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目的 验证双极性指标对重性抑郁发作(major depressive episode,MDE)患者中双相障碍(bipolar disorder,BD)和双相Ⅱ型障碍(bipolar disorder typeⅡ,BDⅡ)的识别效能.方法 采用多中心、横断面诊断性研究,2008年3月至9月在20家精神专科医院连续性收录727例MDE患者,采用双极性指标、《美国精神障碍诊断与统计手册(第4版)》修改版(DSM-Ⅳ-TR)标准和临床诊断进行BD或BDⅡ筛查,比较二者筛检率,采用多因素回归分析分析BD相关危险因素.结果 双极性指标、DSM-Ⅳ-TR标准和临床诊断对MDE患者中BD检出率分别为39.9％(290/727)、14.4％(105/727)和31.9％ (232/727),对BDⅡ检出率分别为30.8％(192/623)、9.5％(59/623)和20.5％(128/623).与DSM-Ⅳ-TR标准相比,双极性指标筛检BD具备较高的灵敏度和特异度(100.0％和70.3％)；与临床诊断相比,双极性指标筛检BDⅡ具备良好的灵敏度和特异度(85.9％和83.4％),较低的误诊率和漏诊率.双极性指标筛查BD阳性者共病边缘型人格障碍或焦虑障碍比例高于筛查阴性者.多因素回归分析显示,双极性指标识别BD的临床标记中,既往抗抑郁疗效转(轻)躁狂(OR=4.66)和抗抑郁治疗中出现情感发作(OR=3.68)为BD的高危因素；双极性指标和DSM-Ⅳ-TR标准识别BD的相同临床标记中,一级亲属存在躁狂或轻躁狂史(OR =3.58)、病程完全缓解(OR=2.54)和以往抗抑郁治疗出现易激惹(OR =2.40)为BD高危因素(均P＜0.01).结论 初步证实双极性指标在MDE患者中筛检BD或BDⅡ型的识别效能良好,对BD亚类区分具有一定临床意义.“,”Objective To validate the recognition efficacy of bipolar disorders (BD) and BD type Ⅱ (BD Ⅱ) under bipolarity specifier among patients with major depressive episode(MDE).Methods This is a multi-site,cross-sectional diagnostic study.727 consecutive subjects with major depressive episode (MDE) were screened for BD and BD Ⅱ under the bipolarity specifier,the DSM-Ⅳ-TR criteria and the clinical known diagnosis criteria at 20 psychiatric hospitals between March and September 2008,to compare the BD recognition rate and analyze factors related with BD using multi-factors regression analysis.Results Screened positive BD were 39.9％,14.4％ and 31.9％ under bipolarity specifier,DSM-Ⅳ-TR and clinical known diagnosis criteria,while screened positive BD Ⅱ were 30.8％,9.5％ and 20.5％ respectively.Compared with DSM-Ⅳ-TR,bipolarity specifier screened BD with relatively high sensitivity and specificity (100％ and 70.3％); while compared with clinical known diagnosis criteria,bipolarity specifier screened BD Ⅱ with very good sensitivity and specificity (85.9％ and 83.4％),plus relatively low under-diagnosis and over-diagnosis rate.Screened positive BD under bipolarity specifier combined with higher rate of borderline personality disorder (BPD)/anxiety disorder compared with negative ones.Multi-factors regression analysis found the OR value of two variables including switching during previous antidepressant treatment (OR =4.66) and mood episode during antidepressant treatment (OR =3.68) were relatively high under bipolarity specifier.These are also different from those under DSM-Ⅳ-TR.For the common markers under either bipolarity specifier or DSM-Ⅳ-TR,the OR value of three variables including relatives of first degree with mania/hypomania (OR =3.58),illness course with free interval (OR =2.54) and irritability during previous antidepressant treatment (OR =2.40) were relatively high,thus indicates five high risk factors of BD with all the P value ＜ 0.01.Conclusions This study initially validated well recognition efficacy of bipolarity specifier for both BD and BD Ⅱ] among patients with MDE.The results may also help for further subset classification of BD.