老年缺血性脑卒中患者远期卒中后抑郁与发病部位的相关性分析  

Correlative analysis of post-stroke depression and pathogenesis in elderly patients with ischemic stroke

作　　者：张莹[1] 方岩[1] 徐辉[1] 段金凤[3] 李玉舟[2] 田一平[2] 姬卫东[1] 周海云[1] 

机构地区：[1]商丘市第一人民医院神经内科,476100 [2]商丘市第一人民医院影像中心,476100 [3]浙江大学医学院附属第一医院精神卫生科,310003

出　　处：《中华老年医学杂志》2017年第7期755-758,共4页Chinese Journal of Geriatrics

基　　金：基金项目：河南省医学科技攻关计划项目（2011030040）

摘　　要：目的探讨首发老年缺血性脑卒中患者发病部位对远期卒中后抑郁（PSD）的预测价值，为早期干预提供依据。方法前瞻性研究，连续人选商丘市第一人民医院神经内科2013年1～7月入院的60岁以上首发缺血性脑卒中患者158例，在发病后2～3年进行PSD与发病部位关系的现状调查，最终完成随访者126例，抑郁的诊断按照精神障碍诊断和统计手册第4版（DSM-Ⅳ）标准，分为卒中抑郁组52例和卒中无抑郁组74例。采用17项汉密尔顿抑郁量表（HAMD）对卒中患者进行抑郁程度评价，通过头颅MRI进行卒中病灶定位及计算病灶数目及体积，使用非条件Logistic回归分析对PSD与发病部位的关系进行分析。结果首发老年缺血性脑卒中患者远期PSD发生率41．3％（52／126例），其中轻、中、重度抑郁分别为21．4％（27／126例）、12．7Voo（16／126例）、7．1％（9／126例）。Logistic回归分析结果显示，病变部位中与远期PSD发生的相关性因素包括额叶（OR=2．824，95％CI：1．189～6．706）、颞叶（OR=3．579，95％CI：1．233～10．393）脑梗死灶，且额叶梗死较颞叶梗死患者远期PSD程度重（x2=6．399，P〈O．05）。卒中抑郁组较卒中无抑郁组脑梗死平均体积大（t=3．271，P〈0．05），平均病灶数目多（t=3．176，P〈O．05）。根据HAMD评分在卒中抑郁组内抑郁程度越重，脑梗死平均体积越大（F=6．280，P〈0．05）、平均病灶数目越多（F=6．132，P〈0．05）。结论首发老年缺血性脑卒中患者远期PSD的发生受发病部位的影响，额叶、颞叶梗死灶是缺血性脑卒中患者远期PSD发生的独立危险因素，且额叶梗死较颞叶梗死患者抑郁症状重。Objective To explore the predictive value of brain lobe location of stroke lesion to development of long-term post-stroke depression（PSD）in the first-episode ischemic stroke patients for providing evidence for early intervention. Methods In the prospective study, 158 patients aged 60 and over with first-episode ischemic stroke were continuously admitted into Department of Neurology of Shangqiu First People＇s Hospital from January 2013 to July 2013. The 2 to 3 years follow-up after stroke episode was performed in 126 cases for inquiring into correlation between brain lobe location of stroke lesion and development of PSD. The diagnosis of depression was in accordance with Mental Disorders Diagnostic and Statistical Manual 4 （DSM-IV）standard, and divided into groups of stroke with depression（n= 52）and stroke without depression（n= 74）. The degree of depression was evaluated by 17-item Hamilton Rating Scale for Depression（HAMD17）. The location, number and volume of stroke lesions were determined by head MRI. The relationship between PSI） and pathogenetic loci was analyzed by unconditional Logistic regression analysis. A difference in hemisphere commensalism. Results The morbidity of PSDwas 41.3%（52/126）,with 21.4%（27/126）,12.7%（16/126）,7.1% （ 9/126 ） in mild, moderate and severe PSD respectively. The frontal lobe （ OR = 2. 824,95 % CI = 1. 189-6. 706）and the temporal lobe（OR=3. 579,95 %CI= 1. 233-10. 393）cerebral infarction were correlated with the occurrence of PSD. The long term PSD severity was more in frontal lobe than in temporal lobe （Zz =6. 399,P〈0.05）. The average volume of cerebral infarction was larger in PSD group than in non-PSD group（t=3. 271,P〈0.05）,and the average number of cerebral infarction loci was more in PSD group than in non PSD group（t = 3. 176,P〈0.05）. The more severe the degree of depression according to H AMD17, the larger the average volume of cerebral infarction （F = 6. 280, P 〈 0.05 ）and the more the average number of

关 键 词：卒中 抑郁 回归分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]