中医杂志

目的 基于现代心理症状网络探讨双相情感障碍（BD）患者情绪症状四时阴阳的消长变化特征。方法 回顾性收集3445例BD患者的临床资料，按入院时间分为生发期组（3月至8月）与收藏期组（9月至次年2月）。以汉密尔顿抑郁量表中抑郁情绪、工作和兴趣下降、绝望感、能力减退感、入睡困难、睡眠不安、自杀7项条目及Young躁狂量表中情绪高涨、行为活动/精力增加、易激惹3项，共10个条目为症状节点，采用EBICglasso模型构建生发期组与收藏期组的情绪症状网络。使用网络比较测试（NCT）比较两组患者情绪症状网络的结构不变性（M）、网络全局强度不变性（S）及节点中心性差异。结果 3445例患者中生发期组1604例，收藏期组1841例。在倾向评分逆概率加权（IPTW）平衡入院年份、入院方式与发作类型等协变量后，生发期组与收藏期组BD患者的情绪症状网络总体结构相似，均呈现由躁狂相关症状和抑郁相关症状构成双簇分布。网络结构差异无统计学意义（M=0.103,P=0.181）。生发期组全局强度（4.168）略高于收藏期组（3.901），但差异无统计学意义（S=0.267,P=0.052），提示在四时气机升降的背景下，网络整体连通性总体保持稳定。节点中心性分析表明，抑郁情绪、行为活动/精力增加为两期共同的核心节点。方向性上，生发期组中入睡困难、兴趣下降、易激惹及行为活动等节点的强度呈轻度上升趋势，而收藏期组中自杀节点的强度略高，但差异均无统计学意义（P>0.05）。结论 BD患者生发期与收藏期的情绪症状网络总体稳定，四时背景可能仅引起部分症状中心性的轻微波动，却不足以重构整体网络。

Objective To explore the seasonal yin-yang waxing and waning characteristics of emotional symptoms in patients with bipolar disorder(BD) based on modern psychological symptom networks.Methods Clinical data of 3445 patients with BD were retrospectively collected and divided into a growth phase group(March to August) and a storage phase group(September to February of the following year) according to admission time.Ten symptom nodes were selected,including seven items from the Hamilton Depression Rating Scale(depressed mood,decreased work and interest,feelings of hopelessness,feelings of incapacity,difficulty falling asleep,restless sleep,and suicidal ideation) and three items from the Young Mania Rating Scale(elevated mood,increased activity/energy,and irritability).The emotional symptom networks of the growth phase group and storage phase group were constructed using the EBICglasso model.Network comparison test(NCT) was used to compare network structural invariance(M),global network strength invariance(S),and differences in node centrality between the two groups.Results Among the 3445 patients,1604 were in the growth phase group and 1841 were in the storage phase group.After balancing covariates including admission year,admission mode,and episode type using inverse probability of treatment weighting(IPTW),the emotional symptom networks of BD patients in the growth phase and storage phase groups showed similar overall structures,both presenting a two-cluster distribution composed of manic-related and depressive-related symptoms.No statistically significant difference was observed in network structure(M=0.103,P=0.181).The global strength of the growth phase group(4.168) was slightly higher than 3.901 of the storage phase group,with no statistically significant difference(S=0.267,P=0.052),suggesting that overall network connectivity remained relatively stable under the influence of seasonal qi dynamics.Node centrality analysis showed that depressed mood and increased activity/energy were common core nodes in both phases.Regarding directional changes,the strength of nodes including difficulty falling asleep,decreased interest,irritability,and increased activity showed a slight upward trend in the growth phase group,whereas the strength of suicidal ideation was slightly higher in the storage phase group; however,none of these differences reached statistical significance(P>0.05).Conclusion The emotional symptom networks of BD patients remained generally stable between the growth and storage phases.Seasonal variations may induce only slight fluctuations in the centrality of certain symptoms but are insufficient to reconstruct the overall symptom network.