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ENGLISH ABSTRACT
强迫症临床特征对药物疗效的影响
王佩
许婷婷
赵青
范青
王勇
刘强
王振
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1006-7884.2018.05.004
The clinical features of obsessive-compulsive disorder and its impact on pharmacotherapeutic effect
Wang Pei
Xu Tingting
Zhao Qing
Fan Qing
Wang Yong
Liu Qiang
Wang Zhen
Authors Info & Affiliations
Wang Pei
Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China
Xu Tingting
Zhao Qing
Fan Qing
Wang Yong
Liu Qiang
Wang Zhen
·
DOI： 10.3760/cma.j.issn.1006-7884.2018.05.004
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摘要

目的探讨强迫症患者的临床特征对药物疗效的影响。

方法选取符合DSM-Ⅳ中强迫症诊断标准的87例强迫症患者进行评估，采用Y-BOCS评估强迫症状严重程度，强迫症状分类量表修订版（Obsessive-Compulsive Inventory-Revised, OCI-R）评估对强迫症状的痛苦感受，贝克抑郁量表第2版、贝克焦虑量表评估抑郁、焦虑症状，儿童期创伤经历问卷评估儿童期创伤水平，并进行为期16周的药物治疗随访，以Y-BOCS减分率评估治疗是否有效。采用Pearson相关分析临床特征与疗效的相关关系，并采用二分类Logistic进行逐步回归分析。

结果总体治疗有效率为65.3%（47/72），晚发强迫症患者（ n=47）OCI-R中检查评分高于早发强迫症患者[ n=40，（6.3±3.7）分与（3.7±3.3）分； t=-2.50， P=0.016]，高创伤强迫症患者（ n=52）的OCI-R中强迫思维评分以及贝克抑郁量表第2版评分均高于低创伤强迫症患者[ n=23，（6.8±3.3）分与（4.5±3.5）分， t=-2.14， P=0.038；（23.8±12.1）分与（15.6±5.8）分， t=-3.08, P=0.003]。强迫症患者的首次发病年龄与Y-BOCS减分率呈正相关（ r=0.25, P<0.05）。Logistic逐步回归分析显示,首次发病年龄进入回归方程（ OR=1.15， P<0.05）。

结论强迫症患者的童年创伤经历越多，强迫思维越严重，首次发病年龄越早，疗效越差。

强迫性障碍;首次发病年龄;治疗结果;童年创伤;疗效
ABSTRACT

ObjectiveTo explore the relation of clinical characteristics and drug therapeutic effect in patients with obsessive-compulsive disorder (OCD).

MethodsTotally 87 patients meeting the DSM-Ⅳ criteria for OCD were recruited. They were assessed with the Y-BOCS and Obsessive-Compulsive Inventory-Revised (OCI-R) to evaluate the degree of obsessive-compulsive symptoms and distress, and Beck Depression Inventor-Ⅱ and Beck Anxiety Inventory to evaluate the degree of depression and anxiety, Childhood Trauma Questionnaire was used to measure the childhood trauma, and the patients were arranged to complete the follow-up of 16 weeks, the reductive rate of Y-BOCS was used to assess efficacy. Pearson correlation and binary logistic stepwise regression were used to analysis the relationship between clinical characteristics and therapeutic effect.

ResultsThe total effective rate of treatment was 65.3% (47/27). Compared with early-onset OCD patients ( n=40), late-onset OCD patients ( n=47) showed higher checking scores of OCI-R (3.7±3.3 vs.6.3±3.7; t=-2.50, P<0.05). Higher-trauma OCD patients ( n=52) scored higher than lower-trauma OCD patients ( n=23) in obsession and Beck Depression Inventor-Ⅱ scores (6.8±3.3 vs.4.5±3.5, t=-2.14, P=0.038; 23.8±12.1 vs. 15.6±5.8, t=-3.08, P=0.003) . The age at onset of OCD was positively correlated with the reductive rate of Y-BOCS ( r=0.25, P<0.05) . Logistic regression analysis reported that age of onset entered into the regression model ( OR=1.15, P<0.05) .

ConclusionsIt suggests that OCD patients with more childhood trauma experience may exhibit more severe obsession, and those with earlier age of onset may exhibit the worse therapeutic effect.

Obsessive-compulsive disorder;Age of onset;Treatment outcome;Childhood trauma;Therapeutic effect
Liu Qiang, Email: mocdef.3ab6191169710731
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引用本文

王佩,许婷婷,赵青,等. 强迫症临床特征对药物疗效的影响[J]. 中华精神科杂志,2018,51(5)：298-303.

DOI:10.3760/cma.j.issn.1006-7884.2018.05.004

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强迫症（obsessive-compulsive disorder, OCD）是一种常见的难治性精神疾病，以侵入性的强迫思维以及重复性的强迫行为主要临床特征。强迫症的终身患病率为2%~3%，给患者家庭及社会带来了沉重负担，然而目前强迫症的病因病理机制尚未完全清楚 [ 1 ]。已有研究表明不同发病年龄以及创伤水平等临床特征与强迫症状严重程度等紧密相关 [ 2 , 3 , 4 ]。有研究显示相比晚发性强迫症患者，早发性强迫症患者具有更多的精神障碍阳性家族史、病程更长等特点，这进一步提示强迫症是一种异质性较大的疾病 [ 5 ]，而以发病年龄区分强迫症的临床亚型可能更有助于减少异质性。童年创伤经历主要包括个体在童年期遭受的躯体、情感以及性等方面的创伤，研究显示其可显著增加多种精神障碍如强迫症、社交障碍、边缘人格障碍等的患病风险 [ 6 , 7 ]。Mathews等 [ 8 ]研究发现童年创伤经历特别是情感虐待、躯体忽视与强迫症状的严重程度密切相关。基于既往研究结果，我们旨在进一步探索强迫症患者的发病年龄、创伤水平等临床特征对药物疗效的影响。
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备注信息
A
刘强，Email: mocdef.3ab6191169710731
B
国家自然科学基金面上项目 (81671340)
上海市教育委员会高峰高原学科建设计划 (20161321)
上海市市级医疗卫生优秀学科带头人培养计划 (2017BR058)
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