三种不同心理测评量表对功能性消化不良患者焦虑、抑郁状态的评估

背景：功能性消化不良（FD）与精神心理因素密切相关,客观评估FD患者的心理状态对理解消化不良症状产生的机制、指导选择综合治疗方案、客观评估疗效均具有重要意义。目的：比较汉密尔顿焦虑/抑郁量表（HAMA/HAMD）、Zung焦虑/抑郁自评量表（SAS/SDS）和罗马Ⅲ心理社会警报问卷（RPAQ）对FD患者焦虑、抑郁状态的检出一致性。方法：纳入2008年11月~2010年4月北京协和医院符合罗马Ⅲ诊断标准的FD患者,同时接受HAMA、HAMD他评以及SAS、SDS和RPAQ自评。结果：共纳入134例FD患者。HAMA对FD患者焦虑检出率为72.4%,明显高于SAS（24.6%）和RPAQ（31.3%）（P〈0.05）;HAMD对FD患者抑郁检出率为47.0%,与SDS无明显差异（44.0%,P〉0.05）,但明显高于RPAQ（20.9%,P〈0.05）。SDS与HAMD检出结果的总符合率为73.1%。HAMA/HAMD较SAS/SDS、RPAQ更易检出重度FD患者合并的焦虑和抑郁;SAS和RPAQ漏检约半数FD患者合并的中重度焦虑。结论：HAMA/HAMD较SAS/SDS、RPAQ更易发现FD患者合并的焦虑、抑郁状态,其检出率差异可能与量表不同的构成有关。

Assessment of Anxiety and Depression by Three Psychological Screening Scales in Functional Dyspepsia Patients

Background: Psychological disorders are common in patients with functional dyspepsia(FD).It is important to assess the abnormal psychological status in patients with FD for understanding the mechanism of dyspepsia symptoms,guidance of therapy and assessment of efficacy.Aims: To compare the consistency of Hamilton anxiety/depression scale(HAMA/HAMD),self-rating anxiety/depression scale(SAS/SDS) and Rome Ⅲ psychosocial alarm questionnaire(RPAQ) as screening tools for detection of anxiety/depression in FD patients.Methods: Patients met Rome Ⅲ diagnostic criteria of FD from Nov.2008 to Apr.2010 at Peking Union Medical College Hospital were enrolled.HAMA and HAMD were assessed by a well trained physician,SAS,SDS and RPAQ were completed by patients themselves following the instruction.Results: A total of 134 patients with FD were enrolled in this study.The detection rate of anxiety by HAMA was significantly higher than that by SAS and RPAQ(72.4% vs.24.6%,31.3%,P<0.05).The detection rate of depression by HAMD was similar to that by SDS(47.0% vs.44.0%,P>0.05),and was significantly higher than that by RPAQ(47.0% vs.20.9%,P<0.05).The overall coincidence detection rate by SDS and HAMD was 73.1%.When evaluated by HAMA/HAMD,patients with severe FD were found to have a higher comorbidity of anxiety/depression.About half of FD patients with moderate to severe anxiety/depression labeled by HAMA/HAMD could not be identified by SAS and RPAQ.Conclusions: Anxiety and depression are found to be more common in FD patients by HAMA/HAMD,the difference of detection rate with different screening scales may be resulted from the difference in items included in these scales.