脑微出血与缺血性脑卒中后抑郁的关联性研究  

Correlation between cerebralmicrobleeds and post stroke depression in patient with ischemic stroke

作　　者：李芸[1] 樊新颖[1] 

机构地区：[1]南京大学医学院附属金陵医院(南京军区南京总医院)神经内科,南京210002

出　　处：《医学研究生学报》2016年第11期1136-1139,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81301017)

摘　　要：目的既往关于缺血性脑卒中后抑郁（post-stroke depression,PSD ）的发病机制并未完全阐明.文中初步探讨脑微出血（ cerebml microbleeds, CMBs）和P S D 的相关性.方法连续纳人2 0 1 5年1 月至2 0 1 5年9 月于南京军区南京总医院神经内科住院的缺血性脑卒中患者2 1 0 例.所有患者于卒中后3 个月采用《美国精神障碍诊断与统计手册（ 第4 版）》躯体疾病所致心境障碍诊断标准进行P S D 的诊断并根据诊断结果分为P S D 组和非P S D 组.单因素分析组间差异,同时多因素logistic回归分析P S D 的独立危险因素.结果2 1 0 例患者中,P S D 组共6 4 例（3 0 .5 % ）.同非P S D 组相比,P S D 组患者年龄、糖尿病患病率、国立卫生院神经功能评分（ National Institute of Health Stroke Scale, NIHSS）及深部CMBs发生率明显较高,而教育程度明显较低, 差异均有统计学意义（P 〈0.05 ） .单因素log istic回归分析示,深部CMBS 是P S D 的危险因素（0R =2.003, 9 5% CI：1.021- 3.930,P = 0 .0 4 3 ）.经多因素logistic回归分析校正年龄、糖尿病、微出血、NIHSS评分及教育程度等混杂因素后,深部CMBs仍为P S D 的独立危险因素（ OR = 2.346, 95% CI：1.037-5.307,P = 0.041） . 结论脑深部CMBs是缺血性脑卒中发生P S D 的独立危险因素,提示深部CMBS可能参与P S D 的发病机制.临床医师可根据患者是否合并深部CMBS,及早干预P S D 的高危患者.Objective The pathogenesis of post-stroke depression remains unclear. The aim of this study was to examine the correlation between cerebral microbleeds( CMBs) and PSD. Methods Two hundred and ten patients with acute ischemic stroke were recruited prospectively from Jan 2015 to Sep 2015. All patients were evaluated with Diagnostic and Statistical Manual of Mental Disorders( DSM-IV) three months after the stoke and divided into PSD group and non-PSD group. The group difference was analyzed by univariate analysis and the independent risk factors of PSD were analyzed by multivariate logistic regression analysis. Results Sixty-four patients( 30.5%) were diagnosed as PSD. Patients with PSD had higher age,NIHSS scores,presence of diabetes mellitus,deep CMBs,and lower education compared with the patients with non-PSD( P<0.05). Univariate logistic regression analysis indicated that deep CMBs was the independent risk factor of PSD( OR = 2.003,95% CI: 1.021 ~ 3.930,P = 0.043). Multivariate logistic regression analysis indicated that deep CMBs was the independent risk factor of PSD( OR = 2.346; 95%CI: 1.037 ~ 5.307,P = 0.041) after adjusted for age,diabetes mellitus,NIHSS scores,and levels of education. Conclusion Deep CMBs was the independent risk factor of PSD,which indicated that deep CMBs may participate the pathogenesis of PSD. The clinicians can give intervention to the patients with high risk of PSD combined with CMBs in time.

关 键 词：微出血 卒中后抑郁 缺血性脑卒中 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]