癫痫患者共患焦虑和抑郁现状调查及其危险因素分析

吴雪梅; 王海艳

doi:10.16766/j.cnki.issn.1674-4152.002748

癫痫患者共患焦虑和抑郁现状调查及其危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002748

吴雪梅^,,
王海艳

浙江大学医学院附属精神卫生中心杭州市第七人民医院精神科，浙江杭州 310013

基金项目:

浙江省医药卫生科技计划项目 2020KY746

详细信息

通讯作者:
吴雪梅, E-mail: boymodeng@163.com

中图分类号: R749.17 R749.4
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- 文章访问数: 255
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- PDF下载量: 16
- 被引次数: 0
出版历程
- 收稿日期: 2021-12-09
- 网络出版日期: 2022-12-30

Investigation and risk factors analysis of comorbid anxiety and depression in patients with epilepsy

WU Xue-mei^,,
WANG Hai-yan

Department of Psychiatry, Affiliated Mental Health Center Zhejiang University School of Medical, the Seventh People' s Hospital of Hangzhou City, Hangzhou, Zhejiang 310013, China

摘要

摘要: 目的调查癫痫患者共患焦虑、抑郁的现状，并分析影响患者共患焦虑、抑郁的危险因素。方法选取2019年2月—2021年2月在杭州市第七人民医院治疗的癫痫患者285例为研究对象。采用中文版广泛性焦虑障碍量表(GAD-7)和癫痫用神经障碍抑郁量表(NDDI-E)调查癫痫患者共患焦虑、抑郁状况。先采用单因素分析研究与癫痫患者共患焦虑、抑郁有关的因素，再采用多因素logistic回归分析研究影响患者共患焦虑、抑郁的独立危险因素。结果 285例癫痫患者共患焦虑47例(16.49%)；共患抑郁73例(25.61%)；共患抑郁和焦虑42例(14.74%)。多因素logistic回归分析结果显示，病程越长、口服药物种类多、发作频率＞2次/月及发作类型为局灶伴意识障碍是癫痫患者共患焦虑的独立危险因素(OR_病程=1.514；OR_{口服药物种类}=1.719；OR_发作频率=6.455；OR_发作类型=3.083)；口服药物种类多、发作频率＞2次/月及发作类型为局灶伴意识障碍是癫痫患者共患抑郁的独立危险因素(OR_{口服药物种类}=1.773；OR_发作频率=5.457；OR_发作类型=2.399)；发作频率＞2次/月、发作类型为局灶伴意识障碍发作是癫痫患者共患焦虑和抑郁的独立危险因素(OR_发作频率=7.205；OR_发作类型=3.958)。结论癫痫共患焦虑、抑郁的患病率较高，临床应根据危险因素采取针对性措施，同时对患者进行心理咨询和疏导，以降低癫痫患者共患焦虑、抑郁的发生率。
- 癫痫 /
- 焦虑 /
- 抑郁 /
- 危险因素
Abstract: Objective To investigate the status of comorbid anxiety and depression in patients with epilepsy and analyse the risk factors of comorbid anxiety and depression. Methods A total of 285 patients with epilepsy treated in the Seventh People' s Hospital of Hangzhou City from February 2019 to February 2021 were recruited in the stduy. The Chinese version of generalised anxiety disorder-7 (GAD-7) and epilepsy with neurological disorders and depression inventory for epilepsy (NDDI-E) were used in surveying epileptic patients with anxiety and depression status. Single-factor analysis was used in epileptic patients with anxiety, depression and related factors, and then multi-factor logistic regression analysis was performed in examining the independent risk factors of comorbid anxiety and depression. Results Among the 285 epilepsy patients, 47 patients (16.49%) suffered from anxiety, 73 patients (25.61%) suffered from depression and 42 patients (14.74%) suffered from both. Multivariate Logistic regression analysis showed that long disease duration, types of oral drugs, seizure frequency of >2 times per month and seizure type with focal disturbance of consciousness were independent risk factors for comorbid anxiety in epileptic patients (OR_duration=1.514; OR_{types of oral drugs}=1.719; OR_{seizure frequency}=6.455; OR_{type of seizures}=3.083); multiple types of oral drugs, seizure frequency >2 times/month and seizure type with focal disturbance of consciousness were independent risk factors for comorbid depression in epileptic patients (OR_{type of oral drug}=1.773; OR_{seizure frequency}=5.457; OR_{seizure type}=2.399); seizure frequency of >2 times/month, focal with the disturbance of consciousness seizures were independent risk factors for comorbid anxiety and depression in epilepsy patients (OR_{seizure frequency}=7.205; OR_{seizure type}=3.958). Conclusion The prevalence of comorbid anxiety and depression in epileptic patients is high. Clinical measures should be taken according to risk factors, and psychological counselling and counselling should be carried out to reduce the incidence of anxiety and depression in patients with epilepsy.
- Epilepsy /
- Anxiety /
- Depression /
- Risk factors

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表 1 癫痫患者共患焦虑单因素分析

Table 1. Univariate analysis of anxiety comorbidity in epilepsy patients

组别	例数	性别[例(%)]		年龄(x±s，岁)	发作频率[例(%)]		病程(x±s，年)	婚姻状况[例(%)]
组别	例数	男性	女性	年龄(x±s，岁)	≤2次/月	＞2次/月	病程(x±s，年)	已婚	未婚
焦虑组	47	28(59.57)	19(40.43)	38.61±2.83	17(36.17)	30(63.83)	8.15±1.25	21(44.68)	26(55.32)
非焦虑组	238	141(59.24)	97(40.76)	37.98±2.98	156(65.55)	82(34.45)	7.51±1.81	116(48.74)	122(51.26)
统计量		0.002^a		1.335^b	14.198^a		2.316^b	0.259^a
P值		0.966		0.183	＜0.001		0.021	0.611

组别	例数	文化程度[例(%)]		初次发病年龄 (x±s，岁)	口服药物种类[例(%)]		发作类型[例(%)]
组别	例数	初中及以下	高中及以上	初次发病年龄 (x±s，岁)	单药	多药	局灶伴意识障碍		局灶伴意识清楚
焦虑组	47	22(46.81)	25(53.19)	30.97±2.25	16(34.04)	31(65.96)	32(68.09)		15(31.91)
非焦虑组	238	107(44.96)	131(55.04)	31.56±2.31	133(55.88)	105(44.12)	71(29.83)		167(70.17)
统计量		0.054^a		-1.067^b	7.504^a		24.885^a
P值		0.816		0.109	0.006		＜0.001
注：^a为χ²值，^b为t值。

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表 2 癫痫患者共患抑郁单因素分析

Table 2. Univariate analysis of depression in epilepsy patients

组别	例数	性别[例(%)]		年龄(x±s，岁)	发作频率[例(%)]		病程(x±s，年)	婚姻状况[例(%)]
组别	例数	男性	女性	年龄(x±s，岁)	≤2次/月	＞2次/月	病程(x±s，年)	已婚	未婚
抑郁组	73	45(61.64)	28(38.36)	38.52±2.29	27(36.99)	46(63.01)	8.17±1.91	36(49.32)	37(50.68)
非抑郁组	212	124(58.49)	88(41.51)	37.97±2.26	146(68.87)	66(31.13)	7.81±1.87	101(47.64)	111(52.36)
统计量		0.224^a		1.787^b	23.138^a		1.411^b	0.061^a
P值		0.636		0.075	＜0.001		0.159	0.805

组别	例数	文化程度[例(%)]		初次发病年龄 (x±s，岁)	口服药物种类[例(%)]		发作类型[例(%)]
组别	例数	初中及以下	高中及以上	初次发病年龄 (x±s，岁)	单药	多药	局灶伴意识障碍		局灶伴意识清楚
抑郁组	73	35(47.95)	38(52.05)	30.79±2.27	27(36.99)	46(63.01)	49(67.12)		24(32.88)
非抑郁组	212	94(44.34)	118(55.66)	31.17±2.32	122(57.55)	90(42.45)	54(25.47)		158(74.53)
统计量		0.285^a		-1.214^b	9.202^a		40.819^a
P值		0.593		0.226	0.002		＜0.001
注：^a为χ²值，^b为t值。

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表 3 癫痫患者共患焦虑和抑郁单因素分析

Table 3. Univariate analysis of anxiety and depression in epilepsy patients

组别	例数	性别[例(%)]		年龄(x±s，岁)	发作频率[例(%)]		病程(x±s，年)	婚姻状况[例(%)]
组别	例数	男性	女性	年龄(x±s，岁)	≤2次/月	＞2次/月	病程(x±s，年)	已婚	未婚
焦虑和抑郁组	42	26(61.90)	16(38.10)	38.52±2.76	15(35.71)	27(64.29)	8.17±1.86	19(45.24)	23(54.76)
非焦虑和抑郁组	243	143(58.85)	100(41.15)	37.79±2.71	158(65.02)	85(34.98)	7.71±1.78	118(48.56)	125(51.44)
统计量		0.139^a		1.608^b	12.893^a		1.536^b	0.158^a
P值		0.710		0.109	＜0.001		0.126	0.691

组别	例数	文化程度[例(%)]		初次发病年龄 (x±s，岁)	口服药物种类[例(%)]		发作类型[例(%)]
组别	例数	初中及以下	高中及以上	初次发病年龄 (x±s，岁)	单药	多药	局灶伴意识障碍		局灶伴意识清楚
焦虑和抑郁组	42	20(47.62)	22(52.38)	30.78±2.25	18(42.86)	24(57.14)	26(61.90)		16(38.10)
非焦虑和抑郁组	243	109(44.86)	134(55.14)	31.29±2.31	131(53.91)	112(46.09)	77(31.69)		166(68.31)
统计量		0.110^a		-1.326^b	1.753^a		14.168^a
P值		0.740		0.186	0.185		＜0.001
注：^a为χ²值，^b为t值。

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表 4 癫痫患者共患焦虑、抑郁以及焦虑和抑郁的多因素分析各变量赋值

Table 4. Values of variables in multivariate analysis of anxiety and depression in epilepsy patients

变量	赋值方法
发作频率	≤2次/月=0，＞2次/月=1
病程	以实际值赋值
]口服药物种类	单药=0，多药=1
发作类型	局灶伴意识障碍=0，局灶伴意识清楚=1

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表 5 癫痫患者共患焦虑、抑郁以及焦虑和抑郁的多因素logistic回归分析

Table 5. Multivariate logistic regression analysis of anxiety, depression and anxiety and depression in epilepsy patients

共患类型	变量	B	SE	Wald χ²	P值	OR值	95% CI
焦虑	病程	0.415	0.102	16.554	< 0.001	1.514	1.240~1.849
	服药情况	0.542	0.149	13.232	< 0.001	1.719	1.284~2.302
	发作频率	1.865	0.752	6.151	< 0.001	6.455	1.479~28.179
	发作类型	1.126	0.579	3.782	< 0.001	3.083	1.005~9.458
抑郁	服药情况	0.573	0.186	9.490	< 0.001	1.773	1.232~2.553
	发作频率	1.697	0.631	7.233	< 0.001	5.457	1.584~18.792
	发作类型	0.875	0.497	3.100	< 0.001	2.399	1.225~6.353
焦虑和抑郁	发作频率	1.975	0.873	5.118	< 0.001	7.205	1.302~39.873
	发作类型	1.376	0.597	5.312	< 0.001	3.958	1.229~12.754

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