基于阳性与阴性症状量表评价的上海市社区精神分裂症患者复发相关因素  

Related factors of relapse based on positive and negative syndrome scale among schizophrenics in Shanghai communities

作　　者：乔颖 江弋舟[3] 何思源 陈春梅 朱益 蔡军[1,2] 谢斌 王娜[3] 张伟波[1,2] QIAO Ying;JIANG Yizhou;HE Siyuan;CHEN Chunmei;ZHU Yi;CAI Jun;XIE Bin;WANG Na;ZHANG Weibo(Shanghai Mental Health Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200030,China;Center for Mental Health Management,China Hospital Development Institute,Shanghai Jiao Tong University,Shanghai 200030,China;School of Public Health,Key Laboratory of Public Health Safety of Ministry of Education,Fudan University,Shanghai 200032,China)

机构地区：[1]上海交通大学医学院附属精神卫生中心,上海200030 [2]上海交通大学中国医院发展研究院心理健康管理研究所,上海200030 [3]复旦大学公共卫生学院,公共卫生安全教育部重点实验室,上海200032

出　　处：《上海预防医学》2023年第3期267-274,共8页Shanghai Journal of Preventive Medicine

基　　金：上海市公共卫生体系建设三年行动计划(2020—2022年)重点学科建设计划项目(GWV-10.1-XK18);上海市卫生健康委员会卫生行业临床研究专项(202040362);上海市“医苑新星”青年医学人才培养资助计划(沪卫人事[2021]99号);上海市“科技创新行动计划”临床医学领域项目(19411950800,19411950802);上海交通大学医学院科技创新项目(人文社科类)(WK2118);上海市2021年度“科技创新行动计划”科普专项项目(21DZ2300400)。

摘　　要：【目的】描述基于阳性与阴性症状量表(PANSS)评价上海市社区精神分裂症患者的复发状况,分析社会人口学特征、生活习惯和临床特征与复发的关联。【方法】采用动态队列的前瞻性研究设计,于2018年3月—2019年2月陆续纳入上海市徐汇区、虹口区、长宁区、嘉定区、松江区和宝山区的社区精神分裂症患者189例,面对面进行基线问卷调查,涵盖社会人口学信息、生活习惯和临床信息等。基线调查后每2周进行1次随访,测量其PANSS得分,共随访6个月。以PANSS总分较基线值增加≥25%(若基线PANSS总分≤40分时,增加≥10分)判定复发。采用Cox回归模型分析基于PANSS评定的复发状况与社会人口学特征、生活习惯和临床特征的关联。【结果】共165例社区精神分裂症患者完成了6个月随访调查,失访率12.7%。排除社会人口学和临床信息缺失者后,共纳入132例患者,年龄为(48.18±12.67)岁,其中男性患者占41.67%。33例患者在6个月随访期间内出现复发,复发率为25.0%。在纳入性别、家族史、年龄、就业情况、教育程度、婚姻状况、吸烟、饮酒、锻炼频率、服药情况、自知力、社会功能、既往肇事肇祸史、近期应激事件、药物不良反应和PANSS基线得分后,患者复发的危险因素包括年龄<40岁(HR=4.47,95%CI:1.15~17.40)、教育程度在小学及以下(HR=7.11,95%CI:1.54~32.83)、无业(HR=8.34,95%CI:1.78~38.98)、存在药物不良反应(HR=5.02,95%CI:1.75~14.37)。【结论】在上海市社区精神分裂症患者的复发管理中,应关注不同年龄段、教育程度、就业情况及药物不良反应等因素的影响,及时识别复发高危人群并及时干预。[Objective]To explore the relapse status based on the positive and negative syndrome scale(PANSS Scale)and related factors of schizophrenics in Shanghai communities,and to analyze the association between socio demographic characteristics,lifestyles,clinical characteristics and relapse.[Methods]A dynamic cohort prospective study design was used in this study.From March 2018 to February 2019,a total of 189 schizophrenics in Xuhui,Hongkou,Changning,Jiading,Songjiang and Baoshan districts were enrolled successively.Baseline questionnaires were conducted through face-to-face interviews at baseline,which contained social demographic information,lifestyle information and clinical information.A follow-up was conducted every 2 weeks for a measurement of PANSS Scale for a total of 6 months.Relapse was assessed by a PANSS score increase of≥25%from baseline(or an increase of 10 points or more if the baseline score was≤40 points).Univariate and multivariate Cox regression models were used to analyze the associations between relapse status(assessed by PANSS Scale)and socio demographic characteristics,lifestyles,and clinical characteristics,respectively.[Results]A total of 165 community schizophrenics completed baseline and follow-up surveys,with a loss to follow-up rate of about 12.7%.After exclusion of sociodemographic and clinical information deficits,132 patients were included in the analysis totally,with an average age of 48.18±12.67 years,among whom 41.67%were male.Totally 33 patients relapsed during the 6-month follow-up period,with a relapse rate of 25.0%.After adjusting for gender,family history,age,employment,education,marital status,smoking,drinking,exercise frequency,medication compliance,insight,social function,violence history,stress recent events,adverse drug reactions and baseline scores of PANSS Scale,risk factors of relapse included the following four factors:age below 40 years(HR=4.47,95%CI:1.15−17.40),primary school or below(HR=7.11,95%CI:1.54−32.83),unemployed(HR=8.34,95%CI:1.78−38.98),and advers

关 键 词：精神分裂症 复发 精神症状 队列研究 

分 类 号：R195[医药卫生—卫生统计学]