目的 从临床现象学角度分析双相障碍抑郁发作与单相抑郁症临床特征的差异。方法 对双相障碍抑郁发作组（n=200）与单相复发抑郁组（n=563）患者的临床资料进行对照研究，对与双相障碍相关的临床特征进行多元逐步Logistic回归分析。结果 双相障碍抑郁发作组患者起病年龄早于单相复发性抑郁组（P<0.001）；双相障碍抑郁发作组首次发病年龄<25岁的患者比例明显高于单相复发性抑郁组（P<0.01）；不典型抑郁症状中，性欲亢进者的比例在双相障碍抑郁发作组中较高（P<0.01）；双相障碍抑郁发作组中伴精神病性症状、精神运动迟滞、心境不稳定、每次抑郁发作＜3个月的患者比例显著高于单相复发性抑郁组（P<0.05）；双相抑郁障碍发作组17项汉密尔顿抑郁量表 (HAMD-17)的认知障碍因子评分显著高于单相复发性抑郁组（P<0.05）。进一步的Logistic回归分析结果显示：起病年龄、首次发病年龄＜25岁、双相障碍家族史、性欲亢进、伴有精神病性症状、精神运动迟滞、心境不稳定、每次抑郁发作＜3个月、认知障碍因子分与双相障碍独立相关，优势比（OR）分别为1.54、1.50、3.25、1.99、1.89、1.48、1.63、1.63、1.42。结论 双相障碍抑郁发作与单相抑郁症是两类疾病，在抑郁发作时存在显著差异的临床特征可能是双相障碍的潜在预测因素。

Objective To explore the differences in clinical features between bipolar depression and unipolar depression from the clinical phenomenology. Methods The clinical data of 200 patients with bipolar depression (bipolar depression group) and 563 patients with recurrent unipolar depression (recurrent unipolar depression group) were compared, and multiple stepwise Logistic regression was employed to identify the clinical features related to bipolar disorder. Results The age at onset in bipolar depression group was younger than that in recurrent unipolar depression group (P<0.001), the percent of patients with age at onset <25 years in bipolar depression group was significantly higher than that in recurrent unipolar depression group (P<0.01). Hypersexuality, which was one of the atypical depressive symptoms, were more common in bipolar depression group than in recurrent unipolar depression group (P<0.01). The percents of patients with psychiatric symptoms, psychomotor retardation, mood instability and duration of every depressive episode <3 months in bipolar depression group were much higher than those in recurrent unipolar depression group (P<0.05). The score of cognitive impairment factor, one of the factors of 17-item Hamilton Rating Scale for Depression (HAMD-17), was significantly higher in bipolar depression group than in recurrent unipolar depression group (P<0.05). Logistic regression analysis revealed that age at onset, age at onset <25 years, family history of bipolar disorder, hypersexuality, psychiatric symptoms, psychomotor retardation, mood instability, duration of every depressive episode <3 months and score of cognitive impairment factor were independent factors for bipolar disorder, and the odds ratios were 1.54, 1.50, 3.25, 1.99, 1.89, 1.48, 1.63, 1.63 and 1.42, respectively. Conclusion Bipolar depression and unipolar depression are different disorders, and distinct clinical features may be potential predictors of bipolar disorder.