本文選題：糖尿病足　切入點(diǎn)：住院病人　出處：《中國(guó)全科醫(yī)學(xué)》2016年28期

【摘要】：目的評(píng)價(jià)病人健康問卷抑郁自評(píng)量表(PHQ-9)在住院糖尿病足潰瘍患者中應(yīng)用的信效度。方法選取2014年8月—2015年6月在廣州市某三甲醫(yī)院內(nèi)分泌科住院治療的糖尿病足潰瘍患者120例。采用自行設(shè)計(jì)的一般資料調(diào)查表收集患者的一般資料;采用PHQ-9評(píng)價(jià)患者的抑郁情況,并對(duì)量表進(jìn)行信效度檢驗(yàn),包括內(nèi)容效度、結(jié)構(gòu)效度、已知族群效度、內(nèi)部一致性及重測(cè)信度;采用美國(guó)《精神障礙診斷與統(tǒng)計(jì)手冊(cè)(4版)》(DSM-IV)臨床定式訪談(SCID)抑郁量表對(duì)PHQ-9的評(píng)價(jià)結(jié)果進(jìn)行驗(yàn)證,并確定重性抑郁的診斷臨界值。結(jié)果 PHQ-9共包括9個(gè)條目,各條目?jī)?nèi)容效度指數(shù)(I-CVI)分別為1.00、1.00、1.00、0.83、1.00、1.00、0.83、1.00、1.00,總量表內(nèi)容效度指數(shù)(S-CVI)為0.96。PHQ-9的平均總得分為(11.7±6.4)分,Pearson相關(guān)分析結(jié)果顯示,各條目得分與量表總得分間均呈線性正相關(guān)(P0.05)。因子分析共獲得2個(gè)公因子,分別為認(rèn)知-情感因子、軀體癥狀因子,可共同解釋量表62.1%的變異量。不同性別、家庭人均月收入、自理能力、Wagner分級(jí)、足潰瘍疼痛評(píng)分(NRS)以及有無截肢/趾史或風(fēng)險(xiǎn)患者的認(rèn)知-情感維度得分比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);不同自理能力、足潰瘍NRS以及有無截肢/趾史或風(fēng)險(xiǎn)患者的軀體癥狀維度得分比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)�？偭勘�、認(rèn)知-情感維度、軀體癥狀維度的Cronbach'sα系數(shù)分別為0.88、0.86、0.70,重測(cè)信度分別為0.87、0.89、0.83。受試者工作特征(ROC)曲線顯示,PHQ-9用于篩查住院糖尿病足潰瘍患者抑郁情況有統(tǒng)計(jì)學(xué)意義〔曲線下面積(AUC)=0.914,95%CI(0.862,0.967),P0.05〕,10分為重性抑郁的診斷臨界值,靈敏度為0.928、特異度為0.804。結(jié)論P(yáng)HQ-9在住院糖尿病足潰瘍患者中應(yīng)用的信效度較好,10分為重性抑郁的診斷臨界值,靈敏度和特異度均較高,建議應(yīng)用于住院糖尿病足潰瘍患者的抑郁篩查。
[Abstract]:Objective to evaluate the reliability and validity of self-rating depression scale (PHQ-9) in patients with diabetic foot ulcer. Methods Diabetic foot was selected from August 2014 to June 2015 in Department of Endocrinology, a third Class Hospital in Guangzhou. 120 patients with ulcers were collected by self-designed general information questionnaire. PHQ-9 was used to evaluate the depression of the patients, and the reliability and validity of the scale were tested, including content validity, structural validity, known population validity, internal consistency and test-retest reliability. The evaluation results of PHQ-9 were verified by using PHQ-9 depression scale with DSM-IVD depression scale, and the critical value of diagnosis of severe depression was determined. Results PHQ-9 included 9 items. The content validity index (I-CVI) of each item was 1.00 / 1.001.00 / 0.83 / 1.00 / 1.001.00 respectively, and the content validity index (S-CVI) of the total table was an average total score of 0.96.PHQ-9 (11.7 鹵6.4). The results of Pearson correlation analysis showed that, There was a linear positive correlation between the scores of each item and the total score of the scale (P 0.05). Two common factors were obtained by factor analysis, which were cognitive-affective factor and somatic symptom factor, which could explain the variation of 62.1% of the scale. The scores of cognitive and affective dimensions of patients with self-care ability, foot ulcer pain score (NRSs) and those with or without amputation / toe history or risk were significantly different (P 0.05). The scores of NRS and somatic symptoms in patients with foot ulcers with or without amputation / toe history or risk were statistically significant (P 0.05). The Cronbach's 偽 coefficient of somatic symptom dimension was 0.88 / 0.86 / 0.70, and the test-retest reliability was 0.870.89 / 0.83 respectively. The test results showed that PHQ-9 was used to screen depression in hospitalized diabetic foot ulcer patients with statistical significance (the area under the curve was 0.8620.967C 0.8620.967g / 10). Diagnostic threshold for depression, The sensitivity was 0.928 and the specificity was 0.804.Conclusion the reliability and validity of PHQ-9 in patients with diabetic foot ulcer is better than that in patients with severe depression. It is suggested that it should be applied to the screening of depression in patients with diabetic foot ulcer.
【作者單位】： 南方醫(yī)科大學(xué)南方醫(yī)院護(hù)理部;南方醫(yī)科大學(xué)南方醫(yī)院內(nèi)分泌科;
【分類號(hào)】：R587.2

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