家庭因素对精神分裂症患者复发的影响及预测价值研究-现代医学

家庭因素对精神分裂症患者复发的影响及预测价值研究

单位：南京医科大学附属脑科医院精神二科620病区, 江苏南京 210029

分类号：R749.3

出版年·卷·期（页码）：2026·54·第七期（1055-1063）

摘要：

目的：探讨家庭功能、情感表达及照顾者负担对精神分裂症患者疾病复发的影响，识别复发相关的危险因素，构建复发风险预测模型。方法：选取2020年1月至2022年6月于本院精神科住院治疗后出院的精神分裂症患者300例为研究对象，根据出院后3年内的复发情况分为复发组(n=108)和稳定组(n=192)。采用家庭环境量表中文版(FES-CV)、家庭情感表达问卷(FEE)、照顾者负担量表(ZBI)及自编一般资料调查表开展资料收集与评估。单因素及多因素Logistic回归分析精神分裂症复发的影响因素，并基于回归结果构建预测模型。采用1 000次Bootstrap重抽样完成内部验证，校准曲线及Hosmer-Lemeshow拟合优度检验评价模型校准度，以受试者工作特征(ROC)曲线下面积(AUC)评价模型区分度。结果：300例患者中复发108例，复发率为36.0%。多因素Logistic回归分析显示，高家庭矛盾性(OR=2.337，95%CI：1.527~3.575)、高批评性情感表达(OR=2.100，95%CI：1.372~3.214)、照顾者重度负担(OR=3.013，95%CI：1.868~4.861)及服药不依从(OR=2.869，95%CI：1.893~4.348)是精神分裂症复发的独立危险因素(均P<0.01)。基于上述4项指标构建的预测模型AUC为0.974(95%CI：0.960~0.989)，约登指数最大值为0.82，灵敏度为0.90，特异度为0.92；经Bootstrap内部验证后偏倚校正AUC为0.966(95%CI：0.952~0.980)。校准曲线显示预测概率与实际观测概率一致性良好，提示模型具有优异的区分度与良好的校准度。结论：高家庭矛盾性、高批评性情感表达、照顾者重度负担等不良家庭因素会显著升高精神分裂症患者的复发风险。基于家庭因素与服药依从性构建的复发风险预测模型具有良好的预测效能，可为临床早期识别高风险患者及实施分层家庭干预提供量化工具。

Objective: To explore the effects of family function, emotional expression and caregiver burden on relapse in patients with schizophrenia, identify the risk factors associated with relapse, and establish a risk prediction model for disease recurrence. Methods: A total of 300 patients with schizophrenia who were discharged after hospitalization in the psychiatry department of our hospital between January 2020 and June 2022 were enrolled. According to the relapse status within 3 years after discharge, the patients were divided into the relapse group(n=108) and the stable group(n=192). The Chinese Version of Family Environment Scale(FES-CV), Family Emotional Expression Questionnaire(FEE), Zarit Burden Interview(ZBI) and a self-designed general information questionnaire were used for data collection and assessment. Univariate analysis and multivariate Logistic regression were performed to screen the influencing factors of schizophrenia relapse, and a prediction model was established based on the regression results. Bootstrap resampling with 1 000 iterations was conducted for internal validation. The calibration curve and Hosmer-Lemeshow goodness-of-fit test were adopted to evaluate model calibration, and the area under the receiver operating characteristic(ROC) curve(AUC) was used to assess model discrimination. Results: Among the 300 enrolled patients, 108 cases experienced relapse, with a relapse rate of 36.0%. Multivariate Logistic regression analysis indicated that high family conflict(OR=2.337, 95%CI：1.527-3.575), highly critical emotional expression(OR=2.100, 95%CI：1.372-3.214), severe caregiver burden(OR=3.013, 95%CI：1.868-4.861) and poor medication adherence(OR=2.869, 95%CI：1.893-4.348) were independent risk factors for schizophrenia relapse(all P<0.01). The AUC of the prediction model constructed based on the above four indicators was 0.974(95%CI：0.960-0.989), with a maximum Youden's index of 0.82, a sensitivity of 0.90 and a specificity of 0.92. The bias-corrected AUC after Bootstrap internal validation was 0.966(95%CI：0.952-0.980). The calibration curve showed good consistency between predicted probability and observed probability, suggesting that the model had excellent discrimination and favorable calibration. Conclusion: Adverse family factors including high family conflict, highly critical emotional expression and severe caregiver burden significantly increase the relapse risk of patients with schizophrenia. The relapse risk prediction model established based on family factors and medication adherence presents satisfactory predictive performance, which can serve as a quantitative tool for early identification of high-risk patients and implementation of stratified family interventions in clinical practice.

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