缺血性脑卒中后抑郁患者临床预后的相关因素研究  

Related factors of clinical prognosis in patients with post-ischemic stroke depression

作　　者：邹琴 张羽康 刘力源 刘惠 杨域舒 林雪娟 李其富[2] 陈永敏[2] ZOU Qin;ZHANG Yukang;LIU Liyuan;LIU Hui;YANG Yushu;LIN Xuejuan;LI Qifu;CHEN Yongmin(Department of Psychology,the First Affiliated Hospital of Hainan Medical University,Haikou,Hainan 570100,China)

机构地区：[1]海南医学院第一附属医院心理科,海南海口570100 [2]海南医学院第一附属医院神经内科,海南海口570100 [3]海南医学院,海南海口570100

出　　处：《中国热带医学》2018年第9期915-918,共4页China Tropical Medicine

基　　金：国家自然科学基金项目(No.81460184);海南省医药卫生科研项目(No.琼卫科教[2014]51号)

摘　　要：目的探索并明确影响缺血性脑卒中后抑郁(post-ischemic stroke depression,PISD)临床预后的相关因素。方法连续性收集曾于2016年1月1日—12月31日在海南医学院第一附属医院神经内科住院治疗,且符合纳入标准的PISD患者,采集所有患者的一般信息、临床检验资料以及梗死病灶部位情况。随访1年后,由心理专业医师再次采用17项汉密尔顿抑郁量表(17-items Hamilton Rating Scales of Depression,HAMD)进行抑郁情况评估,根据患者HAMD评估得分,将患者分为无抑郁的痊愈组(Cured group)及未痊愈组(Uncured group)两组,对两组患者间差异具有统计学意义的相关因素进行Logistic回归统计分析。结果本次研究共纳入PISD患者148例,最终完成随访者132例。1年痊愈率为66.67%(88/132),轻度抑郁(mild depression,mi D)患者23例(17.42%),中度抑郁(moderate depression,mo D)患者13例(9.85%)以及重度抑郁(severe depression,SD)患者8例(6.06%)。痊愈组患者的平均动脉压(mean arterial pressure,MAP,t=-3.04)及肌酐水平(t=-2.14)均较未痊愈组患者低,且两组间差异均具有统计学意义(P<0.05),两组间基底节病灶差异具有统计学意义(P<0.05)。此外,多因素Logistic回归分析结果表明,MAP与基底节(basal ganglia,BG)病灶是PISD预后的相关因素(OR值分别为2.18、10.33)。结论 MAP及基底节病灶可能是PISD预后的相关危险因素,因此,早期干预及认识该因素,将有助于改善PISD患者的预后情况。Objective To explore and identify the related factors that affect the prognosis of post-ischemic strokedepression（PISD）.Methods The patients hospitalized in the Department of Neurology in the First Affiliated Hospital ofHainan Medical University and diagnosed with PISDfrom January 1, 2016 to December 31, 2016 were included. Generalinformation, clinical test data, and lesion locations were collected from all patients. After one year of follow-up, 17-itemversion of the Hamilton Rating Scales of Depression（HAM-D17） was used by psychologists to assess depression. According tothe score of HAM-D17 assessment, the patients were divided into the cured group and the uncured group. Logistic regressionanalysis was used to analyze the related factors which had statistically significant difference between the two groups. Results In this study, 148 cases of PISD were included, and finally 132 patients completed the follow-up. The cured rate of one yearswas 66.67%（88/132）, of which 23 cases（17.42%） of mild depression（mi D）, 13 patients（9.85%） with moderate depression（mo D） and 8 patients（6.06%） with severe depression（SD）. The levels of mean arterial pressure（MAP）（t=-3.04） and creatinine（t=-2.14） in the cured group were significantly lower than those in the uncured group（P〈0.05）. The difference of basal ganglia（BG） between the two groups was statistically significant（P〈0.05）. In addition, multivariate logistic regression analysis showedthat MAP and BG were prognostic factors of PISD（OR values were 2.18, 10.33, respectively）.Conclusions MAP and BG maybe the related risk factors of PISD prognosis. Therefore, the early intervention and understanding of this factor will help toimprove the prognosis of PISD patients.

关 键 词：缺血性脑卒中后抑郁 临床预后 相关因素 平均动脉压 基底节 

分 类 号：R743.31[医药卫生—神经病学与精神病学]