Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Respir Med. 2022 Sep;201:106895. doi: 10.1016/j.rmed.2022.106895. Epub 2022 May 31.
Depression is a common and important comorbidity in patients with chronic obstructive pulmonary disease (COPD). Depressive status is associated with a high COPD assessment test (CAT) total score, but it is difficult to distinguish patients with depression from those with severe symptomatic COPD. We hypothesized that a non-respiratory symptom-dominant elevation in CAT score is associated with depression in patients with COPD.
A total of 226 patients in the KYOTO cohort in Japan and 924 patients in the Korea COPD Subgroup Study (KOCOSS) cohort in the Republic of Korea were analyzed. Depression was diagnosed based on a PHQ-9 (patient health questionnaire-9) ≥5 in the KYOTO cohort and a BDI-II (Beck Depression Inventory-II) ≥17 in the KOCOSS cohort. Sums of respiratory symptoms (Q1-Q4; Q1234) and non-respiratory symptoms (Q5-Q8; Q5678) from CAT items were analyzed.
Fifty-three (23.5%) patients in the KYOTO cohort and 111 (11.2%) patients in the KOCOSS cohort were identified as having depression. Fifty-five patients (24.3%) in the KYOTO cohort and 249 patients (26.9%) in the KOCOSS cohort showed non-respiratory symptom dominance (Q1234 ≤ Q5678), and they had a significantly higher prevalence of depression than did patients with respiratory symptom dominance (Q1234 > Q5678). Multivariable logistic regression analysis showed that both the CAT total score and Q1234 ≤ Q5678 were significantly associated with depression in both cohorts. Moreover, even in symptomatic patients (CAT total score ≥10), these significant associations were preserved.
Non-respiratory symptom dominance in CAT is a suspicious feature for depression in patients with COPD.
抑郁症是慢性阻塞性肺疾病（COPD）患者常见且重要的合并症。抑郁状态与 COPD 评估测试（CAT）总分较高相关，但难以将抑郁症患者与 COPD 中症状严重的患者区分开来。我们假设 CAT 评分中以非呼吸系统症状为主的升高与 COPD 患者的抑郁有关。
分析了来自日本 KYOTO 队列的 226 例患者和来自大韩民国 COPD 亚组研究（KOCOSS）队列的 924 例患者。在 KYOTO 队列中，根据 PHQ-9（患者健康问卷-9）≥5 诊断为抑郁症，在 KOCOSS 队列中，根据 BDI-II（贝克抑郁量表-2）≥17 诊断为抑郁症。对 CAT 项目中的呼吸症状（Q1-Q4；Q1234）和非呼吸症状（Q5-Q8；Q5678）的总和进行了分析。
KYOTO 队列中有 53 例（23.5%）患者和 KOCOSS 队列中有 111 例（11.2%）患者被诊断为患有抑郁症。KYOTO 队列中有 55 例（24.3%）患者和 KOCOSS 队列中有 249 例（26.9%）患者表现出非呼吸系统症状为主（Q1234≤Q5678），且他们的抑郁患病率显著高于以呼吸系统症状为主（Q1234＞Q5678）的患者。多变量逻辑回归分析表明，在两个队列中，CAT 总分和 Q1234≤Q5678 均与抑郁症显著相关。此外，即使在有症状的患者（CAT 总分≥10）中，这些显著关联仍然存在。
CAT 中的非呼吸系统症状为主是 COPD 患者抑郁的可疑特征。
