中文摘要：

目的探讨双相障碍首次抑郁发作使用SSRI类抗抑郁剂治疗后,出现自杀风险的相关因素。方法回顾性记录177例以抑郁发作为首次发作形式的双相抑郁障碍患者人口学资料和临床特征,并比较它们在没有出现自杀组和出现自杀组之间的差异,采用逐步Logistic回归方法进行分析,受试者工作特征曲线（ROC）与Hosmer-Lemeshow分别评估危险因素模型的准确度和拟合优度。结果没有出现自杀风险患者154例,出现自杀风险患者23例。出现自杀风险的患者组中饮酒史、心境障碍家族史、有易激惹症状、绝望感和伴随精神病性症状的比例高于未出现自杀风险的患者组（均P〈0.05）。进一步回归分析显示,使用SSRI类抗抑郁剂治疗而导致自杀风险的相关因素为：易激惹（OR=4.04,95%CI：1.40～11.67,P〈0.05）,有精神病性症状（OR=6.23,95%CI：1.41～27.56,P〈0.05）。ROC为0.71。Hosmer-Lemeshow为0.58。结论易激惹症状、精神病性症状是双相障碍首次抑郁发作予SSRI治疗出现自杀风险的潜在预测因素。

英文摘要：

Objective To explore the factors associated with occurrence of suicidal risk after treatment of selective serotonin reuptake inhibitor（SSRI） in bipolar disorder with their first depressive episode.Methods One hundred and seventy seven bipolar patients were enrolled in this retrospective study.Demographic and clinic features between non-occurrence of suicidal risk group and occurrence of suicidal risk group were compared.Stepwise Logistic regression model was used to identify the associated factors.Concordance statistics（i.e.the area under the ROC curve） was used to compute the discrimination of the associated factors,and Hosmer-Lemeshow goodness-of-fit statistic was used to measure the goodness-of-fit.Results One hundred and fifty four patients were included in non-occurrence of suicidal risk group,while twenty three were included in occurrence of suicidal risk group.Compared with non-occurrence of suicidal risk group,the rates of drinking,family history of mood disorder,symptom of irritability,feeling of despair and psychotic symptom were higher in occurrence of suicidal risk group（all P 0.05）.Clinical features associated with occurrence of suicidal risk after treatment of SSRI in bipolar disorder were as follows： symptom of irritability（OR = 4.04,95%CI：1.40 ～ 11.67,P 0.05） and psychotic symptom（OR = 6.23,95%CI：1.40 ～ 27.56,P 0.05）.Concordance statistics was 0.71 and Hosmer-Lemeshow was 0.58.Conclusion This study has demonstrated that psychotic symptom and symptom of irritability are associated with occurrence of suicidal risk after treatment of SSRI in bipolar disorder,which suggests that these two symptoms might be the predictors of occurrence of suicidal risk in patients with first depressive episode after treatment of SSRI.