首发脑卒中后抑郁的相关因素分析  

Related factors analysis in patients with post-stroke depression

作　　者：李晓一[1] 邢葆平[1] 吴皓[2] 陈炜[2] 

机构地区：[1]浙江省立同德医院精神科,浙江杭州310012 [2]浙江大学医学院附属邵逸夫医院精神卫生科

出　　处：《全科医学临床与教育》2013年第5期535-538,共4页Clinical Education of General Practice

基　　金：浙江省中医药科学研究基金项目(2012ZB004)

摘　　要：目的探讨首发脑卒中患者抑郁（PSD）的发生率及其相关因素。方法收集169例首发脑卒中患者，应用汉密尔顿抑郁量17项（HAMD-17）进行抑郁症状评定PSD，比较不同年龄、病灶性质、部位、抑郁程度的PSD发生率，及不同病灶部位的HAMD-17评分。并进行logisitic 回归。结果 HAMD-17评分≥16的83例，首发PSD的发生率为50.89％；不同性别、病变性质及左右半球病变部位的PSD发生率比较，差异均无统计学意义（χ2分别=1.73、2.71、3.29， P均＞0.05）；首发脑卒中后3～6个月与2月内及7～12个月比较，PSD发生率差异有统计学意义（χ2=3.82、4.15， P＜0.05），与7～12个月比较，前6个月内的PSD发生率差异有统计学意义（χ2=3.19，P＜0.05）；轻度神经功能缺损中PSD发生率22.92％（11/48）、中度为57.02％（47/85）、重度为69.44％（25/36），中度PSD发生率高于轻度，重度高于中度，差异均有统计学意义（χ2分别=4.12、4.38， P均＜0.05）；不同病灶部位的HAMD-17评分比较显示，前后半球比较及右前半球、左后半球、右后半球与左前半球比较，差异均有统计学意义（t分别=2.84、4.62、3.75、4.02，P均＜0.05）。 Spearman秩相关分析显示，PSD的发病率与神经功能缺损程度及前半球、左前半球部位的病灶有相关性（r分别=0.79、0.84、0.81，P均＜0.05）。结论首发PSD的发生率较高，高峰期为第3个月至第6个月；与前半球、左前半球部位的病灶及神经功能缺损严重程度相关。Objective To explore the influencing factors of post-stroke depression patients. Methods A total of 169 cases of initial stroke were enrolled in the study. The post-stroke depression （PSD） was assessed by HAMD-17. The inci-dence of PSD of different ages, the nature of the lesion, lesion, the degree of depression and HAMD-17 scores were com-pared and the logistic regression were performed at the same time. Results There were 83 cases that the score of HAMD-17 were higher than 16. The incidence of PSD was 50.89%. There were no statistically significant differences of PSD incidence among different gender, pathological changes and left or right hemisphere lesions（χ2=1.73, 2.71, 3.29, P〉0.05）. Compared with that in 2 months and during 7 to12 months after stroke, the incidence of PSD during 3 to 6 months were statistically dif-ferent（χ2=3.82, 4.15, P〈0.05）;Compared with 7 to12 months after stroke, the PSD incidence within 6 months was statisti-cally different（χ2=3.19, P〈0.05）. The PSD incidence in mild nerve function defect patients was 22.92%, which was signifi-cantly lower than that in moderate nerve function defect patients （57.02%） that was also significantly lower than that in the severe nerve function defect patients （69.44%）（χ2=4.12,4.38,P〈0.05）. The HAMD-17 score comparisons between the for-mer and poster-hemisphere, the left-former hemisphere and the right-former hemisphere, left-poster hemisphere and right-poster hemisphere were statistically different （t=2.84, 4.62, 3.75, 4.62, P〈0.05）. The spearman correlation showed that the PSD incidence was related to the nerve function defect, the former hemisphere and the left-former hemisphere （r=0.79,0.84,0.81,P〈0.05）. Conclusion The incidence of PSD is high, especially during the third months to the six months. It relate to the former hemispheres, the left-former hemisphere nervous lesion and the heavier degree of nervous function deficit.

关 键 词：脑卒中 抑郁 相关因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]