心境障碍问卷和32项轻躁狂症状清单在单相抑郁障碍和双相障碍患者中的应用
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国家自然科学基金项目(81901355);北京市自然科学基金面上项目(7192081)


Application of mood disorder questionnaire and 32-item hypomania checklist in patients with unipolar depressive disorder and bipolar disorder
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    摘要:

    目的 比较心境障碍问卷(MDQ)和 32 项轻躁狂症状清单(HCL-32)在单相抑郁障碍和双相 障碍患者中的应用效果。方法 纳入 2014 年 9 月至 2015 年 12 月于首都医科大学附属北京安定医院就 诊的 212 例心境障碍患者,其中单相抑郁障碍组患者 107 例,双相障碍组患者 105 例。采用主成分分析 法对 2 个量表进行因子分析。采用 Cronbach's α 系数评估 2 个量表的内部一致性信度,采用 Spearman 相 关分析 2 个量表各条目得分与总分的相关性,比较两组患者 2 个量表的阳性应答率及得分。采用受试者 工作特征(ROC)曲线分析 2 个量表的筛查性能并比较 ROC 曲线下面积。结果 MDQ 为两因子结构,特 征值分别为 5.39、1.47,对总方差的累积贡献率为 52.81%;HCL-32 为三因子结构,特征值分别为 12.61、 2.87、1.84,对总方差的累积贡献率为 54.11%。MDQ 和 HCL-32 的 Cronbach's α 系数分别为 0.88(95%CI: 0.85~0.90)、0.95(95%CI:0.94~0.96)。MDQ、HCL-32 各条目与总分之间的相关系数分别为 0.50~0.72 (P< 0.01)、0.16~0.78(P< 0.05)。双相障碍组 MDQ 所有条目的阳性应答率均高于单相抑郁障碍组;除 条目 32 外,双相障碍组 HCL-32 各条目的阳性应答率均高于单相抑郁障碍组。单相抑郁障碍组的 MDQ 总分为 3.00(0,5.00)分,HCL-32 总分为 9.00(1.00,17.00)分,低于双相障碍组的 5.00(1.50,9.00)、17.00 (12.00,23.50)分,差异有统计学意义(Z=-4.03、-5.02;P< 0.01)。MDQ 区分单相抑郁障碍和双相障碍的 ROC 曲线下面积为 0.66(95%CI:0.59~0.73,P< 0.001),与 HCL-32 的 0.70(95%CI:0.63~0.77,P< 0.001) 比较,差异无统计学意义(Z=1.07,P=0.28)。MDQ 的最佳划界分为 6 分,灵敏度为 0.48,特异度为 0.82; HCL-32 的最佳划界分为 8 分,灵敏度为 0.85,特异度为 0.47。结论 MDQ 和 HCL-32 在单相抑郁障碍 和双相障碍患者中应用的信度较好,均可适用于专科医院鉴别双相障碍和单相抑郁障碍。HCL-32 较 MDQ 灵敏度高,但特异度低。

    Abstract:

    Objective To compare the reliability and validity of Mood Disorder Questionnaire (MDQ) and 32 Items Hypomania Checklist (HCL-32) in patients with mood disorders. Methods A total of 212 patients with mood disorders in Beijing Anding Hospital Affiliated to Capital Medical University from September 2014 to December 2015 were recruited, including 107 patients with unipolar depressive disorder (UP) in UP group and 105 patients with bipolar disorder (BP) in BP group. Principal component analysis was used to analyze the two scales. Cronbach's α coefficient was used to evaluate the internal consistency reliability of the two scales, and Spearman correlation was used to analyze the correlation between each item score of the two scales and the total score. The positive response rates and scores of the two scales were compared between the two groups. The screening performance of the two scales was analyzed by using the receiver operating characteristic (ROC) curve. The area under the ROC curve was also compared. Results MDQ had a two-factor structure, with eigenvalues of 5.39 and 1.47 respectively, and the two factors explained 52.81% of the total variance. HCL- 32 had a three-factor structure, with eigenvalues of 12.61, 2.87 and 1.84 respectively, and the three factors explained 54.11% of the total variance. Cronbach's α for MDQ and HCL-32 were 0.88 (95%CI=0.85-0.90) and 0.95 (95%CI=0.94-0.96) respectively. The correlation coefficients between each item of MDQ and HCL-32 and the total score were 0.50-0.72 (P< 0.01) and 0.16-0.78 (P< 0.05), respectively. In all MDQ items, the positive response rate of BP group was higher than that of UP group. For HCL-32, positive response rates were higher in the BP group than in the UP group except item 32. The total score of MDQ in UP group was lower than that in BP group [3.00 (0, 5.00) vs 5.00 (1.50, 9.00)]. The total score of HCL-32 in UP group was lower than that in BP group [9.00(1.00,17.00) vs 17.00 (12.00, 23.50)]. The differences are statistically significant (Z= -4.03,-5.02; P< 0.01). The areas under the ROC curve of MDQ and HCL-32 were 0.66 (95%CI=0.59-0.73, P < 0.001) and 0.70 (95%CI=0.63-0.77, P < 0.001). There was no significant difference in the area under the ROC curve between the two scales (Z=1.07, P=0.28). The optimal cut-off of MDQ was 6, sensitivity was 0.48, specificity was 0.82. The optimal cut-off of HCL-32 was 8, sensitivity was 0.85, and specificity was 0.47. Conclusions MDQ and HCL-32 have good reliability and validity in patients with mood disorders, and both can be applied to the screening of UP and BP in specialized hospitals. HCL-32 has higher sensitivity and lower specificity than MDQ.

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付兆燕,毛珍,孙悦,李峰,李田,王传跃,薄奇静.心境障碍问卷和32项轻躁狂症状清单在单相抑郁障碍和双相障碍患者中的应用[J].神经疾病与精神卫生,2022,22(9):
DOI :10.3969/j. issn.1009-6574.2022.09.008.

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  • 在线发布日期: 2022-09-21