共病焦虑和抑郁与慢性阻塞性肺疾病的关联
Association of comorbid anxiety and depression with chronic obstructive pulmonary disease.
作者信息
Dua Ruchi, Das Anindya, Kumar Abhishek, Kumar Sandeep, Mishra Mayank, Sharma Kapil
机构信息
Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
出版信息
Lung India. 2018 Jan-Feb;35(1):31-36. doi: 10.4103/lungindia.lungindia_537_16.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is a disease with known systemic manifestations including psychiatric comorbidities most commonly being depression and/or anxiety. Studies regarding the association of these psychiatric comorbidities in terms of symptom scores, spirometric variables, and hospitalizations among patients of COPD are lacking, especially in India.
MATERIALS AND METHODS
One hundred and twenty-eight patients of COPD attending the Outpatient Department of AIIMS Rishikesh, and fulfilling inclusion criteria were screened by Hospital Anxiety and Depression Scale, and those who scored above the cutoff underwent psychiatric evaluation using the International Classification of Diseases, Tenth Edition Diagnostic Criteria for Research for confirmation of their diagnosis. All patients were then evaluated by physician-administered questionnaire for symptom scores by Modified Medical Research Council Scale (mMRC) for dyspnea, Hindi-validated Clinical COPD Questionnaire (CCQ), and for functional capacity by 6-min walk distance (6MWD) according to the American Thoracic Society Guidelines. All patients also underwent spirometric evaluation, and postbronchodilator forced expiratory volume in 1 s (FEV1), BODE index (body mass index [BMI], postbronchodilator FEV1, mMRC for dyspnea, 6MWD) and a history of hospitalization/exacerbations over the past 1 year was also obtained. Comparison of symptom scores, functional capacity in terms of 6MWD, history of exacerbations or hospitalizations over preceding 1 year and BODE index between patients of COPD with or without anxiety and/or depression was done.
RESULTS
COPD patients with comorbid anxiety and/or depression had higher dyspnea scores and CCQ scores though the proportion of current smokers, BMI, history of hospitalization over the past 1 year, FEV1, and BODE index was not statistically significant between the two groups.
CONCLUSIONS
Depression is a common comorbidity and leads to higher symptom scores as well as poorer quality of life among COPD patients.
背景
慢性阻塞性肺疾病（COPD）是一种具有已知全身表现的疾病，包括精神共病，最常见的是抑郁和/或焦虑。关于这些精神共病在COPD患者的症状评分、肺功能变量和住院方面的关联研究尚缺，尤其是在印度。
材料与方法
对在全印医学科学研究所瑞诗凯诗分院门诊部就诊且符合纳入标准的128例COPD患者，采用医院焦虑抑郁量表进行筛查，得分高于临界值的患者使用《国际疾病分类第十版研究用诊断标准》进行精神评估以确诊。然后，所有患者通过医生填写的问卷进行评估，使用改良医学研究委员会呼吸困难量表（mMRC）评估呼吸困难症状评分、印地语验证的临床COPD问卷（CCQ），并根据美国胸科学会指南通过6分钟步行距离（6MWD）评估功能能力。所有患者还进行了肺功能评估，并获取了支气管扩张剂后1秒用力呼气量（FEV1）、BODE指数（体重指数[BMI]、支气管扩张剂后FEV1、呼吸困难mMRC、6MWD）以及过去1年的住院/病情加重史。对有或无焦虑和/或抑郁的COPD患者之间的症状评分、6MWD功能能力、前1年病情加重或住院史以及BODE指数进行了比较。
结果
合并焦虑和/或抑郁的COPD患者呼吸困难评分和CCQ评分较高，尽管两组之间当前吸烟者比例、BMI、过去1年住院史、FEV1和BODE指数无统计学差异。
结论
抑郁是常见的共病，会导致COPD患者症状评分更高以及生活质量更差。
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