风湿性疾病患者焦虑-抑郁谱系障碍的比较分析

Comparative analysis of anxiety-depressive spectrum disorders in patients with rheumatic diseases.

作者信息

Lisitsyna T A, Veltishchev D Yu, Seravina O F, Kovalevskaya O B, Starovoytova M N, Desinova O V, Abramkin A A, Ovcharov P S, Vasil'ev V I, Alekberova Z S, Krasnov V N, Nasonov E L

机构信息

Federal State Budgetary Scientific Institution «Research Institute of Rheumatology named after V.A. Nasonova», Moscow, Russia.

Moscow Research Institute of Psychiatry, Branch «National Medical Research Center of Psychiatry and Narcology» Ministry of Health of Russia, Moscow, Russia.

出版信息

Ter Arkh. 2018 May 11;90(5):30-37. doi: 10.26442/terarkh201890530-37.

DOI:10.26442/terarkh201890530-37

PMID:30701894

Abstract

AIM

Research objective - comparative analysis of incidence and structure of anxiety-depressive spectrum disorders (ADD) in patients with various rheumatic diseases (RD).

MATERIALS AND METHODS

613 patients with RD were enrolled in the study: 180 with a reliable diagnosis of systemic lupus erythematosus (SLE), 128 with rheumatoid arthritis (RA), 110 with systemic sclerosis (SSc), 115 with Behcet's disease (BD), 80 with primary Sjögren's syndrome (pSS). Female prevailed in all groups (95% of patients with pSS, 88,2% - SSc, 87,2% - RA, 85,5% of SLE) except BD patients (70% male). The mean age was 42.3±1.54 years and was lower in patients with BD (33.3±0.98 years) and SLE (34.6±0.93 years) compared to patients with SSc (49.9±2.47 years), RA (47.4±0.99 years) and pSS (46.2±2.3 years). The mean RD duration was 130,0±8,65 months and was more at BD - 148,5±10,4 months, pSS - 141,6±8,92 months, RA - 138,4±10,1months, and less at SLE - 134,9±8,8 months and SSc - 87,0±5,04 months. The mean SLE activity index SLEDAI was 9,13±0,63 points (high), RA (DAS28) - 5,26±0,17 points (high), BD (BDCAF) - 3,79±0,2 points (moderate) and SSc by G. Valentini - 1,1±0,20 points (moderate). Glucocorticoids took 100% of patients with pSS, 91,1% - SLE, 90% - SSc, 87% - BD and 67,2% - RA patients; conventional disease modifying anti-rheumatic drugs (cDMARDs) took 90% of patients with SSc, 84% - BD, 79,6% - RA, 68% - pSS, 40,6% - SLE. Biologic DMARDs took 32% of patients with RA, 17,4% - BD, 7,3% - SSc and 7,2% - SLE. Mental disorders were diagnosed by psychiatrist as a result of screening by the hospital anxiety and depression scale (HADS) and in semi-structured interview in accordance with the ICD-10/ DSM-IV. The severity of depression was evaluated by Montgomery-Asberg Depression Rating Scale (MADRS) and anxiety - by Hamilton Anxiety Rating Scale (HAM-A). Projective psychological methods were used for cognitive impairment detection.

RESULTS

Screening of depressive disorders (HADS-D≥8) was positive in 180 (29,4%) patients with RD, including 74 (41%) patients with SLE, 38 (35%) - SSc, 29 (23%) - RA, 23 (20%) - BD and 16 (20%) - pSS; anxiety disorders (HADS-A≥8) - in 272 (44,4%) patients, including 66 (52%) patients with RA, 40 (50%) - pSS, 77 (43%) - SLE, 45 (41%) - SSc and 44 (38%) - BD. In accordance with the ICD-10/ DSM-IV depressive disorders have been identified in 389 (63%) patients, including 94 (73%) patients with RA, 71 (64,5%) - SSc, 69 (60%) - BD, 90 (50%) - SLE and 39 (49%) - pSS; anxiety disorders - in 377 (61,5%) patients, including 20 (25%) patients with pSS, 44 (24,5%) - SLE, 29 (23%) - RA, 20 (17%) - BD and 7 (6,4%) - SSc.

CONCLUSION

Anxiety-depressive spectrum disorders are typical for most patients with RA, SLE, SSc, pSS and BD. ADDs diagnosis in RD patients with the use of the HADS did not reveal a significant proportion. To obtain objective data on the frequency and structure of ADDs, psychopathological and clinical psychological diagnosis is necessary.

摘要

目的

研究目标——比较分析各类风湿性疾病（RD）患者焦虑抑郁谱系障碍（ADD）的发病率及构成。

材料与方法

613例RD患者纳入本研究：180例确诊为系统性红斑狼疮（SLE），128例类风湿关节炎（RA），110例系统性硬化症（SSc），115例白塞病（BD），80例原发性干燥综合征（pSS）。除BD患者（男性占70%）外，所有组女性居多（pSS患者中女性占95%，SSc患者中占88.2%，RA患者中占87.2%，SLE患者中占85.5%）。平均年龄为42.3±1.54岁，BD患者（33.3±0.98岁）和SLE患者（34.6±0.93岁）的平均年龄低于SSc患者（49.9±2.47岁）、RA患者（47.4±0.99岁）和pSS患者（46.2±2.3岁）。RD的平均病程为130.0±8.65个月，BD患者病程更长——148.5±10.4个月，pSS患者——141.6±8.92个月，RA患者——138.4±10.1个月，SLE患者病程较短——134.9±8.8个月，SSc患者——87.0±5.04个月。SLE平均活动指数SLEDAI为9.13±0.63分（高），RA（DAS28）——5.26±0.17分（高），BD（BDCAF）——3.79±0.2分（中度），G. Valentini评估的SSc为1.1±0.20分（中度）。100%的pSS患者、91.1%的SLE患者、90%的SSc患者、87%的BD患者和67.2%的RA患者使用糖皮质激素；90%的SSc患者、84%的BD患者、79.6%的RA患者、68%的pSS患者、40.6%的SLE患者使用传统改善病情抗风湿药物（cDMARDs）。32%的RA患者、17.4%的BD患者、7.3%的SSc患者和7.2%的SLE患者使用生物DMARDs。通过医院焦虑抑郁量表（HADS）筛查及根据ICD - 10/DSM - IV进行半结构化访谈，由精神科医生诊断精神障碍。采用蒙哥马利 - 阿斯伯格抑郁评定量表（MADRS）评估抑郁严重程度，采用汉密尔顿焦虑评定量表（HAM - A）评估焦虑程度。采用投射性心理方法检测认知障碍。

结果

RD患者中，180例（29.4%）筛查出抑郁障碍（HADS - D≥8），其中SLE患者74例（41%），SSc患者38例（35%），RA患者29例（23%），BD患者23例（20%），pSS患者16例（20%）；272例（44.4%）患者筛查出焦虑障碍（HADS - A≥8），其中RA患者66例（52%），pSS患者40例（50%），SLE患者77例（43%），SSc患者45例（41%），BD患者44例（38%）。根据ICD - 10/DSM - IV，389例（63%）患者确诊为抑郁障碍；其中RA患者94例（73%），SSc患者71例（64.5%），BD患者69例（60%），SLE患者90例（50%），pSS患者39例（49%）；377例（61.5%）患者确诊为焦虑障碍，其中pSS患者20例（25%），SLE患者44例（24.5%），RA患者29例（23%），BD患者20例（17%），SSc患者7例（6.4%）。