老年性抑郁和认知：与脑血管危险因素的交互作用  

Late life depression and cognition：interaction with cerebrovascular factors

作　　者：王月菊[1] 董凌燕[1] 俞立强[2] 侯宝元[1] 李虹[1] 李建中[1] 方琪[3] 

机构地区：[1]江苏省苏州大学附属第一医院老年病科,215006 [2]江苏省苏州大学附属第一医院博习诊疗中心,215006 [3]江苏省苏州大学附属第一医院神经内科,215006

出　　处：《中华神经科杂志》2016年第11期833-838,共6页Chinese Journal of Neurology

基　　金：国家自然科学基金资助项目（81371387）

摘　　要：目的：探讨排除血管危险因素和脑萎缩等因素的影响后，老年性抑郁症（ LLD）与认知功能和脑白质损害（ WML）三者之间的相互关系。方法选择2014—2015年在苏州大学附属第一医院老年病科住院的患者277例，采用多种神经心理学量表对这277例患者抑郁情况、认知损害进行评估。把实际入组患者分为LLD组（77例）和非抑郁症组（103例），采集受试者的血管危险因素、WML及脑萎缩等情况。采用独立样本t检验及多因素Logistic回归分析，在控制年龄、性别、受教育年限（模式Ⅰ）和控制年龄、性别、教育年限、高血压、糖尿病、冠心病因素（模式Ⅱ）后，分析LLD的独立危险因素。在控制模式Ⅱ及脑萎缩的前提下，采用偏相关分析方法分析抑郁症状、认知功能和WML的相关性及抑郁症状与各认知分项的相关性。结果与非抑郁症组相比LLD组患者高血压比例（90.9％、74.7％，χ2＝6.342，P＝0.046）显著增高，认知评分（19.23±7.05、22.99±6.71，t＝3.343， P＝0.001）显著降低，WML 2级患者比例增多（65.1％、34.9％，χ2＝7.373，P＝0.025），反映颞叶萎缩的海马沟回比（0.24±0.03、0.22±0.03，t＝－2.040，P＝0.044）差异有统计学意义。多因素Logistic回归分析表明，模式Ⅰ下认知功能（OR＝1.63，95％ CI 1.01～2.80，P＝0.030）是LLD的独立危险因素。排除脑血管危险因素，偏相关分析结果表明，抑郁症状与认知功能（r＝－0.239，P＝0.004）、白质严重度（r＝0.222，P＝0.008）、颞叶和海马的萎缩（r＝0.173，P＝0.040）显著相关；模式Ⅱ下抑郁症状与认知功能中注意（r＝－0.175，P＝0.040）、回忆（r＝－0.140，P＝0.050）、画钟（r＝－0.186，P＝0.029）显著相关。结论排除血管危险因素、脑萎缩及WML等因素后，认知障碍仍然与LLD显著相关，血管危险因素参与LLD的发生，WML可以作为认知储备损�Objective To investigate the relationship among the late-life depression （ LLD ） , cognitive function and white matter lesions （ WML） , after excluding vascular risk factors and brain atrophy.Methods The depression and cognition status of 277 patients were assessed using a variety of neurological scales, and the actually enrolled patients were divided into LLD group （ 77 cases ） and the non-depressed group （103 cases）.The independent samples t test and multivariate Logistic regression were used to analyze independent risk factors for depressive symptoms with the model Ⅰ of controlling age , sex, years of education and the model Ⅱof controlling age, sex, years of education, high blood pressure, diabetes and coronary heart disease.Under the premise of controlling mode Ⅱand brain atrophy , partial correlation was used to analyze the correlations of depressive symptoms and cognitive function and WML , and the correlation between depressive symptoms and cognitive items.Results The results showed that the proportion of high blood pressure （90.9%vs 74.7%, χ2 =6.342,P=0.046）, cognitive scores （19.23 ±7.05 vs 22.99 ±＆amp;nbsp;6.71, t=3.343,P=0.001）, WML level 2 proportion （65.1% vs 34.9%, χ2 =7.373,P=0.025） and temporal lobe atrophy of hippocampal sulcus ratio （0.24 ±0.03 vs 0.22 ±0.03, t=-2.041,P=0.044） had statistically significant difference between the two groups.Multivariate Logistic regression showed that cognitive function was an independent risk factor for depression （ OR=1.63,95% CI 1.01 -2.80, P=0.030）.Controlling for all risk factors , partial correlation analysis showed that depressive symptoms were correlated with cognitive function （ r=-0.239,P=0.004） and WML （ r=0.222,P=0.008） and the atrophy of temporal lobe and hippocampus （ r=0.173, P=0.040 ）.Under the model Ⅱ, depressive symptoms correlated with attention （r=-0.175, P=0.040）, memories （r=-0.140, P=0.050） and drawing clock test （ r=-0.186, P=0.029 ）.Conclusions Excluding vascular

关 键 词：老年性抑郁 认知障碍 脑白质损害 血管因素 脑萎缩 

分 类 号：R749.1[医药卫生—神经病学与精神病学]