抗抑郁药使用对双相抑郁患者疾病纵向抑郁负担的影响  

Effect of antidepressant treatment on longitudinal depressive burden in patients with bipolar depression

作　　者：朱玥[1] 李志营[1] 高慧敏[1] 纪俊 周书喆 于欣[1] 马燕桃[1] Zhu Yue;Li Zhiying;Gao Huimin;Ji Jun;Zhou Shuzhe;Yu Xin;Ma Yantao(Peking University Sixth Hospital,Peking University Institute of Mental Health,NHC Key Laboratory of Mental Health(Peking University),National Clinical Research Center for Mental Disorders(Peking University Sixth Hospital),Beijing 100191,China;College of Computer Science and Technology,Qingdao University,Qingdao 266071,China)

机构地区：[1]北京大学第六医院、北京大学精神卫生研究所、国家卫生健康委员会精神卫生学重点实验室(北京大学)国家精神心理疾病临床医学研究中心(北京大学第六医院),北京100191 [2]青岛大学计算机科学技术学院,青岛266071

出　　处：《中华精神科杂志》2025年第2期134-140,共7页Chinese Journal of Psychiatry

基　　金：首都卫生发展科研专项(首发2018-2-4112)。

摘　　要：目的探究抗抑郁药使用对双相抑郁中纵向抑郁负担的影响。方法被试来源于1项全国多中心的自然观察项目:“双极性指数评估表中文版信效度评价及心境障碍转归的随访研究(CAFE-BD)。2012年1月至2013年12月于9家医疗机构(包括6所精神专科医院、3所综合医院的精神科)门诊或住院连续入组双相抑郁患者共110例,其中男51例,女59例,年龄18~64(34.4±11.1)岁。根据本研究定义的是否使用抗抑郁药分为用药组74例和未用药组36例。采用MINI中文版诊断双相抑郁,使用心境障碍评估表(Mood Disorders Evaluation,ADE)、临床监测表(Clinical Monitoring Form,CMF)进行基线评估和随访。分析比较用药组和未用药组在随访中期(6个月)和终点(12个月)的抑郁总分(aggregate depression scores,SUM-D)、抑郁症状数量(number of depressive symptoms,NUM-D)及总抑郁负担,以及上述抑郁负担指标的纵向变化。结果双相抑郁患者使用抗抑郁药比例为67%(74/110);用药组在基线、中期及终点使用抗抑郁药的比例分别为85%(63/74)、76%(56/74)、64%(47/74)。基线时用药组SUM-D高于未用药组[9(6.5,11)分比7.38(5.5,9.0)分,W=1712.00,P=0.015];2组间不同时点的NUM-D及总抑郁负担差异均无统计学意义(均P>0.05)。与基线相比,用药组在随访中期和终点的SUM-D[0.5(0,1)分、1.33(0.5,2.5)分比9(6.5,11)分,W=2770.00、2743.00]、NUM-D[0(0,0)分、0(0,1)分比7(5,8)分,W=2621.00、2601.50]、总抑郁负担(χ^(2)=64.36、59.00)均显著下降(均P<0.001);未用药组在随访中期和终点的SUM-D[0.59(0.4,0.7)分、1(0.8,2.5)分比7.38(5.5,9.0)分,W=664.50、666.00]、NUM-D[0(0,0)分、0(0,1)分比6(4,7)分,W=527.00、528.00]、总抑郁负担(χ^(2)=31.00、31.00)也均显著下降(均P<0.001);2组自基线到中期或终点、以及中期到终点的抑郁负担各项指标变化值差异均无统计学意义(均P>0.05)。结论在为期12个月的真实世界自然随访中,双相抑郁用药组及未用药�ObjectiveTo examine the effect of antidepressant treatment on the longitudinal depressive burden in patients with bipolar depression.MethodsSubjects were recruited from a national multicenter,naturalistic observational project:Comprehensive Assessment and Follow-up Descriptive Study on Bipolar Disorder study(CAFE-BD).A total of 110 patients with bipolar depression(51 males,59 females;aged 18-64 years,mean age 34.4±11.1 years)were consecutively enrolled between January 2012 and December 2013 from outpatients and inpatients of nine medical institutions,including six psychiatric hospitals and three general hospitals.Based on the use of antidepressants as defined in this study,patients were classified into a medicated group(Ads,n=74)and a non-medicated group(nAds,n=36).Diagnosis of bipolar depression was confirmed using the MINI(Chinese version),and baseline and follow-up assessments were conducted using the Assessment of Mood Disorders Evaluation(ADE)and the Clinical Monitoring Form(CMF).Depression burden indicators,including aggregate depression scores(SUM-D),number of depressive symptoms(NUM-D),and total depression burden,were compared between the Ads group and nAds group at mid-term(the 6 th month)and endpoint(the 12 nd month).Longitudinal changes in these indicators were also analyzed.ResultsThe proportion of bipolar depressive patients on antidepressants was 67%(74/110).Among them,85%(63/74)were taking antidepressants at baseline;this dropped to 76%(56/74)at mid-term,and 64%(47/74)at the endpoint.SUM-D were higher in the Ads group than in the nAds group at baseline(9(6.5,11)vs 7.38(5.5,9.0);W=1712.00,P=0.015),and there was no statistically significant difference in NUM-D and total depressive burden between two groups at any time points(P>0.05).Compared to baseline,the Ads group had significantly lower SUM-D(0.5(0,1),1.33(0.5,2.5)vs.9(6.5,11);W=2770.00,2743.00),NUM-D(0(0,0),0(0,1)vs.7(5,8);W=2621.00,2601.50)and total depressive burden(c 2=64.36,59.00)at both mid-term and endpoint(all P<0.001);While SUM-D(0.59(0

关 键 词：双相情感障碍 双相抑郁 抗抑郁药 抑郁负担 自然随访研究 

分 类 号：R749.4[医药卫生—神经病学与精神病学]