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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:

37

期数:

2020年5

页码:

475-480

栏目:

临床研究

出版日期:

2020-05-05

文章信息/Info

Title:

Clinical characteristics of obsessive-compulsive disorder and the influencing factors of prognosis

作者:

郭慧荣; 黄百灵; 王亚丽; 张延妍; 马全刚

（郑州大学第一附属医院精神医学科，河南　郑州　450052）

Author(s):

GUO Huirong; HUANG Bailing; WANG Yali; ZHANG Yanyan; MA Quangang

（Department of Psychiatry,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052，Henan Province，China)

关键词:

强迫症; 随访; 病程转归; 预后

Keywords:

obsessive-compulsive disorder; follow-up; clinical outcome; prognosis

分类号:

R749.3

DOI:

10.7683/xxyxyxb.2020.05.018

文献标志码:

A

摘要:

目的　分析强迫症患者的临床特征、预后转归及影响治疗效果的因素。方法　选择2014年1月至2015年6月于郑州大学第一附属医院精神医学科就诊的强迫症患者153例为研究对象。患者病程发展4 a后进行随访，并采用自制的一般情况调查表收集强迫症患者的临床特征、治疗过程、预后转归、病程特点等；采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、Yale-Brown强迫量表（Y-BOCS）评估患者的临床症状，并根据Y-BOCS的2个分量表Yale-Brown强迫思维量表（Y-BOS）、Yale-Brown强迫动作量表（Y-BCS）评分将患者分为强迫思维组（n=37）、强迫动作组（n=14）和混合组（n=66），根据Y-BOCS评分降分率评估3组患者的治疗效果；采用Spearman′s非参数相关、偏相关分析患者的疗效与临床特征的相关性；分析影响治疗效果的因素。结果　153例患者中，117例（76.47%）获得随访。男性患者的年龄小于女性患者（P<0.05）,男性和女性患者婚姻状况比较差异有统计学意义（P<0.05），男性患者发病年龄早于女性患者（P<0.01）。117例患者中71例（60.7%）患者发病前有一定社会心理因素，46例（39.3%）患者发病前无明显诱因；持续治疗者50例（42.7%），间断治疗者65例（55.6%），2例（1.7%）未进行过任何治疗。男性和女性患者延迟治疗时间比较差异无统计学意义（P>0.05）。强迫思维组、强迫动作组、混合组患者年龄分布、教育年限、延迟治疗时间、病程、性别、婚姻、诱因、治疗方法、治疗形式、HAMA、HAMD评分及临床疗效等方面比较差异均无统计学意义（P>0.05）；强迫思维组患者平均发病年龄早于强迫动作组和混合组（P<0.01），强迫动作组和混合组患者发病年龄比较差异无统计学意义（P>0.05）；3组患者病程形式比较差异有统计学意义（P<0.05）；强迫动作组、混合组患者Y-BOCS评分高于强迫思维组（P<0.05），强迫动作组和混合组患者Y-BOCS评分比较差异无统计学意义（P>0.05）。117例患者中治疗显效49例（41.9%），有效39例（33.3%），无效29例（24.8%）。强迫思维组、强迫动作组、混合组患者治疗显效率分别为51.35%（19/37）、35.71%(5/14)、37.88%（25/66），3组患者治疗显效率比较差异无统计学意义（χ²=5.938， P>0.05）。117例患者随访时HAMA、HAMD、Y-BOS、Y-BCS、Y-BOCS得分均显著低于入组时（P<0.01）。相关性分析结果显示，患者的临床疗效与患者性别、发病年龄、病程形式、临床分型、既往治疗方法和是否有诱发因素无关（P>0.05）；与治疗延迟时间和病程呈显著负相关（r=-0.239、-0.284，P<0.01）；与HAMA、HAMD、Y-BOCS评分减分呈显著正相关（r=0.367、0.357、0.578，P<0.01）。患者的年龄、教育年限、发病年龄、延迟治疗、病程、性别、婚姻状况、病前是否有诱发因素、治疗方法、治疗形式和临床分型与预后无关（P>0.05），HAMA、HAMD、Y-BOS、Y-BCS、Y-BOCS评分及病程形式与患者的预后有关（P<0.05）。结论　强迫症多呈慢性波动病程或持续病程，治疗效果不理想，四分之一患者治疗困难或进行性恶化；且患者治疗依从性差，连续治疗1 a以上者不足50%，需进行全病程管理。

Abstract:

Objective　To analyse the clinical characteristics and prognosis and the influencing factors of therapeutic effect of patients with obsessive-compulsive disorder (OCD).Methods　One hundred and fifty-three patients with OCD admitted to the Department of Psychiatry of the First Affiliated Hospital of Zhengzhou University were selected as the study objects.The patients were followed-up after four years;at the same time,the clinical characteristics,treatment process,prognosis and course characteristics of patients were collected by self-made general information questionnaire.The clinical symptoms of patients were evaluated by hamilton depression scale (HAMD),hamilton anxiety scale (HAMA),Yale-Brown obsessive compulsive scale (Y-BOCS);and the patients were divided into compulsive thinking group（n=37）,compulsive action group（n=14） and mixed group（n=66） according to the scores of two subscales of Y-BOCS of Yale-Brown obsessive scale (Y-BOS) and Yale-Brown compulsive scale(Y-BCS);the treatment effect of patients in the three groups was evaluated by reduction rate of Y-BOCS score.The correlation between the therapeutic effect and clinical characteristics was analysed by Spearman′s nonparametric correlation and partial correlation.Results　One hundred and seventeen(76.47%) of 153 patients were followed up.The age of male patients was lower than that of female patients (P<0.05);There was significant difference in the marriage status between the male and female patients (P<0.05);the average age of onset of male patients was earlier than that of female patients (P<0.01).Among the 117 patients,71 (60.7%) patients had certain social and psychological factors before onset,46 (39.3%) patients had no obvious inducement before onset;50 (42.7%) patients received continuous treatment,65 (55.6%) patients received intermittent treatment,and 2 (1.7%) patients not received any treatment.There was no significant difference in delayed treatment time between male and female patients (P> 0.05).There was no significant difference in age distribution,education years,delayed treatment time,course of disease,gender,marital status,inducement,treatment method,treatment form,HAMA score,HAMD score and clinical effect among the forced thinking group,forced action group and mixed group (P>0.05);the average age of onset of patiens in the forced thinking group was earlier than that in the forced action group and the mixed group (P<0.01),and there was no significant difference in the average age of onset of patients between the forced action group and the mixed group (P>0.05);there was significant difference in the course form among the three groups (P<0.05);the Y-BOCS score of patients in the forced action group and the mixed group was higher than that in the forced thinking group (P<0.05).There was no significant difference in the Y-BOCS score of patients between the forced action group and the mixed group (P>0.05).Among the 117 patients,49 (41.9%) were excellent,39 (33.3%) were effective and 29 (24.8%) were ineffective.The excellent rate of patients in compulsive thinking group,compulsive action group and mixed group was 51.35%(19/37),35.71%(5/14),37.88%(25/66) respectively;there was no significant difference in the excellent rate among the three groups (χ²　=5.938,P>0.05).The scores of HAMA,HAMD,Y-BOS,Y-BCS and Y-BOCS of 117 patients during follow up were significantly lower than those at the time of enrolling this study (P<0.01).The results of correlation analysis showed that the clinical efficacy of the patients was not related to the gender,age of onset,course form,clinical typing,previous treatment methods and whether there were induced factors (P>0.05);and the dinical efficacy was negatively related to the treatment delay time and the course of disease (r=－0.239,－0.284；P<0.01);and was positively related to the scores of HAMA,HAMD,Y-BOCS (r=0.367,0.357,0.578；P<0.01）.The age,education,age of onset,delayed treatment,the course of disease,gender,marital status,predisposing factors before onset,treatment methods,treatment forms and clinical typing were not related to prognosis (P>0.05);the HAMA,HAMD,Y-BSW,Y-BDZ,Y-BOCS scores and course form were related to prognosis (P<0.05).Conclusion　OCD is chronic fluctuating course or persistent course,and the treatment effect is not ideal，one quarter of patients are difficult to treat or progressive deterioration;and the treatment compliance of patients is poor,less than 50% of patients with more than one year of continuous treatment.So the whole course management is need to carry out.

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更新日期/Last Update: 2020-05-05