Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Int J Chron Obstruct Pulmon Dis. 2019 Oct 9;14:2331-2341. doi: 10.2147/COPD.S216746. eCollection 2019.
Depression is a major comorbidity that affects clinical outcomes in patients with chronic obstructive pulmonary disease (COPD). COPD patients with depression are hospitalized more frequently, and show more acute exacerbations, decreased physical and social activities, and higher mortality compared to their non-depressed counterparts. In the present study, we investigated the clinical impact of depressive symptoms and associated clinical factors in Korean patients with COPD by evaluating multicenter cohort data.
Patients with COPD enrolled in the Korean COPD Subtype Study, a multicenter observational study, from December 2011 to October 2014 were selected for evaluation. The initial evaluation of all patients included pulmonary function tests, 6 min walk distance (6MWD), the COPD Assessment Test (CAT), and the COPD-specific version of the St. George's Respiratory Questionnaire (SGRQ-C). Significant depression was defined as a Beck Depression Inventory-II (BDI-II) score ≥17.
Among the 270 study patients, 19.6% had significant depression. The depressed group showed a higher proportion of females (41.4%), lower body mass index (BMI), and lower education level compared to the non-depressed group ( 0.002, = 0.008, and = 0.019, respectively). The depressed group had significantly higher CAT and SGRQ-C scores, as well as a lower 6MWD, compared to the non-depressed group based on 6 month-interval serial measurements over 3 years. The total SGRQ-C score and the symptoms, activity, and impact domain scores were significant predictors of depression (area under curves [AUCs] of 0.699 [0.613-0.786], 0.670 [0.581-0.758], 0.680 [0.589-0.770], and 0.689 [0.603-0.776], respectively). From CAT score domains, sleep and energy scores were significant predictors of depression (AUCs of 0.619 [0.522-0.715] and 0.595 [0.504-0.685], respectively). SGRQ-C score, low BMI, and decreased 6MWD were significantly associated with depression in a multivariable analysis.
A considerable proportion of patients with COPD had depression, and a high SGRQ-C score, low BMI, and low 6MWD were significantly associated with depression. As improving quality of life in this subgroup is difficult, physicians should be more active in screening patients with significant depression.
抑郁是一种主要的合并症，会影响慢性阻塞性肺疾病（COPD）患者的临床结局。与无抑郁的 COPD 患者相比，有抑郁的 COPD 患者住院频率更高，急性加重次数更多，身体和社会活动减少，死亡率更高。在本研究中，我们通过评估多中心队列数据，研究了韩国 COPD 患者抑郁症状及相关临床因素的临床影响。
从 2011 年 12 月至 2014 年 10 月，选择参加韩国 COPD 亚型研究的 COPD 患者进行评估。该研究为一项多中心观察性研究。所有患者的初始评估均包括肺功能检查、6 分钟步行距离（6MWD）、COPD 评估测试（CAT）和 COPD 特异性圣乔治呼吸问卷（SGRQ-C）。采用贝克抑郁量表 II （BDI-II）评分≥17 分来定义显著抑郁。
在 270 例研究患者中，19.6%存在显著抑郁。与无抑郁组相比，抑郁组女性比例（41.4%）较高，体重指数（BMI）较低，教育程度较低（P 值均<0.002，=0.008 和=0.019）。抑郁组 CAT 和 SGRQ-C 评分明显更高，6MWD 明显更低，与无抑郁组相比，这三组数据均基于 3 年内的 6 个月间隔的系列测量结果。总的 SGRQ-C 评分和症状、活动和影响域评分是抑郁的显著预测因素（曲线下面积[AUCs]分别为 0.699[0.613-0.786]、0.670[0.581-0.758]、0.680[0.589-0.770]和 0.689[0.603-0.776]）。从 CAT 评分的各个领域来看，睡眠和能量评分是抑郁的显著预测因素（AUCs 分别为 0.619[0.522-0.715]和 0.595[0.504-0.685]）。多元分析显示，SGRQ-C 评分、低 BMI 和 6MWD 降低与抑郁显著相关。
相当一部分 COPD 患者患有抑郁症，较高的 SGRQ-C 评分、低 BMI 和低 6MWD 与抑郁症显著相关。由于改善这一亚组患者的生活质量较为困难，医生应更积极地对有显著抑郁的患者进行筛查。
