摘要
目的在前瞻性队列研究中调查卒中单元模式下的缺血性卒中急性期卒中后抑郁(post-strokedepression,PSD)发生的独立危险因素。方法收集发病14 d内的缺血性卒中患者,收集患者的人口学资料、既往病史、相关临床指标及影像学资料。发病后14 d进行神经功能缺损和心理量表的评定,分为PSD组和非PSD组,比较两组的人口学资料和临床资料差异,分析缺血性卒中急性期卒中后抑郁的危险因素。结果共有268例患者入组,其中PSD组116例,非PSD组152例。PSD组女性、糖尿病史、性格急躁和内向的患者的比例高于非PSD组;PSD组发病后14 d NIHSS分值高于非PSD组,MMSE低于非PSD组;PSD组梗死病灶累及基底节的比例高于非PSD组;PSD组双侧内侧颞叶、右侧顶叶、双侧枕叶脑萎缩出现率高于非PSD组。女性(P<0.0001,OR 7.064,95%CI 3.334～14.966)、发病14 d NIHSS(P=0.0020,OR 1.158,95%CI1.055～1.272)是PSD发生的独立危险因素;病前性格随和(P=0.0264,OR 0.447,95%CI0.220～0.910)是避免急性期卒中后抑郁发生的保护性因素。结论女性、发病后14 d的神经功能缺损水平是卒中急性期发生抑郁的独立危险因素,病前性格随和是避免发生PSD的保护性因素。
Objective To explore the independent risk factors of post-stroke depression（PSD） at the acute stage ofischemic stroke in the stroke unit in a prospective cohort study. Methods Eligible inpatients with acute ischemic cerebrovascular diseases within 14 days after onset were enrolled in this study. Demographic data, past history, associated clinical indicators and imaging data were collected. The assessments of neurological deficit and mental scale were carried out for all the enrolled patients within 14 day after onset, and according to the depression evaluation all patients were divided into PSD group and non-PSD group. Demographic data and clinical data were compared between the two groups to analyze the risk factors for depression at the acute stage of ischemic stroke. Results Total of 268 patients were included in this study, 116 in PSD group and 152 in non-PSD group. Compared with the non-PSD group, a significantly higher proportion of patients in the PSD group were females, with a history of diabetes, and had impetuous and inward dispositions. The PSD group had significantly higher National Institutes of Health Stroke Scale（NIHSS） and lower Mini-Mental State Examination（MMSE） score than the non-PSD group on 14 days after onset. The imaging findings showed that acute infarction at basal ganglia was associated with high PSD incidence; the detection rate of encephalatrophy at bilateral medial temporal lobe, right parietal lobe, and bilateral occipital lobe were significantly higher in PSD group than that in non- PSD group. Gender（P〈0.0001, OR 7.064, 95%CI 3.334-14.966） and NIHSS score on 14 days after onset（P-0.0020, OR 1.158, 95%C1 1.055-1.272） were the independent risk lhctors of PSD Easygoing disposition before onset（P-0.0264, OR 0.447, 95%C1 0.220-0.910） was a protective lhctor for PSD. Conclusion Female-gender and neurological deficit on 14 days after onset are independent risk factors of PSD. Easygoing disposition before onset is a protective factor for PSD.
出处
《中国卒中杂志》
2012年第9期698-704,共7页
Chinese Journal of Stroke
基金
国家自然科学基金:识别脑区功能连接网络的研究及其在白质疏松患者认知功能障碍方面的应用(81071115)
北京市自然科学基金:卒中后抑郁神经传导通路及mGluR2/3候选基因研究(7102050)
关键词
抑郁
危险因素
脑萎缩
前瞻性队列研究
Depression
Risk factor
Encephalatrophy
Prospective cohort study
