| 周萍,王楚瑶,谢民耀,陈豪诚,宋莎莎,张焕,柳娜.早发和晚发型强迫症住院患者临床特征及发病年龄的影响因素[J].四川精神卫生杂志,2023,36(5):396-401.Zhou Ping,Wang Chuyao,Xie Minyao,Chen Haocheng,Song Shasha,Zhang Huan,Liu Na,Clinical characteristics and influencing factors of onset age in inpatients with early- and late-onset obsessive-compulsive disorder inpatients[J].SICHUAN MENTAL HEALTH,2023,36(5):396-401 |
| 早发和晚发型强迫症住院患者临床特征及发病年龄的影响因素 |
| Clinical characteristics and influencing factors of onset age in inpatients with early- and late-onset obsessive-compulsive disorder inpatients |
| 投稿时间：2023-07-27 |
| DOI：10.11886/scjsws20230727003 |
| 中文关键词: 早发型强迫症 晚发型强迫症 回顾性分析 |
| 英文关键词:Early-onset obsessive-compulsive disorder Late-onset obsessive-compulsive disorder Retrospective analysis |
| 基金项目:江苏省社会发展重点研发计划专项（项目名称：全国多中心强迫症诊疗现况调查及优化认知行为治疗的疗效与神经机制研究，项目编号：BE2021616）；江苏省社会发展面上项目（项目名称：强迫症电子化专病队列管理及数字化心理干预模式探索，项目编号：BE2022678）；南京市医学科技发展基金重点项目（项目名称：强迫症及其一级亲属错误处理的分子神经机制研究，项目编号：ZKX20029） |
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| 中文摘要: |
| 背景 强迫症病因复杂且临床表现异质性高，不同年龄段起病的强迫症患者在临床症状及病因学上存在差异，目前针对早发型和晚发型强迫症住院患者的研究有限。目的 探讨早发型和晚发型住院强迫症患者临床特征的差异及影响强迫症发病年龄的因素，为强迫症患者的早期筛查及治疗提供参考。方法 收集2012年3月-2023年3月在南京医科大学附属脑科医院住院治疗的540例强迫症患者的病历资料。以起病年龄18岁为界，将患者分为早发组（n=310）和晚发组（n=230），比较两组患者人口学资料及临床症状的差异。使用二元Logistic回归分析影响强迫症患者发病年龄的因素。结果 人口学资料方面，早发组和晚发组的性别、婚姻状况、精神疾病家族史、共病精神疾病、工作情况、受教育程度、强迫症状种类差异均有统计学意义（χ2=22.302、170.556、9.224、13.624、242.277、59.791、7.231，P均<0.05或0.01），两组起病年龄、住院时年龄差异有统计学意义（Z=-19.915、16.831，P均<0.01）；临床症状方面，早发组强迫思维（χ2=11.998，P<0.05）、排序类（χ2=7.731，P<0.05）、仪式化类症状（χ2=7.714，P<0.05）比例高于晚发组，检查类（χ2=8.204，P<0.05）及清洗类（χ2=7.506，P<0.05）症状比例低于晚发组。共病神经发育障碍、共病情感障碍、有精神分裂症家族史、有情感障碍家族史是影响强迫症患者发病年龄的独立危险因素（OR=19.587、1.830、3.065、4.431，P均<0.05），其中共病神经发育障碍是影响强迫症患者发病年龄的核心因素，女性是早发患者的保护因素（OR=0.417，P<0.01）。结论 早发和晚发型强迫症住院患者在人口学资料及临床症状上存在差异，共病神经发育障碍是影响强迫症住院患者起病年龄的核心危险因素。 |
| 英文摘要: |
| Background The obsessive-compulsive disorder （OCD） features complexity in etiological factors and high heterogeneity in clinical manifestations. OCD patients with different ages of onset vary in clinical symptoms and etiology. However， current studies on inpatients with early- and late-onset OCD are limited.Objective To explore the differences in clinical characteristics between early- and late-onset OCD inpatients as well as the factors affecting the onset age of OCD， so as to provide references for early screening and treatment of OCD patients.Methods This study was based on collected medical records of 540 patients with OCD who received inpatient treatments at the Affiliated Brain Hospital of Nanjing Medical University between March 2012 and March 2023. Patients with onset age above 18 were placed into early-onset group （n=310） and the others into late-onset group （n=230）. Then differences in demographic data and clinical symptoms between two groups of patients were compared. Binary logistic regression was used to analyze the factors that affect the onset age of OCD.Results Observing the demographic data， there were significant differences between the two groups in the results in gender， marital status， family history of mental illness， ratio of comorbidities with other mental illnesses， occupational composition， education level and types of obsessive-compulsive symptoms （χ2=22.302、170.556， 9.224， 13.624， 242.277， 59.791， 7.231， P<0.05 or 0.01）. Also， the results in ages of onset and hospitalization between two groups were significantly different （Z=-19.915， 16.831， P<0.01）. In terms of clinical symptoms， the early onset group had a higher proportion of symptoms including obsessive thinking （χ2=11.998， P<0.05）， ordering （χ2=7.731， P<0.05） and rituals （χ2=7.714， P<0.05）， while the proportion of obsessive checking （χ2=8.204， P<0.05） and washing （χ2=7.506， P<0.05） symptoms were relatively low. In terms of risk factors， there were several independent risk factors that influence the onset age of OCD inpatients， including comorbid neurodevelopmental disorder， comorbid affective disorder， family history of schizophrenia and family history of affective disorder （OR=19.587， 1.830， 3.065， 4.431， P<0.05）. Among them， comorbid neurodevelopmental disorder was the core influencing factor， and female gender was a protective factor for early-onset patients （OR=0.417， P<0.01）.Conclusion There are differences in demographic data and clinical symptom characteristics between early- and late-onset OCD inpatients， and comorbid neurodevelopmental disorder plays as a core risk factor affecting the onset age of OCD inpatients. ［Funded by Jiangsu Province Key Research and Development Plan for Social Development Special Project（number， BE2021616） ； Jiangsu Province Social Development General Project （number， BE2022678）； Key Project of Nanjing Medical Science and Technology Development Fund （number， ZKX20029）］ |
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