慢性阻塞性肺疾病患者焦虑抑郁症状与BODE指数的相关性研究

  本文关键词：慢性阻塞性肺疾病患者焦虑抑郁症状与BODE指数的相关性研究，由笔耕文化传播整理发布。

        【目的】应用慢性阻塞性肺疾病多维分级评分系统（BODE index)、医院焦虑抑郁量表(HAD)综合测评稳定期慢性阻塞性肺疾病（COPD)患者，探索BODE指数与稳定期COPD患者焦虑抑郁症状的相关性，为临床评估COPD患者病情、预后及防治方法提供新的思路。【方法】根据病史、临床症状、体征及肺功能，选择2010年4月1日至2012年3月30日在广西医科大学第一附属医院呼吸疾病研究所住院及慢性阻塞性肺疾病门诊就诊的186例稳定期慢性阻塞性肺疾病患者为研究对象，进行横断面调查。入选后①测量患者身高，体重；记录吸烟包/年；测6分钟步行距离(6MWD);采用英国医学研究委员会呼吸困难量表（MRCdyspned scale)记录气促分级并评分；测量肺功能，，进行BODE多维分级系统评分；②采用医院焦虑抑郁量表(HAD)进行患者心理状态评分；③评估COPD患者焦虑抑郁程度，分析COPD稳定期患者BODE指数（体重指数；肺功能（FEV1%);6分钟步行距离；呼吸困难评分）及各因子与焦虑或抑郁的相关性，调查何种指标为最密切相关，探讨潜在的焦虑抑郁预测因子；调査COPD病情严重程度各级分期及BODE指数各级分期中患者焦虑、抑郁症状的发生率。【结果】(l)COPD患者焦虑抑郁程度：186例COPD稳定期患者焦虑分数为（7.8土4.73)分，77例（41.4%)有焦虑情绪（焦虑评分》8分），其中45例患者（24.2%)为轻度焦虑（评分8?：10分），32例患者（17.2%)有明确焦虑症状，为中重度焦虑（焦虑评分>11分）。186例COPD稳定期患者抑郁分数为（8.8±4.62)分，86例（46.2%)患者有抑郁情绪（抑郁评分>8分），其中35例（18.8%)患者为轻度抑郁（评分8?10分）；51例（27.4%)患者有明确抑郁症状，为中重度抑郁（抑郁评分>11分）。(2)COPD患者焦虑抑郁的影响因素：单因素相关分析及多因素回归显示，BODE总分及分项指标中的呼吸困难指数与患者情绪障碍呈显著正相关(K0.05);6分钟步行距离(6MWD)与患者情绪障碍呈显著负相关（K0.05)；肺功能（FEVl%pred)及营养状况（BMI)对COPD患者焦虑抑郁的影响较小。性别、住院次数、合并症数目、负性情绪史、焦虑抑郁共病等为COPD患者情绪障碍的危险因素。(3)COPD患者焦虑、抑郁症状与BODE分级的关系：COPD患者焦虑抑郁症状随着BODE指数分级增加而加重，且每级之间的差异有统计学意义；而COPD患者焦虑评分在"慢性阻塞性肺疾病全球倡议"（GOLD)分级中，层级之间无统计学差异；抑郁评分在GOLD分级中有统计学意义。【结论】（1)焦虑抑郁症状在COPD患者中发病率较高，合并焦虑抑郁的COPD患者生活质量较正常心理的COPD患者差；（2) BODE指数总分及其分项的6分钟步行距离(6丽D)及呼吸困难指数是预测COPD患者焦虑抑郁的有效指标。（3) BODE指数分级与以肺功能（FEV1%)为基础的GOLD分级比较，前者与COPD患者焦虑抑郁相关度更高，BODE级数越高，焦虑抑郁症状越严重；而(GOLD)分级不能全面反映焦虑抑郁症状。

    Objective: Anxiety and depression are two of the most commonandmodifiable co-morbidities of chronic obstructive pulmonary disease (COPD)and have an independent effect on health and prognosis. FEVl%pred has beenshown to be a poor predictor of anxiety and depression. The body mass index,degree of airflow obstruction, dyspnea, and exercise capacity (BODE) index is amultidimensional assessment system which may predict health outcome inCOPD patients. The purpose of this study was to investigate the predictivevalidity of the BODE index for anxious and depressive symptoms in COPDpatients.Methods: This was a multicenter, prospective, cross-sectional study in186patients with stable COPD. Anxious and depressive symptoms were assessedusing the Hospital Anxiety and Depression Scale (HADS). The relationshipsbetween anxiety, depression and potential predictors (including the BODE index)were analyzed by a binary Logistic regression model.Results: Subjects who had anxiety and depression, walked a shortersix-minute walking distance (6MWD), had more dyspnea, a higher BODE index,and lower health-related quality of life (P <0.05). Anxiety and depression score was significantly correlated with BODE(P<0.05). The prevalence ofanxiety and depression elevated with increasing BODE stage(P <0.05). On thebasis of binary Logistic regression, the BODE index was a good andindependent predictor of anxiety and depression because it compirsed dyspneaand6MWD, which were shown to be the main determinants.Conclusion:The predictive validity of the BODE index for anxiety and depression wasdemon-strated. We propose that the BODE index should be included inassessment of COPD severity.

        慢性阻塞性肺疾病患者焦虑抑郁症状与BODE指数的相关性研究

摘要4-6ABSTRACT6-7前言9-121 资料与方法12-162 结果16-333 讨论33-45结论45-46参考文献46-51附录51-55综述55-66    参考文献62-66致谢66-67攻读学位期间发表论文情况67

  本文关键词：慢性阻塞性肺疾病患者焦虑抑郁症状与BODE指数的相关性研究，由笔耕文化传播整理发布。