慢性阻塞性肺疾病合并焦虑抑郁的临床分析

doi:10.3877/cma.j.issn.1674-6902.2019.06.002

中华肺部疾病杂志(电子版) ›› 2019, Vol. 12 ›› Issue (06) : 677 -681. doi: 10.3877/cma.j.issn.1674-6902.2019.06.002

论著

慢性阻塞性肺疾病合并焦虑抑郁的临床分析

陈华萍¹, 尹燕², 贺斌峰¹, 袁明¹, 魏征华¹, 胡明冬¹, 张明周¹, 高瞻¹(

), 徐瑜¹, 杨昱¹^,^†(

), 康健², 王关嵩¹^,^†(

)

^1. 400038　重庆，陆军军医大学（第三军医大学）第二附属医院全军呼吸内科研究所
^2. 110000　辽宁，中国医科大学第一附属医院呼吸与危重症医学科

收稿日期:2019-07-13 出版日期:2019-12-20
通信作者: 高瞻, 杨昱, 王关嵩
基金资助:
科技部重点研发计划项目(2016YFC1304503)

Clinical analysis of chronic obstructive pulmonary disease combined with anxiety/depression

Huaping Chen¹, Yan Yin², Binfeng He¹, Ming Yuan¹, Zhenghua Wei¹, Mingdong Hu¹, Mingzhou Zhang¹, Yu Yang¹^,^†(), Zhan Gao¹, Yu Xu¹(), Jian Kang², Guansong Wang¹^,^†()

^1. Institute of Respiratory Diseases, Xinqiao Hospital, Army Military Medical University, Chongqing 400037, China
^2. Department of Respiratory and Critical Care Medicine, First Affiliated Hospital, China Medical University, Shenyang 110000, China

Received:2019-07-13 Published:2019-12-20
Corresponding author: Yu Yang, Yu Xu, Guansong Wang

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引用本文：

陈华萍, 尹燕, 贺斌峰, 袁明, 魏征华, 胡明冬, 张明周, 高瞻, 徐瑜, 杨昱, 康健, 王关嵩. 慢性阻塞性肺疾病合并焦虑抑郁的临床分析[J]. 中华肺部疾病杂志(电子版), 2019, 12(06): 677-681.

Huaping Chen, Yan Yin, Binfeng He, Ming Yuan, Zhenghua Wei, Mingdong Hu, Mingzhou Zhang, Yu Yang, Zhan Gao, Yu Xu, Jian Kang, Guansong Wang. Clinical analysis of chronic obstructive pulmonary disease combined with anxiety/depression[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2019, 12(06): 677-681.

目的

分析COPD合并焦虑抑郁的患病率，探讨焦虑抑郁程度分级与COPD症状评分间的关系。

方法

选择154例COPD患者，通过问卷调查，评估患者医院焦虑抑郁量表(HADS)和COPD评估测试(CAT)评分，汉密尔顿抑郁量表(HAMD)评分，汉密尔顿焦虑量表(HAMA)评分，圣乔治呼吸问题调查问卷(SGRQ)总分，呼吸困难(mMRC)评分，结合肺功能检查，按照HADS≥11分表示存在焦虑、抑郁进行分组，进行相关因素分析；同时依据HAMD、HAMA进行焦虑抑郁分级，观察焦虑抑郁分级与COPD患者病情的关系。

结果

154例COPD患者中，41例合并焦虑抑郁障碍，患病率为26.63%，其中单纯焦虑或抑郁患者6例，轻度焦虑抑郁患者19例，中重度焦虑抑郁患者16例，COPD合并焦虑抑郁组在性别、年龄、病程、吸烟、教育水平方面与单纯COPD无差异(P>0.05)，但低收入人群比例、疾病每年花费、肺功能分级3、4级患者比例显著高于单纯COPD组(P<0.05)；在与COPD症状评分关系的研究中，结果表明HAD评分与HAMD评分，HAMA评分，SGRQ总分，mMRC评分呈正相关，与肺功能FEV占预计值%、FEV₁/FVC呈负相关(P<0.05)；焦虑抑郁分级分析结果显示合并中重度焦虑抑郁COPD患者HAMD评分、HAMA评分、SGRQ总分、mMRC评分、FEV占预计值%、FEV₁/FVC均较合并轻度焦虑抑郁COPD患者差(P<0.05)。

结论

COPD合并焦虑抑郁的患病率较高，且焦虑抑郁分级程度与患者病情严重度与呈正相关，提示临床上在治疗COPD患者基础疾病的同时还需关注患者的精神疾病，以进一步提高疗效。

关键词: 肺疾病, 慢性阻塞性, 焦虑抑郁, 临床分析

Objective

To analyze the prevalence of chronic obstructive pulmonary disease (COPD) combined with anxiety/depression, and to explore the relationship between the anxiety/depression grade and COPD symptom score.

Methods

A total of 154 COPD patients were enrolled in this study. Hospital Anxiety and Depression Scale (HADS) and COPD assessment test (CAT), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), St. George′s Respiratory Questionnaire (SGRQ) and dyspnea (mMRC) were used for the patients. According to the pulmonary function test, the patients were grouped according to HADS (>11) indicating anxiety/depression, and the literature factors were analyzed. Meanwhile, the anxiety/depression was graded according to the scores of HAMD and HAMA, and the relationship between anxiety and depression grading and the condition of COPD patients was observed.

Results

Among the 154 COPD patients, 41 were combined with anxiety/depression, with the prevalence rate of 26.63%. Among 41 patients, 6 had simple anxiety/depression, 19 had mild anxiety/depression, and 16 had moderate or severe anxiety/depression. There was no significant difference in sex, age, course of disease, smoking history or educational level between the patients with COPD combined with anxiety/depression and the patients with simple COPD (P>0.05). However, there were significant differences in the proportions of rural patients, low-income population, the patients with higher annual cost of disease, and the patients with pulmonary functions grading 3 and 4 between the patients with COPD combined with anxiety/depression and the patients with simple COPD (P<0.05). In the study of the relationship between HAD score and COPD symptom score, the results showed that HAD score was positively correlated with HAMD score, HAMA score, SGRQ total score and mMRC score, and negatively correlated with the FEV and FEV₁/FVC of the pulmonary function. The results of anxiety/depression grading analysis showed that the HAMD score, HAMA score, SGRQ total score, mMRC score, FEV ratio and FEV₁/FVC of the COPD patients with moderate and severe anxiety/depression were worse than those of the COPD patients with mild anxiety/depression (P<0.05).

Conclusion

The prevalence is high in the patients with COPD combined with anxiety/depression and the degree of anxiety/depression is positively correlated with the severity of COPD, suggesting that doctors should pay more attention to the mental illness of the patients in the treatment of COPD patients, in order to further improve the curative effects.

Key words: Chronic obstructive pulmonary disease, Anxiety/depression, Clinical analysis

表1 COPD患者临床资料[n(%)]

临床资料		单纯COPD组	COPD合并焦虑抑郁组
医院焦虑抑郁量表评分		3.12±2.21	13.83±4.18
病例数		113(73.37)	41(26.63)
性别(男/女)		107/6	36/5
年龄(岁)		62.25±7.96	62.05±11.08
病程(年)		6.82±10.17	6.64±8.72
吸烟例数		89(78.76)	34(82.92)
吸烟时间		31.09±12.22	34.66±18.89
GOLD分级
	1级	3(2.7)	0
	2级	63(55.8)	8(19.5)
	3级或4级	47(41.5)	33(80.5)
居住环
	城市	46(40.70)	15(36.58)^a
	农村	67(59.3)	26(63.42)
教育水平
	高中以下	82(72.56)	33(80.48)
	高中及以上	31(27.44)	8(19.52)
个人收入(RMB/月)
	1 500以下	45(39.82)	28(68.29)
	1 500～3 000	39(34.51)	6(14.63)^a
	3 000以上	29(25.67)	7(27.08)
COPD每年花费
	5 000以下	66(58.40)	11(26.82)
	5 000～10 000	21(18.58)	5(12.19)
	10 000以上	26(23.02)	25(60.99)^a

表1 COPD患者临床资料[n(%)]

临床资料		单纯COPD组	COPD合并焦虑抑郁组
医院焦虑抑郁量表评分		3.12±2.21	13.83±4.18
病例数		113(73.37)	41(26.63)
性别(男/女)		107/6	36/5
年龄(岁)		62.25±7.96	62.05±11.08
病程(年)		6.82±10.17	6.64±8.72
吸烟例数		89(78.76)	34(82.92)
吸烟时间		31.09±12.22	34.66±18.89
GOLD分级
	1级	3(2.7)	0
	2级	63(55.8)	8(19.5)
	3级或4级	47(41.5)	33(80.5)
居住环
	城市	46(40.70)	15(36.58)^a
	农村	67(59.3)	26(63.42)
教育水平
	高中以下	82(72.56)	33(80.48)
	高中及以上	31(27.44)	8(19.52)
个人收入(RMB/月)
	1 500以下	45(39.82)	28(68.29)
	1 500～3 000	39(34.51)	6(14.63)^a
	3 000以上	29(25.67)	7(27.08)
COPD每年花费
	5 000以下	66(58.40)	11(26.82)
	5 000～10 000	21(18.58)	5(12.19)
	10 000以上	26(23.02)	25(60.99)^a

表2 COPD患者HAD评分与mMRC、CAT、肺功能的状况比较

组　别		HAD评分	病例数(%)	HAMD评分	HAMA评分	mMRC评分	CAT评分	FEV占预计值(%)	FEV₁/FVC(%)	急性加重次数(次)
单纯COPD组		3.12±2.21	113(73.37%)	4.43±2.84	4.22±2.34	1.49±1.02	13.2±6.09	51.92±10.7	59.15±7.39	1.8±1.38
COPD合并焦虑抑郁组		13.83±4.18^a	41(26.63%)	12.77±4.59^a	15.88±4.88^a	2.19±1.27	23.10±6.38^a	41.59±11.30^a	48.02±8.32^a	2.86±2.53^a
	P值			0.82	0.81	0.38	0.64	-0.59	-0.56	0.18

表2 COPD患者HAD评分与mMRC、CAT、肺功能的状况比较

组　别		HAD评分	病例数(%)	HAMD评分	HAMA评分	mMRC评分	CAT评分	FEV占预计值(%)	FEV₁/FVC(%)	急性加重次数(次)
单纯COPD组		3.12±2.21	113(73.37%)	4.43±2.84	4.22±2.34	1.49±1.02	13.2±6.09	51.92±10.7	59.15±7.39	1.8±1.38
COPD合并焦虑抑郁组		13.83±4.18^a	41(26.63%)	12.77±4.59^a	15.88±4.88^a	2.19±1.27	23.10±6.38^a	41.59±11.30^a	48.02±8.32^a	2.86±2.53^a
	P值			0.82	0.81	0.38	0.64	-0.59	-0.56	0.18

表3 COPD合并焦虑抑郁程度分级比较

分组/评价指标	病例数(%)	HAMD评分	HAMA评分	SGRQ总分	呼吸症状	活动受限	疾病影响	mMRC评分	CAT评分	急性加重次数(次)	FEV₁占预计值(%)	FEV₁/FVC(%)
单纯焦虑或抑郁组	6(14.6)	9.00±0.81	7.66±2.08	58.77±9.97	55.53±8.81	60.44±9.92	63.54±7.17	1.69±1.50	19.00±5.09	2.66±1.52	51.17±8.28	49.33±6.31
轻度焦虑抑郁组	19(46.34)	11.70±2.62	17.09±5.59	62.83±11.53	57.33±11.36	56.83±10.08	59.67±8.22	1.9±0.87	20.6±6.48	2.23±3.2	43.00±11.10	51.52±7.51
中重度焦虑抑郁组	16(39.1)	19.00±2.08^a	24.42±3.59^a	71.90±11.29^a	69.58±12.37^a	62.21±9.90	68.43±11.98^a	3.00±0.81^a	25.57±6.39^a	2.25±1.48	36.00±8.30^a	43.75±11.34^a

表3 COPD合并焦虑抑郁程度分级比较

分组/评价指标	病例数(%)	HAMD评分	HAMA评分	SGRQ总分	呼吸症状	活动受限	疾病影响	mMRC评分	CAT评分	急性加重次数(次)	FEV₁占预计值(%)	FEV₁/FVC(%)
单纯焦虑或抑郁组	6(14.6)	9.00±0.81	7.66±2.08	58.77±9.97	55.53±8.81	60.44±9.92	63.54±7.17	1.69±1.50	19.00±5.09	2.66±1.52	51.17±8.28	49.33±6.31
轻度焦虑抑郁组	19(46.34)	11.70±2.62	17.09±5.59	62.83±11.53	57.33±11.36	56.83±10.08	59.67±8.22	1.9±0.87	20.6±6.48	2.23±3.2	43.00±11.10	51.52±7.51
中重度焦虑抑郁组	16(39.1)	19.00±2.08^a	24.42±3.59^a	71.90±11.29^a	69.58±12.37^a	62.21±9.90	68.43±11.98^a	3.00±0.81^a	25.57±6.39^a	2.25±1.48	36.00±8.30^a	43.75±11.34^a

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[12]	刘玲, 肖颖, 王蓉. 严重创伤并发肺部感染死亡病例分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 581-583.
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[14]	周婷, 孙培培, 张二明, 安欣华, 向平超. 北京市石景山区40岁及以上居民慢性阻塞性肺疾病诊断现状调查[J]. 中华临床医师杂志(电子版), 2023, 17(07): 790-797.
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Clinical analysis of chronic obstructive pulmonary disease combined with anxiety/depression

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Clinical analysis of chronic obstructive pulmonary disease combined with anxiety/depression