首发抑郁患者转相情况及其影响因素分析:基于7年随访  

Analysis of phenotype conversion and its influencing factors in patients with first-episode depression:Based on a 7-year follow-up

作　　者：崔伟[1] 于超[1] 王琳彦 宋丽华 芦云平 张云淑[1] CUI Wei;YU Chao;WANG Linyan;SONG Lihua;LU Yunping;ZHANG Yunshu(Hebei Provincial Mental Health Center,Baoding 071000,China)

机构地区：[1]河北省精神卫生中心,保定071000

出　　处：《中国神经精神疾病杂志》2025年第1期38-44,共7页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的了解首发抑郁患者7年间转相情况,探讨转相与未转相患者疾病纵向特点和功能结局,进一步分析影响转相的因素。方法纳入汉密尔顿抑郁量表17项(Hamilton depression scale-17,HAMD-17)≥18分、年龄18~60岁、重性抑郁障碍单次发作的患者346例,自然观察随访7年,收集首发时人口学信息、疾病特征,以及随访中是否发生转相、治疗情况等资料,7年末随访时采用药物副反应量表(treatment emergent symptom scale,TESS)、药物依从性评定量表(medication adherence rating scale,MARS)、整体功能评定量表(global assessment function,GAF)分别评估调查时患者存在的药物不良反应、对药物治疗的依从情况和整体功能水平等。根据7年间是否发生转相,患者分为转相组(7年间出现躁狂或轻躁狂发作者)、未转相组(7年间未出现躁狂或轻躁狂发作者)。结果共138例患者完成7年随访,转相组54例(39.1%)、未转相组84例(60.9%)。首发时,转相组发病年龄早于未转相组[(27.63±9.63)岁vs.(41.20±11.92)岁],婚姻状况与未转相组存在差异(未婚40.7%vs.7.1%,初婚53.7%vs.85.7%,再婚3.7%vs.2.4%,分居/离异0.0%vs.2.4%,丧偶1.9%vs.2.4%),有诱因起病者比例低于未转相组(29.6%vs.48.8%),治疗延迟(duration of untreated psychosis,DUP)时间短于未转相组[60(15,90)d vs.90(30,180)d],急性期处方方式单用抗抑郁药者低于未转相组(61.1%vs.81.0%)、抗抑郁药联合心境稳定剂者高于未转相组(31.5%vs.16.7%),差异有统计学意义(P<0.05)。7年间,转相组总发作次数高于未转相组(4.33±1.21 vs.2.70±1.25,P<0.05)。7年后,转相组GAF总分低于未转相组(66.57±8.22 vs.69.21±7.20,P<0.05)。二分类多因素logistic回归分析显示,发病年龄(OR=1.109,95%CI:1.058~1.161,P<0.001)、DUP时间(d)(OR=1.005,95%CI:1.001~1.009,P=0.017)与首发抑郁患者7年间发生转相相关联。结论本组首发抑郁患者7年间转相率为39.1%,转相者较未转相者,发病年龄更早、首发�Objective To understand phenotype conversion in patients with first-episode depression over a 7-year period,to explore the longitudinal disease characteristics and functional outcomes of transitions and non-transitions,and to further analyse the relevant factors affecting transitions.Methods A total of 346 patients with Hamilton depression scale-17(HAMD-17)score≥18,aged 18-60 years and a single episode of major depressive disorder were included in the study.They were follow-up for 7 years to assess their natural history including demographic data,disease characteristics,whether transitions to manic occurred,treatment status.At the end of the 7-year follow-up,treatment emergent symptom scale(TESS),medication adherence rating scale(MARS),and global assessment function(GAF)were used to evaluate adverse reactions,compliance to medication,and patient’s overall functional level.Patients were divided into two groups based on the occurrence of mania or hypomania episodes during the 7-year period:the conversion group(those who developed episodes)and the non-conversion group(those who did not).Results A total of 138 patients were followed up for 7 years,including 54 patients(39.1%)in the conversion group and 84 patients(60.9%)in the nonconversion group.When the first episode was enrolled at baseline,the age of first episode was earlier in the conversion group than in the non-conversion group[(27.63±9.63)years vs.(41.20±11.92)years],and there were differences in marital status(unmarried 40.7%vs.7.1%,first marriage 53.7%vs.85.7%,remarriage 3.7%vs.2.4%,separated/divorced 0.0%vs.2.4%,widowed 1.9%vs.2.4%).The proportion of patients with precipitating factors was lower in the conversion group(29.6%vs.48.8%)and shorter duration of untreated psychosis(DUP)[60(15,90)d vs.90(30,180)d].The treatment method in the conversion group had lower only used antidepressant drugs(61.1%vs.81.0%)and more antidepressant combined with mood stabilizers(31.5%vs.16.7%)(all P<0.05).In the 7 years,total number of episodes in the conversion group

关 键 词：首发抑郁 转相 自然观察 随访研究 治疗延迟 影响因素 功能结局 

分 类 号：R749.4[医药卫生—神经病学与精神病学]