.70(95%CI:0.63~0.77,P<0.001)比较,差异无统计学意义(Z=1.07,P=0.28)。MDQ的最佳划界分为6分,灵敏度为0.48,特异度为0.82;HCL-32的最佳划界分为8分,灵敏度为0.85,特异度为0.47。结论MDQ和HCL-32在单相抑郁障碍和双相障碍患者中应用的信度较好,均可适用于专科医院鉴别双相障碍和单相抑郁障碍。HCL-32较MDQ灵敏度高,但特异度低。Objective To compare the reliability and validity of Mood Disorder Questionnaire(MDQ)and 32 Items Hypomania Checklist(HCL-32) in patients with mood disorders.Methods A total of 212 patients with mood disorders in Beijing Anding Hospital Affiliated to Capital Medical University from September 2014 to December 2015 were recruited,including 107 patients with unipolar depressive disorder(UP) in UP group and 105 patients with bipolar disorder(BP) in BP group.Principal component analysis was used to analyze the two scales.Cronbach’s α coefficient was used to evaluate the internal consistency reliability of the two scales,and Spearman correlation was used to analyze the correlation between each item score of the two scales and the total score.The positive response rates and scores of the two scales were compared between the two groups.The screening performance of the two scales was analyzed by using the receiver operating characteristic(ROC)curve.The area under the ROC curve was also compared.Results MDQ had a two-factor structure,with eigenvalues of 5.39 and 1.47 respectively,and the two factors explained 52.81% of the total variance.HCL-32 had a three-factor structure,with eigenvalues of 12.61,2.87 and 1.84 respectively,and the three factors explained 54.11% of the total variance.Cronbach’s α for MDQ and HCL-32 were 0.88(95%CI=0.85-0.90)and 0.95(95%CI=0.94-0.96) respectively.The correlation coefficients between each item of MDQ and HCL-32 and the total score were 0.50-0.72(P<0.01) and 0.16-0.78(P <0.05),respectively.In all MDQ items,the positive response rate of BP group was higher than that of UP group.For HCL-32,positive response rates were higher in the BP group than in the UP group except item 32.The total score of MDQ in UP group was lower than that in BP group [3.00(0,5.00) vs 5.00(1.50,9.00)].The total score of HCL-32 in UP group was lower than that in BP group [9.00(1.00,17.00) vs 17.00(12.00,23.50)].The differences are statistically significant(Z=-4.03,-5.02;P<0.01).The areas under the ROC curve of MDQ

关 键 词：双相情感障碍 心境障碍问卷 32项轻躁狂症状清单 单相抑郁障碍 信度 

分 类 号：R749.4[医药卫生—神经病学与精神病学]