Lou Peian, Zhu Yanan, Chen Peipei, Zhang Pan, Yu Jiaxi, Wang Yong, Chen Na, Zhang Lei, Wu Hongmin, Zhao Jing
1Department of Control and Prevention of Chronic Non-Communicable Diseases, Xuzhou Center for Disease Control and Prevention , Xuzhou, Jiangsu Province, Xuzhou , China.
COPD. 2014 Aug;11(4):444-50. doi: 10.3109/15412555.2013.822856.
Depressive and anxiety symptoms increase the risk of death in patients with Chronic Obstructive Pulmonary Disease (COPD), but the combined effects of the two factors are unknown.
To assess the possible interactive effects of depressive and anxiety symptoms on the death of patients with COPD.
Prospective data for 7787 Chinese patients with COPD was analyzed and the deaths were recorded. Depressive and anxiety symptoms were evaluated using the Hospital Anxiety and Depression Scale. A product of depressive and anxiety symptoms was added to the logistic regression model to evaluate the multiplicative interaction, and relative excess risk of interaction (RERI), attributable proportion (AP) of interaction, and synergy index (S) were applied to evaluate the additive interaction of the two factors. Bootstrap was used to calculate 95% confidence intervals (CIs) of RERI, AP and S. RERI > 0, AP > 0, or S > 1 indicated biological interaction.
After 4 years' follow-up, the cumulative mortality was 20.0%, and the percentages of deaths in patients with depressive and anxiety symptoms were 28.5% and 30.9%, respectively. When adjusting for variables such as age, sex, disease duration, marital status, income, education level, co-morbidity, smoke status, biomass smoke, 6MWD, MRC, BMI and FEV1. the RERI, AP, and S (with 95% CIs) resulted in depression and anxiety scores of 6.54 (1.23-13.79), 0.54 (0.18-0.83), and 2.64 (1.33-4.75) respectively.
Interaction effects were found between depressive and anxiety symptoms on the death of patients with COPD. Patients with both depressive and anxiety symptoms have an increased risk of death from COPD.
抑郁和焦虑症状会增加慢性阻塞性肺疾病（COPD）患者的死亡风险，但这两个因素的综合影响尚不清楚。
评估抑郁和焦虑症状对COPD患者死亡的可能交互作用。
分析了7787例中国COPD患者的前瞻性数据并记录死亡情况。使用医院焦虑抑郁量表评估抑郁和焦虑症状。将抑郁和焦虑症状的乘积添加到逻辑回归模型中以评估相乘交互作用，并应用交互作用的相对超额危险度（RERI）、交互作用的归因比例（AP）和协同指数（S）来评估这两个因素的相加交互作用。采用Bootstrap法计算RERI、AP和S的95%置信区间（CI）。RERI>0、AP>0或S>1表示存在生物学交互作用。
经过4年的随访，累积死亡率为20.0%，有抑郁和焦虑症状患者的死亡率分别为28.5%和30.9%。在调整年龄、性别、病程、婚姻状况、收入、教育水平、合并症、吸烟状况、生物质烟雾、6分钟步行距离（6MWD）、医学研究委员会（MRC）呼吸困难量表、体重指数（BMI）和第1秒用力呼气容积（FEV1）等变量后，抑郁和焦虑评分的RERI、AP和S（及其95%CI）分别为6.54（1.23 - 13.79）、0.54（0.18 - 0.83）和2.64（1.33 - 4.75）。
发现抑郁和焦虑症状在COPD患者死亡方面存在交互作用。同时有抑郁和焦虑症状的患者死于COPD的风险增加。
