共病广泛性焦虑障碍对抑郁症患者执行功能的影响:多中心回顾性病例对照研究

  目的  探讨共病广泛性焦虑障碍(generalized anxiety disorder, GAD)及不同焦虑水平对抑郁症(major depressive disorder, MDD)患者执行功能的影响。  方法  回顾性收集并分析2014年2月至2016年1月北京协和医院、山西医科大学第一医院、中国医科大学附属第一医院招募的MDD患者及对照人群的临床资料。MDD患者均采用汉密尔顿焦虑量表(Hamilton anxiety scale，HAMA)对焦虑程度进行评定，并依据是否合并GAD，分为MDD+GAD组、MDD-GAD组。3组均采用MATRICS共识认知成套测验(MATRICS consensus cognitive battery, MCCB)评估其执行功能，包括动物流畅性测验(animal fluency test, AFT)、符号编码分测验(brief assessment of cognition in schizophrenia-symbolic coding, BACS-SC)、颜色连线测验(color trail test, CTT)、Stroop色词测验(Stroop color word test，SCWT)。比较3组及不同焦虑水平的MDD患者执行功能差异，采用Spearman法分析HAMA评分与MDD患者执行功能的相关性。  结果  共230例MDD患者及77名精神健康对照者入选本研究。其中MDD+GAD组86例、MDD-GAD组144例。MDD+GAD组和MDD-GAD组AFT、BACS-SC、SCWT正确数目均较对照组少，CTT完成时间较对照组长(P均＜0.05)；MDD+GAD组AFT正确数目多于MDD-GAD组(P＜0.05)，CTT、BACS-SC、SCWT结果与MDD-GAD组无显著性差异(P均＞0.05)。轻度焦虑患者(7分＜HAMA≤14分)AFT、BASC-CS、SCWT正确数目少于中度焦虑(14分＜HAMA≤29分)及重度焦虑患者(HAMA＞29分)(P均＜0.05)，中度焦虑与重度焦虑患者之间差异无统计学意义(P均＞0.05)。Spearman相关分析结果表明，HAMA评分与AFT(r_s=0.26, P＜0.001)、BASC-CS(r_s=0.26, P＜0.001)、SCWT(r_s=0.27, P＜0.001)正确数目呈正相关，与CTT完成时间无线性相关(r_s=-0.11, P=0.106)。  结论  共病GAD可能减轻MDD患者词语流畅功能损害；随焦虑程度加重，MDD患者的词语流畅度、信息处理速度、抑制等执行功能受损得到一定缓解。

Effects of Comorbidity of Generalized Anxiety Disorder on Executive Functions of Patients with Major Depressive Disorder: A Multi-center Retrospective Case-control Study

  Objective  To analyze the effect of comorbidity of generalized anxiety disorder (GAD) at different levels on executive functions (EFs) of patients with major depressive disorder (MDD).  Methods  Data of MDD patients and healthy controls in three general hospitals from February 2014 to January 2016 were retrospectively collected. Hamilton anxiety scale (HAMA) was used to evaluate the level of anxiety. MDD patients were grouped into MDD+GAD or MDD-GAD based on the result of the mini-international neuropsychiatric interview (MINI). EFs were evaluated by the animal fluency test (AFT), brief assessment of cognition in schizophrenia-symbolic coding (BACS-SC), color trail test (CTT), and Stroop color word test (SCWT) from MATRICS consensus cognitive battery (MCCB). We compared the EFs of different groups, and then explored the relevance between the level of anxiety and EFs by Spearman analysis.  Results  A total of 230 MDD patients and 77 healthy controls (G0: HC) were included. There were 86 comorbid with GAD (G1: MDD+GAD), 144 without GAD (G2: MDD-GAD). AFT, BACS-SC, CTT and SCWT results were lower in G1 and G2 than in G0(all P < 0.05). G1 had better AFT results than G2 (P < 0.05), while the difference in the results of BACS-SC, CTT and SCWT were unremarkable between G1 and G2 (all P > 0.05). MDD patients with mild anxiety symptoms (7 < HAMA≤14) had statistically significant lower scores in AFT, BACS-SC and SCWT than those with moderate (14 < HAMA≤29) or severe (HAMA > 29) anxiety symptoms (all P < 0.05), while no significant difference in test results were found between the subgroups of moderate and severe anxiety (all P > 0.05). Spearman analysis showed HAMA scores were relevant with AFT, BACS-SC and SCWT results (AFT: r_s=0.26, P < 0.001; BACS-SC: r_s=0.26, P < 0.001; SCWT: r_s=0.27, P < 0.001), but irrelevant with CTT results (r_s=-0.11, P=0.106).  Conclusions  Comorbidity of GAD may alleviate deficits of verbal fluency in MDD patients. MDD patients with anxiety at a higher level tend to have better executive functions such as verbal fluency, information processing speed, and inhibition.