Martín-Santos R, Bulbena A, Porta M, Gago J, Molina L, Duró J C
Department of Psychiatry, Hospital del Mar, Barcelona, Spain.
Am J Psychiatry. 1998 Nov;155(11):1578-83. doi: 10.1176/ajp.155.11.1578.
The purpose of this study was to assess whether joint hypermobility syndrome is more frequent in patients with panic disorder, agoraphobia, or both than in control subjects and, if so, to determine whether mitral valve prolapse modifies or accounts in part for the association.
A case-control study was conducted in a general teaching hospital outpatient clinic. Subjects were 99 patients, newly diagnosed and untreated, with panic disorder, agoraphobia, or both and two groups of age- and sex-matched control subjects: 99 psychiatric patients and 64 medical patients who had never suffered from any anxiety disorder. Measures consisted of the Structured Clinical Interview for DSM-III-R, Beighton's criteria for joint hypermobility syndrome, and two-dimensional and M-mode echocardiogram. The presence of mitral valve prolapse and joint hypermobility syndrome was explored by raters who were blind to subjects' psychiatric status.
Joint hypermobility syndrome was found in 67.7% of patients with anxiety disorder but in only 10.1% of psychiatric and 12.5% of medical control subjects. On the basis of statistical analysis, patients with anxiety disorder were over 16 times more likely than control subjects to have joint laxity. These findings were not altered after the presence of mitral valve prolapse was taken into account. Of the patients with anxiety disorder, those who had joint hypermobility syndrome were younger and more often women and had an earlier onset of the disorder than those without joint hypermobility syndrome.
Joint laxity is highly prevalent in patients with panic disorder, agoraphobia, or both and may reflect a constitutional disposition to suffer from anxiety. Mitral valve prolapse plays a secondary role in the association between joint hypermobility and anxiety.
本研究旨在评估惊恐障碍、广场恐惧症或两者兼具的患者中，关节活动过度综合征是否比对照组更常见；若如此，则确定二尖瓣脱垂是否会改变或部分解释这种关联。
在一家综合教学医院门诊进行了一项病例对照研究。研究对象为99例新诊断且未接受治疗的惊恐障碍、广场恐惧症或两者兼具的患者，以及两组年龄和性别匹配的对照组：99例精神科患者和64例从未患过任何焦虑症的内科患者。测量指标包括《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）的结构化临床访谈、关节活动过度综合征的贝ighton标准，以及二维和M型超声心动图。由对受试者精神状态不知情的评估者来探究二尖瓣脱垂和关节活动过度综合征的存在情况。
焦虑症患者中67.7%存在关节活动过度综合征，而精神科对照组中仅为10.1%，内科对照组中为12.5%。基于统计分析，焦虑症患者出现关节松弛的可能性是对照组的16倍多。在考虑二尖瓣脱垂的存在后，这些发现并未改变。在焦虑症患者中，患有关节活动过度综合征的患者比未患该综合征的患者更年轻，女性更多，且疾病起病更早。
关节松弛在惊恐障碍、广场恐惧症或两者兼具的患者中非常普遍，可能反映了患焦虑症的体质倾向。二尖瓣脱垂在关节活动过度与焦虑之间的关联中起次要作用。
