老年人卒中后抑郁与脑微出血的相关性研究  

Correlation between post-stroke depression and cerebral microbleeds in elderly patients with ischemic stroke

作　　者：王凯 荣良群 魏秀娥 陶中海 肖利杰 Wang Kai;Rong Liangqun;Wei Xiue;Tao Zhonghai;Xiao Lijie(Department of Neurology, the Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China)

机构地区：[1]徐州医科大学第二附属医院神经内科,徐州221006

出　　处：《中华老年医学杂志》2019年第7期750-754,共5页Chinese Journal of Geriatrics

基　　金：徐州市科技计划课题(KC16SL121).

摘　　要：目的探讨老年人卒中后抑郁(PSD)与脑微出血(CMBs)的相关性。方法前瞻性研究,纳入220例老年缺血性卒中患者,随访到发病后1个月,按照美国精神病学会精神障碍诊断和统计手册第4版(DSM-Ⅳ)的诊断标准,分为PSD组和非PSD组。采用17项汉密尔顿抑郁量表(HAMD)进行抑郁程度评价,分为轻度抑郁组、中度抑郁组和重度抑郁组。通过磁敏感加权成像(SWI)技术判断有无CMBs及计算病灶数及评定病灶分布、位置。按CMBs病灶位置分为脑叶型、深部型和混合型。比较有无CMBs、病灶数及CMBs病灶位置对PSD的影响。结果最终纳入214例老年缺血性卒中患者,其中PSD组84例,PSD发病率为39.3%(84/214),女性55例(65.5%),男性29例(34.5%)。轻度抑郁组51例(60.7%),中度抑郁组25例(29.8%),重度抑郁组8例(9.5%)。CMBs患病率为轻度抑郁组62.5%(32/51)、中度抑郁组71.0%(22/25)、重度抑郁组81.8%(6/8)、非PSD组45.4%(49/108),各组之间的差异有统计学意义(χ^2=11.637,P=0.008)。CMBs病灶数为轻度抑郁组(4.5±1.2)个、中度抑郁组(7.8±2.0)个、重度抑郁组(12.6±2.7)个、非PSD组(1.8±0.5)个,各组之间的差异有统计学意义(F=2.79,P=0.041)。CMBs病灶位置(脑叶型、深部型和混合型)为轻度抑郁组40.6%(13/32)、34.4%(11/32)、25.0%(8/32),中度抑郁组,36.4%(8/22)、40.9%(9/22)、22.7%(5/22),重度抑郁组33.3%(2/6)、50.0%(3/6)、16.7%(1/6),非PSD组40.8%(20/49)、12.2%(6/49)、46.9%(23/49),各组之间的差异有统计学意义(Fisher精确检验,P=0.043)。CMBs病灶分布(左侧、右侧和双侧)为轻度抑郁组37.5%(12/32)、43.8%(14/32)、18.8%(6/32),中度抑郁组36.4%(8/22)、40.9%(9/22)、22.7%(5/22),重度抑郁组50.0%(3/6)、33.3%(2/6)、16.7%(1/6),非PSD组36.7%(18/49)、40.8%(20/49)、22.5%(11/49),各组之间的差异无统计学意义(Fisher精确检验,P=0.998)。结论CMBs患病率、CMBs病灶数及深部型CMBs与老年PSD严重程度密切相关,CMBs病灶分布与老年PSD严重程度无�Objective To investigate the correlation between post-stroke depression(PSD)and cerebral microbleeds(CMBs)in elderly patients with ischemic stroke. Methods In the prospective study, 220 elderly patients with ischemic stroke were enrolled and followed up to one month after onset.Finally a total of 214 elderly patients performed a follow-up.According to DSM-Ⅳ Diagnostic and Statistical Manual of Mental Disorders, patients were divided into the PSD group and non-PSD group.The degree of depression was evaluated by17-item Hamilton Depression Scale(HAMD-17)score, and patients were divided into mild depression, moderate depression and severe depression group.The loci number, distribution and location of CMBs lesions were assessed by SWI.Patients were divided into brain lobe type, deep lobe type and mixed type according to the CMBs lesion location.The influence of CMBs or not, loci number and location of CMBs lesions on PSD were compared. Results A total of 214 elderly patients with ischemic stroke were enrolled, in whom 84(84/214, 39.3%)had PSD with 29(34.5%)males and 55(65.5%)females.According to the HAMD scale, there were 51 patients(60.7%)with mild depression, 25(29.8%)with moderate depression, and 8(9.5%)with severe depression.The prevalence rate of CMBs was 62.5%(32/51)in mild depression group, 71.0%(22/25)in moderate depression group, 81.8%(6/8)in severe depression group and 45.4%(49/108)in non-PSD group(all P=0.008). The number of CMBs lesions were(4.5±1.2)in mild depression group,(7.8±2.0)in moderate depression group,(12.6±2.7)in severe depression group and(1.8±0.5)in non-PSD group, with the statistically significant differences between groups(F=2.79, P=0.041). The proportions of CMBs lesions location(brain lobe type, deep lobe type and mixed type)were 40.6%(13/32), 34.4%(11/32) and 25.0%(8/32) in mild depression group, 36.4%(8/22), 40.9%(9/22) and 22.7%(5/22) in moderate depression group, 33.3%(2/6), 50.0%(3/6) and 16.7%(1/6) in severe depression group, 40.8%(20/49), 12.2%(6/49) and 46.9%(23/49) in non-PS

关 键 词：卒中 抑郁 脑微出血 

分 类 号：R743.3[医药卫生—神经病学与精神病学]