真实世界伴自杀意念或行为的抑郁障碍患者的临床特征与药物治疗决策研究  

Clinical features and therapeutic decision making of major depressive disorder with suicide based on real-world evidence

作　　者：王红来 赵茜[2,3] 张玲 黄娟[2,3] Wang Honglai;Zhao Qian;Zhang Ling;Huang Juan(Beijing Miyun District Mental Health Prevention and Control Hospital,Beijing 101500,China;Beijing Key Laboratory of Mental Disorders,National Clinical Research Center for Mental Disorders&National Center for Mental Disorders,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]北京市密云区精神卫生防治院,101500 [2]首都医科大学附属北京安定医院,国家精神疾病医学中心,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,100088 [3]首都医科大学人脑保护高精尖创新中心,100069

出　　处：《神经疾病与精神卫生》2024年第7期494-500,共7页Journal of Neuroscience and Mental Health

基　　金：首都卫生发展科研专项(首发2024-2-1174);北京市属医院科研培育计划(PX2022076)。

摘　　要：目的 探索真实世界伴自杀意念或行为的抑郁障碍患者的临床特征与治疗决策。方法 采用描述性研究的分析方法,利用基于医院信息系统的电子健康记录(electronic health record,EHR)提取患者的临床资料。选取2013年1月1日—2020年12月31日在首都医科大学附属北京安定医院住院及急诊留观治疗的7 985例抑郁症患者为研究对象,按照是否存在自杀意念或行为分为不伴自杀意念和行为(MDNS)组、伴自杀意念(MDSI)组和伴自杀行为(MDSB)组。比较3组患者的一般资料、临床特征与药物治疗决策的差异。采用多因素Logistic回归分析抑郁障碍患者伴自杀意念或自杀行为的危险因素。结果 7 985例抑郁症患者中,MDSI组3 297例(41.3%),MDSB组840例(10.5%),MDNS组3 848例(48.2%)。MDSI、MDSB组患者年龄、起病年龄低于MDNS组,在职/在校患者比例高于MDNS组,差异均有统计学意义(均P<0.05)。MDSB组伴精神病性症状患者比例高于MDSI组,差异有统计学意义(P<0.05)。MDSI组有发病诱因的患者比例高于MDNS组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,在职/在校(OR=1.230,95%CI=1.022~1.480,P<0.05)、有发病诱因(OR=1.186,95%CI=1.021~1.378,P<0.05)是抑郁障碍患者有自杀意念的危险因素。女性是抑郁障碍患者有自杀行为的危险因素(OR=1.487,95%CI=1.147~1.929,P<0.05)。MDSI和MDSB组采用抗抑郁药联合心境稳定剂、抗抑郁药联合心境稳定剂及抗精神病药这些复杂治疗方案的患者比例高于MDNS组,差异有统计学意义(P<0.05)。结论 女性、目前在职/在校、有发病诱因是抑郁障碍患者出现自杀意念或行为的危险因素,需更多采用抗抑郁药联合心境稳定剂或联合心境稳定及抗精神病药物的治疗方案。Objective To explore the clinical characteristics and treatment decisions of depressive disorder patients with suicidal ideation or behavior based on real-world evidence.Methods The clinical data of patients were extracted utilizing the electronic health record(EHR)based on the hospital information system and analyzed by descriptive research method.A total of 7985 depression patients who were hospitalized and treated with emergency observation at Beijing Anding Hospital affiliated with Capital Medical University from January 1,2013 to December 31,2020 were selected as the study subjects.They were divided into three groups based on the presence of suicidal ideation or behavior:major depressive disorder with nonsuicide(MDNS),major depressive disorder with suicidal ideation(MDSI),and major depressive disorder with suicidal behavior(MDSB).The differences were compared among the three groups in demographics,clinical characteristic,and treatment decisions.The risk factors for suicidal ideation or behavior in patients with depression were analyzed by multivariate logistic regression.Results Among the 7985 patients with depression,3297(41.3%)were in the MDSI group,840(10.5%)were in the MDSB group,and 3848(48.2%)were in the MDNS group.The age and onset age of patients in the MDSI and MDSB groups were lower than those in the MDNS group,and the proportion of working/studying patients was higher than that in the MDNS group,with statistical significance(all P<0.05).The proportion of patients with psychiatric symptoms in the MDSB group was higher than that in the MDSI group,and the difference was statistically significant(P<0.05).The proportion of patients with pathogenic factors in the MDSI group was higher than that in the MDNS group,and the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that working/studying(OR=1.230,95%CI=1.022-1.480,P<0.05)and having underlying causes(OR=1.186,95%CI-1.021-1.378,P<0.05)were risk factors for suicidal ideation in patients with depression.The

关 键 词：抑郁症 自杀 真实世界 治疗决策 

分 类 号：R749.4[医药卫生—神经病学与精神病学]