摘要
目的探讨急性期老年双相抑郁障碍与单相抑郁障碍患者临床特征、神经内分泌的差异。方法回顾性连续纳入2018年6月1日至2019年9月30日于北京安定医院老年病房住院的急性期单相抑郁障碍患者(单相组,60例)及同期住院的性别、年龄和受教育程度相匹配的双相抑郁障碍患者(双相组,60例),使用自编调查量表收集两组抑郁患者临床特征、神经内分泌相关指标及汉密尔顿抑郁量表(HAMD)、简易精神状态检查(MMSE)量表评分,并进行组间单因素分析及多因素Logistic回归分析,分析老年双相抑郁障碍患者发病的影响因素。结果双相组患者首发年龄小于单相组[(43.35±16.04)岁比(54.40±14.36)岁;t=3.975,P<0.01],总病程长于单相组[23.50(11.25,37.25)年比7.00(1.00,16.75)年;Z=-4.301,P<0.01],入院次数大于单相组[2(1,3)次比1(1,1)次;Z=-4.851,P<0.01];双相组发病前多无诱因,两组差异有统计学意义(P<0.05)。双相组总三碘甲状腺原氨酸(TT3)[(1.25±0.29)nmol/L]、游离三碘甲状腺原氨酸(FT3)[(4.27±0.60)pmol/L]低于单相组[分别为(1.42±0.29)nmol/L、(4.58±0.67)pmol/L;t值分别为3.118、2.621,均P<0.05],且TT3异常比例(18.3%)高于单相组(5.0%),差异有统计学意义(P<0.05),而其余指标两组差异均无统计学意义(均P>0.05)。多因素Logistic回归分析结果显示,发病前无诱因(OR=0.264,P=0.004,95%CI:0.107~0.651)、入院次数为(OR=2.031,P=0.006,95%CI:1.224~3.371)可能老年双相抑郁障碍发生的危险因素。结论急性期老年单、双相抑郁障碍患者存在不同特征,双相患者首发年龄早、病程长、入院次数多,多无发病诱因,甲状腺功能也存在不同特征,主要表现在TT3、FT3差异。发病诱因、入院次数可能是与老年双相抑郁障碍关系较密切的因素,但需要进一步探索分析。
Objective To explore the different characteristics of clinical characteristics and neuroendocrine of the elderly hospitalized patients with acute bipolar and unipolar depression.Methods A total of 60 elderly patients with unipolar depression(unipolar group)and sixty patients with bipolar depression(bipolar group),with the same structure of gender,age,and education background were collected from June 1,2018 to September 30,2019.Self-made questionnaire was used to collect clinical features,neuroendocrine,and Hamilton Depression Scale(HAMD),and Min-mental State Examination(MMSE).Intergroup univariate analysis and multivariate logistic regression analysis were performed to analyze the influencing factors of the incidence of elder patients with bipolar depression.Results The onset age of patients in the bipolar group[(43.35±16.04)years]was smaller than that of the unipolar group[(54.40±14.36)years];t=3.975,P<0.01;The total course of disease was longer than that of the unipolar group[(23.50(11.25,37.25)years and 7.00(1.00,16.75)years;Z=-4.301,P<0.01].The number of hospital admissions was greater than that of the unipolar group[(2(1,3)times and 1(1,1)time;Z=-4.851,P<0.01].There were mostly no premorbid causes in the bipolar group,and the difference between the two groups was statistically significant(P<0.05).TT3 values[(1.25±0.29)nmol/L]and FT3 values[(4.27±0.60)pmol/L]in the bipolar group were less than those in the unipolar group[(1.42±0.29)nmol/L and(4.58±0.67)pmol/L;t=3.118,2.621,P<0.05].The TT3 abnormal proportion(18.3%)was higher than that in the unipolar group(5.0%),the difference was statistically significant(P<0.05),while the difference in other indicators between the two groups was not statistically significant(all P>0.05).The results of multivariate Logistic regression analysis showed that premorbid inducement(OR=0.264,P=0.004,95%CI:0.107-0.651)and the number of hospital admissions(OR=2.031,P=0.006,95%CI:1.224-3.371)may affect the incidence of bipolar depression in the elderly.The lack of premorbid inducement and the number of hospital admissions may be the risk factors for the incidence of bipolar depression in the elderly.Conclusions Elderly patients with acute unipolar and bipolar depression has different characteristics.Bipolar depression patients have earlier onset age,longer course of disease,and more hospital admissions.There are also different characteristics of thyroid function,mainly manifested by differences in TT3 and FT3.The risk factors and hospitalization frequency may be closely related to bipolar depression in the elderly,but need to be further explored and analyzed.
作者
甄文凤
马辛
张庆娥
Zhen Wenfeng;Ma Xin;Zhang Qing'e(Beijing Key Laboratory of Diagnosis and Treatment of Mental Disorders,National Clinical Medical Research Center for Mental Disorders,Capital Medical University Affiliated Beijing Anding Hospital,Beijing 100088,China)
出处
《神经疾病与精神卫生》
2020年第4期241-246,共6页
Journal of Neuroscience and Mental Health
关键词
老年
双相抑郁障碍
单相抑郁障碍
临床特征
神经内分泌
Elderly
Bipolar depression
Unipolar depression
Clinical characteristics
Neuroendocrine
