Pirraglia Paul A, Biswas Kousick, Kilbourne Amy M, Fenn Howard, Bauer Mark S
Providence VA Medical Center and the Warren Alpert Medical School of Brown University, United States.
J Affect Disord. 2009 Jun;115(3):355-9. doi: 10.1016/j.jad.2008.09.020. Epub 2008 Oct 18.
Several studies suggest that medical comorbidity is associated with worse clinical status in bipolar disorder. It is unclear which aspect of medical comorbidity is responsible: simple disease count, risk for future morbidity, or current physical burden.
We analyzed three years of prospective data from a randomized clinical trial of collaborative care in 306 bipolar veterans. We examined the association of clinical outcome with baseline medical comorbidity defined as: (1) simple active disease count, (2) diseases with risk for future morbidity measured with the Charlson Comorbidity Index, and (3) current physical burden measured with the SF-36 Physical Component Summary score (PCS). Bipolar outcomes were weeks in episode, mean depression score, and change in mental health burden measured by the SF-36 Mental Component Summary score (MCS).
The three medical comorbidity measures were not highly correlated, indicating that each conveyed novel information. Controlling for potential confounders, worse baseline PCS predicted significantly higher mean depression scores (p=0.011) and less improvement in MCS scores (p=0.0099) over three years. Simple disease count and risk for future risk did not predict worse bipolar outcomes.
Some potential limitations include not accounting for all confounding factors, selection bias for participants, increased the likelihood of Type I error due to multiple comparisons and having a predominantly male population.
This long-term prospective study extends cross-sectional and retrospective research on the link between medical illness and bipolar outcomes. It is the current experience of burden of physical illness, rather than an unweighted or weighted disease count, that leads to worse bipolar outcomes.
多项研究表明，合并躯体疾病与双相情感障碍更差的临床状态相关。尚不清楚合并躯体疾病的哪个方面起作用：单纯疾病数量、未来发病风险或当前身体负担。
我们分析了306名双相情感障碍退伍军人协作护理随机临床试验的三年前瞻性数据。我们研究了临床结局与基线合并躯体疾病之间的关联，合并躯体疾病定义为：（1）单纯活动性疾病数量，（2）用查尔森合并症指数衡量的未来发病风险疾病，以及（3）用SF-36身体成分汇总评分（PCS）衡量的当前身体负担。双相情感障碍结局指标为发作周数、平均抑郁评分以及用SF-36精神成分汇总评分（MCS）衡量的心理健康负担变化。
这三种合并躯体疾病的测量方法相关性不高，表明每种方法都传达了新的信息。在控制潜在混杂因素后，基线PCS较差预示着三年期间平均抑郁评分显著更高（p=0.011），MCS评分改善更少（p=0.0099）。单纯疾病数量和未来发病风险并未预示更差的双相情感障碍结局。
一些潜在局限性包括未考虑所有混杂因素、参与者的选择偏倚、多次比较导致I型错误可能性增加以及研究对象主要为男性。
这项长期前瞻性研究扩展了关于躯体疾病与双相情感障碍结局之间联系的横断面和回顾性研究。导致更差双相情感障碍结局的是当前身体疾病负担的体验，而非未加权或加权的疾病数量。
