北京社区缺血性卒中后抑郁与卒中再发和死亡关系的研究  

Relationship between post-stroke depression and recurrent stroke and death in Beijing communities

作　　者：梅利平[1] 刘宏军[1] 方向华[1] 穆丽媛 张红梅[3] 秦晓明[1] 张新卿[4] 

机构地区：[1]首都医科大学宣武医院循证医学中心,北京100053 [2]北京市社区卫生协会 [3]首都医科大学宣武医院神经内科,北京100053 [4]天津医科大学第二医院综合科

出　　处：《中国脑血管病杂志》2013年第5期239-243,272,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金资助项目(30671797;81072361)

摘　　要：目的探讨社区缺血性卒中后抑郁(PSD)与卒中再发及死亡的关系。方法于2003年1月—2006年12月,对北京5家二级医院所属的社区卫生服务机构就诊的首次或二次缺血性卒中急性期后3个月的患者进行登记和基线调查。共登记1087例患者,其中1074例符合入选标准并完成抑郁自评量表检查。每6个月随访一次患者卒中的再发和死亡情况,随访截止到2008年12月31日。采用COX比例风险模型分析PSD与卒中再发及死亡的关系。结果①基线调查时PSD患病率为49.9%(536/1074)。轻度和中、重度PSD的构成比分别是52.2%(280/536)、47.8%(256/536)。②在平均3.5年的随访中,卒中累积再发率和总死亡率分别为12.9%和7.6%。③在对年龄、性别、文化程度、吸烟、饮酒、高血压、糖尿病、心脏病史、卒中病史、血脂代谢异常、体质量超标或肥胖进行调整后,COX比例风险模型分析显示,PSD患者死亡的风险比(HR值)为1.66(95%CI:1.04～2.68),卒中再发的HR值为1.41(95%CI:0.99～2.01)。轻度PSD是卒中再发的独立危险因素(HR=1.67,95%CI:1.02～2.24),而中、重度PSD是死亡的独立危险因素(HR=2.68,95%CI:1.61～4.46)。结论社区卫生服务机构就诊的缺血性卒中患者有较高的PSD患病率,PSD患者卒中再发和死亡的风险增加。Objective To investigate the relationship between post-stroke depression （PSD） ,recurrent stroke and death in Beijing communities. Methods At 3 months after the first or second attack of ischemic stroke, the patients were surveyed at baseline. 1087 patients were treated in the community health service institutions in 5 hospitals in Beijing area from January 2003 to December 2006. 1074 of them met the inclusion criteria and completed the self-rating depression scale test. The patients were followed up for every 6 months until December 31, 2008. The Cox proportional hazard model was used to analyze the relationship between PSD and recurrent stroke and death. Results ①The incidence of PSD was 49.9% （536/1074） at baseline survey. The constituent ratios of mild, moderate and severe PSD were 52.2% （280/536） and 47.8% （256/536） , respectively. ②In an average 3.5 years of follow-up period, the cumulative recurrence rate and total mortality of stroke were 12.9% and 7.6% , respectively. ③After adjusting for the age, sex, educational level, smoking, alcohol consumption, history of hypertension, diabetes, heart disease and stroke, abnormal lipid metabolism, as well as overweight or obese, the Cox proportional hazards model analysis showed that the hazard ratio （FIR） of death in patients with PSD was 1.67 （95% C1 1.04 -2.68） , and the HR of recurrent stroke was 1.41 （95% CI O. 99 -2.01 ）. The mild PSD was an independent risk factor for recurrent stroke （HR = 1.51, 95 % CI 1.02 -2.24）, and the moderate and severe PSD were the independent risk factors for death of the patients （HR = 2.68, 95% CI 1.61 -4.46）. Conclusion The ischemic stroke patients treated in community health service institutions have a higher prevalence of PSD. The risks of recurrent stroke and death increase in patients with PSD.

关 键 词：缺血性卒中 抑郁 预后 前瞻性研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]