郝明茹,刘乐伟,赵鑫,申晴晴,凡豪杰,夏磊,耿峰,莫大明,刘寰忠.青少年抑郁障碍患者伴发精神病性症状的影响因素[J].四川精神卫生杂志,2024,37(6):507-514.Hao Mingru,Liu Lewei,Zhao Xin,Shen Qingqing,Fan Haojie,Xia Lei,Geng Feng,Mo Daming,Liu Huanzhong,Related factors of psychotic symptoms in adolescent patients with depressive disorder[J].SICHUAN MENTAL HEALTH,2024,37(6):507-514

青少年抑郁障碍患者伴发精神病性症状的影响因素

Related factors of psychotic symptoms in adolescent patients with depressive disorder

投稿时间：2024-01-31

DOI：10.11886/scjsws20240131002

中文关键词: 青少年抑郁障碍精神病性症状 BDNF 临床特征

英文关键词:Adolescents Depressive disorder Psychotic symptoms BDNF Clinical characteristics

基金项目:安徽省转化医学研究院科研基金项目（项目名称：青少年抑郁症发病机制与临床干预的多模态整合性研究，项目编号：2022zhyx-B01）；安徽省2019年中央财政省级临床重点专科建设项目

作者	单位	邮编
郝明茹	安徽医科大学精神卫生与心理科学学院，安徽合肥 230032 安徽医科大学附属巢湖医院，安徽合肥 238001 安徽省精神医学中心，安徽合肥 238001	238001
刘乐伟	安徽医科大学精神卫生与心理科学学院，安徽合肥 230032 安徽医科大学附属巢湖医院，安徽合肥 238001 安徽省精神医学中心，安徽合肥 238001	238001
赵鑫	安徽医科大学精神卫生与心理科学学院，安徽合肥 230032 安徽医科大学附属巢湖医院，安徽合肥 238001 安徽省精神医学中心，安徽合肥 238001	238001
申晴晴	安徽医科大学精神卫生与心理科学学院，安徽合肥 230032 安徽医科大学附属巢湖医院，安徽合肥 238001 安徽省精神医学中心，安徽合肥 238001	238001
凡豪杰	安徽医科大学精神卫生与心理科学学院，安徽合肥 230032 安徽医科大学附属巢湖医院，安徽合肥 238001 安徽省精神医学中心，安徽合肥 238001	238001
夏磊	安徽医科大学附属巢湖医院，安徽合肥 238001 安徽省精神医学中心，安徽合肥 238001	238001
耿峰	安徽医科大学第二附属医院，安徽合肥 230601	230601
莫大明	合肥市第四人民医院，安徽合肥 230000	230000
刘寰忠^*	安徽医科大学附属巢湖医院，安徽合肥 238001 安徽省精神医学中心，安徽合肥 238001 脑库构建及资源利用安徽省重点实验室，安徽合肥 230000	230000

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中文摘要:

背景伴精神病性症状的抑郁障碍患者往往存在更高的死亡风险及更差的预后。既往关于抑郁障碍患者伴发精神病性症状影响因素的研究多集中于成年抑郁障碍患者，针对青少年抑郁障碍患者的研究有限。目的探讨青少年抑郁障碍患者伴发精神病性症状的影响因素，为临床对这一群体的早期识别和干预提供参考。方法纳入2022年9月—2023年1月在安徽医科大学附属巢湖医院和合肥市第四人民医院精神科就诊的、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）诊断标准的青少年抑郁障碍患者96例。同期在安徽医科大学附属巢湖医院健康体检中心招募健康体检者56例为对照组。根据是否存在精神病性症状，将患者分为伴精神病性症状组（n=32）和不伴精神病性症状组（n=64）。采用汉密尔顿抑郁量表24项版（HAMD-24）、阳性和阴性症状量表（PANSS）、青少年自杀意念量表（PANSI）及童年创伤问卷简化版（CTQ-SF）进行评定。使用超敏多因子电化学发光分析仪测定血浆脑源性神经营养因子（BDNF）水平。采用Pearson相关分析和Spearman相关分析考查伴精神病性症状的青少年抑郁障碍患者PANSS阳性症状分量表评分与血浆BDNF水平及临床特征的相关性。采用二元Logistic回归分析探讨青少年抑郁障碍患者伴发精神病性症状的影响因素。采用多元线性回归分析精神病性症状严重程度的影响因素。结果青少年抑郁障碍患者血浆BDNF水平低于对照组（t=-3.080，P<0.01）。伴精神病性症状组的血浆BDNF水平低于不伴精神病性症状组（t=2.418，P<0.05），体质量指数（BMI）、PANSI评分、CTQ-SF评分以及HAMD-24总评分均高于不伴精神病性症状组（t=-2.024、-2.530、-2.187、-4.977，P<0.05或0.01）。相关分析显示，伴精神病性症状组的PANSS阳性症状分量表评分与HAMD-24的焦虑/躯体化因子评分及体重因子评分均呈负相关（r=-0.438、-0.498，P<0.05或0.01）。二元Logistic回归分析显示，BMI、血浆BDNF水平、HAMD-24总评分及认知障碍因子评分是青少年抑郁障碍患者伴发精神病性症状的影响因素。多元线性回归分析显示，HAMD-24的体重因子评分（β=-0.349，P<0.05）及焦虑/躯体化因子评分（β=-0.433，P<0.05）是精神病性症状严重程度的影响因素。结论 BMI较高、血浆BDNF水平较低、严重的抑郁症状和认知功能障碍可能是青少年抑郁障碍患者伴发精神病性症状的危险因素；体质量及焦虑症状可能与精神病性症状的严重程度存在关联。

英文摘要:

Background Patients demonstrating depressive disorder with psychotic symptoms often have increased risk of death and poor prognosis. A large amount of research has explored the factors influencing psychotic symptoms in adult patients with depressive disorder， but few has focused on adolescent patients.Objective To explore the influencing factors of psychotic symptoms in adolescent patients with depressive disorder， so as to provide references for early screening and intervention in clinic.Methods A total of 96 adolescent patients who met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） for depressive disorder and were seen in the psychiatry departments of Chaohu Hospital of Anhui Medical University and The Fourth People's Hospital of Hefei from September 2022 to January 2023 were included. Another 56 healthy individuals from the health examination center of Chaohu Hospital of Anhui Medical University were concurrently recruited as control group. Patients were assigned into psychotic group （n=32） and non-psychotic group （n=64） according to the presence or absence of psychotic symptoms. Hamilton Depression Scale-24 item （HAMD-24）， Positive and Negative Syndrome Scale （PANSS）， Positive and Negative Suicide Ideation （PANSI） and Childhood Trauma Questionnaire-Short Form （CTQ-SF） were used for evaluation. Plasma brain-derived neurotrophic factor （BDNF） concentration was obtained using Meso Scale Discovery electrochemiluminescence assay. Pearson and Spearman correlation analysis were adopted to determine the correlation of PANSS positive symptom subscale score with plasma BDNF concentration and clinical characteristics of adolescent depression patients with psychotic symptoms. Binary Logistic regression analysis was used to identify the factors influencing the presence of psychotic symptoms in adolescent patients with depressive disorder， and multiple linear regression analysis was utilized to screen the factors affecting the severity of psychotic symptoms.Results The plasma BDNF concentration of adolescent patients with depressive disorder was lower than that of control group （t=-3.080， P<0.01）.The plasma BDNF concentration of psychotic group was lower than that of non-psychotic group （t=2.418， P<0.05）， while the body mass index （BMI） PANSI scores， CTQ-SF scores and HAMD-24 total scores were all higher than those of non-psychotic group （t=-2.024， -2.530， -2.187， -4.977， P<0.05 or 0.01）. Correlation analysis showed that PANSS positive symptom subscale scores were negatively correlated with anxiety/somatization factor score and weight factor score in HAMD-24 of psychotic group （r=-0.438， -0.498， P<0.05 or 0.01）. Binary Logistic regression showed that BMI， plasma BDNF concentration， HAMD-24 total scores and cognitive dysfunction factor score were the influencing factors of psychotic symptoms in adolescent patients with depressive disorder. Multiple linear regression analysis demonstrated that weight factor scores （β=-0.349， P<0.05） and anxiety/somatization factor score （β=-0.433， P<0.05） in HAMD-24 were the factors influencing the severity of psychotic symptoms.Conclusion High BMI， low plasma BDNF concentration， severe depressive symptoms and cognitive dysfunction may be the risk factors of psychotic symptoms in adolescent patients with depressive disorder， furthermore， BMI and anxiety symptoms are found to be associated with the severity of psychotic symptoms. ［Funded by Scientific Research Fund Project of Anhui Institute of Translational Medicine （number， 2022zhyx-B01）； Central Finance Supported Provincial Key Clinical Specialty Construction Project of Anhui Province in 2019］

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