抑郁情绪对慢性阻塞性肺疾病患者疾病转归和生活质量的影响

目的 调查住院慢性阻塞性肺疾病(COPD)患者抑郁症的发病率,研究其对患者健康相关生活质量的影响.方法 对65例住院COPD患者进行汉密尔顿抑郁量表(HAMD),StGeorge呼吸问卷(SGRQ),简明健康调查问卷(SF-36)调查.结果 共调查COPD患者65例.HAMD分值8～20分者10例,21～35分者5例,35分以上者2例.不合并抑郁(HAMD＜8分)与合并抑郁(HAMD≥8分)的COPD患者SGRQ总分(38.6士19.4)分比(53.3±27.6)分]、活动受限(39.8±18.5)分比(57.7 ±24.4)分]、疾病影响(33.9±13.7)分比(43.5±18.9)分]差异均有统计学意义(P＜0.05),不合并抑郁的COPD患者低于合并抑郁的COPD患者.与合并抑郁的COPD患者比较,不合并抑郁的患者SF-36的8个维度分值均较高,其中生理功能(51.1±10.8)分比(26.9±14.4)分]、生理职能(26.6±11.7)分比(8.3±1.4)分]、社会功能(33.3±14.5)分比(17.9±7.5)分]、情感职能(41.7±19.2)分比(23.8±8.8)分]、精神健康(37.4±11.4)分比(23.8±8.0)分]分值相比,差异有统计学意义.较轻的COPD患者(Ⅰ期和Ⅱ期)和较重的COPD患者(Ⅲ期和Ⅳ期)SGRQ总分(37.8±15.7)分比(58.6±20.4)分]、活动受限(37.8±16.4)分比(59.2±21.6)分]、疾病影响(31.7±8.2)分比(45.6±17.8)分]相比,较轻的COPD患者均低于较重的COPD患者,差异有统计学意义(P＜0.05).较轻和较重的COPD患者SF-36表的生理机能(57.5±29.7)分比(27.0±12.9)分]、生理职能(33.0±13.9)分比(6.0±2.7)分]、一般健康状况(76.6±l9.4)分比(55.1±24.8)分]、社会功能(41.1±16.8)分比(10.3±2.8)分]和精神健康(40.6±1.6)分比(24.6±6.6)]相比,较轻的COPD患者评分均高于较重的COPD患者,差异有统计学意义(P＜0.05).结论 抑郁症在COPD患者中有一定的发生率,且严重影响COPD患者的健康生活质量.

Relationship between depression and health-related quality of life in patients with chronic obstructive pulmonary disease

Objectives To determine the prevalence of depression and examine its impact on the health-related quality of life (HRQoL) among patients with chronic obstructive pulmonary disease (COPD).Methods A total of 65 COPD patients completed the St.George respiratory questionnaire ( SGRQ),Medical outcomes short form-36 (SF-36) and Hamilton depression inventory (HAMD).Results The prevalence of depression was 26.2％.The SGRQ total(53.3 ± 27.6) vs (38.6 ± 19.4),P ＜ 0.001 ],activity(57.7 ± 24.4) vs (39.8 ±18.5),P=0.038]and impact(43.5 ±18.9) vs (33.9±13.7),P=0.042]subscores were significantly worse in the patients with depression.The physical functioning(26.9 ± 14.4) vs (51.1 ± 10.8),P =0.024],role physical( 8.33 ± 1.4) vs (26.6 ± 11.7),P =0.003 ],social functioning( 17.9 ± 7.5) vs (33.3 ± 14.5),P =0.039],rele emotion(23.8±8.8) vs (41.7 ±19.2),P=0.037]and mental health(23.8 ±8.0) vs (37.4±11.4),P =0.043]dimensions from the SF-36 were statistically poor in the patients with depression.The patients with severe and very severe lung function defects showed significantly worse total( 37.8 ± 15.7) vs ( 58.6 ±20.4),P=0.029],activity(37.8 ±16.4) vs (59.2 ±21.6),P=0.033]and impact(31.7±8.2) vs (45.6±17.8 ),P =0.043]scores of the SGRQ and significantly poor physical functioning(27.0 ± 12.9) vs (57.5 ± 29.7),P=0.018],relephysical(6.0±2.7) vs (33.0 ±13.9),P=0.007],general health(55.1 ±24.8) vs (76.6 ± 19.4),P =0.048 ],social functioning( 10.3 ± 2.8) vs (41.1 ± 16.8),P =0.017]and mental health (24.6 ± 6.6) vs (40.6 ± 1.6),P =0.031]scores on the SF-36.Conclusion The prevalence of depression in COPD patients is considerable,and depression has a negative impact on the HRQoL among COPD patients.