急性缺血性脑卒中后抑郁与脑小血管病负荷的相关性研究  

Association between post-stroke depression and cerebral small vessel disease in acute ischemic stroke patients

作　　者：杜娟[1] 陈念东[1] 张雪玲[1] 肖露露 

机构地区：[1]南京鼓楼医院集团宿迁市人民医院神经内科,223800 [2]南京大学医学院附属金陵医院(解放军南京总医院)神经内科

出　　处：《中华老年心脑血管病杂志》2017年第12期1287-1290,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：南京军区南京总医院院管课题(2015038)

摘　　要：目的探讨急性缺血性脑卒中后抑郁(PSD)与脑小血管病(CSVD)负荷轻重程度的相关性。方法选择急性缺血性脑卒中患者301例,根据脑卒中后3个月PSD发生情况分为PSD组86例,非PSD组215例。所有患者根据TOAST分型标准进行病因分型、美国国立卫生研究院卒中量表(NIHSS)评分,并于入院当日完善患者人口学和脑血管病相关危险因素等资料。结果 PSD组年龄、高血压、入院NIHSS评分、脑微出血、血管周围间隙增加和重度CSVD负荷评分明显高于非PSD组,轻度CSVD负荷评分和中度CSVD负荷评分明显低于非PSD组(P<0.05)。在二分类logistic回归模型中,首先矫正人口学因素(年龄和性别),以轻度CSVD负荷评分为参照,中度CSVD负荷评分(OR=1.32,95%CI:1.29~4.56,P=0.04)和重度CSVD负荷评分(OR=3.02,95%CI:1.35~7.07,P=0.01)与PSD的发生独立相关。将单因素分析中P<0.2的变量纳入二分类logistic回归模型中,矫正年龄、性别、高血压、糖尿病、NIHSS评分、收缩压,仍以轻度CSVD负荷评分为参照,中度CSVD负荷评分对PSD失去了预测价值(OR=1.26,95%CI:0.96~4.16,P=0.65),重度CSVD负荷评分(OR=2.65,95%CI:1.11~6.92,P=0.04)与PSD联系依然存在。结论急性缺血性脑卒中CSVD负荷严重程度与患者3个月后PSD密切相关。Objective To study the association between PSD and CSVD in AIS patients.MethodsThree hundred and one AIS patients were divided into PSD group（n=86）and non-PSD group（n=215）.The patients underwent TOAST classification and were scored according to the NIHSS.The demographic data and risk factors for CSVD were recorded on admission.Results The age was older,the history of hypertension was longer,the NIHSS score,severe CSVD score and cerebral microbleeds（CMB）score were higher,the lacuna vasorum was larger in PSD group than in non-PSD group（P〈0.05）.Logistic regression analysis showed that moderate CSVD score and severe CSVD score were the independent risk factors for PSD after adjustment of demographic data（age and gender）with mild CSVD as its reference（OR=1.32,95%CI：1.29-4.56,P=0.04;OR=3.02,95%CI：1.35-7.07,P=0.01）.Moderate CSVD score could not predict PSD.However,severe CSVD score was associated with PSD after adjustment for P〈0.2 variables in univariate analysis and with age,gender,hypertension,DM,NIHSS score,and SBP with mild CSVD as its reference（OR=1.26,95%CI：0.96-4.16,P=0.65;OR=2.65,95%CI：1.11-6.92,P=0.04）.Conclusion The severity of CSVD is closely associated with PSD in AIS patients.

关 键 词：卒中 抑郁 脑梗死 认知障碍 脑缺血 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R749.4[医药卫生—临床医学]