未破裂颅内动脉瘤患者血管内治疗前产生焦虑和抑郁情绪影响因素分析  

Analysis of influencing factors of anxiety and depression in patients with unruptured intracranial aneurysm before endovascular treatment

作　　者：曾张伟 甘丽芬 郑静 黄清海 Zeng Zhangwei;Gan Lifen;Zheng Jing;Huang Qinghai(Cerebrovascular Disease Center,the First Affiliated Hospital of Naval Military Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院脑血管病中心,上海200433

出　　处：《中国脑血管病杂志》2022年第1期1-8,共8页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金面上项目(81771264);国家重点研发项目(2016YFC1300700)。

摘　　要：目的探究未破裂颅内动脉瘤(UIA)患者血管内治疗前后焦虑、抑郁状况,分析UIA患者血管内治疗前产生焦虑、抑郁情绪的影响因素。方法前瞻性纳入2019年2月至2020年12月就诊于海军军医大学第一附属医院脑血管病中心的156例UIA患者,分别于血管内治疗前1~2 d(医师术前谈话后)以及血管内治疗后出院前行汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评估,HAMA评分≥7分为存在焦虑情绪,HAMD评分≥8分为存在抑郁情绪。记录人口学、临床资料,人口学资料包括性别、年龄、受教育程度(小学、初中、高中、大学及以上)、家庭年收入(≤5、>5~10、>10~20、>20万元);临床资料包括高血压病、糖尿病、心肌疾病、吸烟史、饮酒史,UIA发现方式[症状(头痛、头晕、耳鸣等)、偶然(健康体检等)]、确诊时间,动脉瘤部位[颈内动脉、大脑前动脉、大脑中动脉、椎-基底动脉、混合类型(含颈内动脉、大脑前动脉、大脑中动脉、椎-基底动脉中的两个部位及以上)]、动脉瘤最大径、数量[单发、多发(≥2个)]等。采用非参数符号秩和检验分析血管内治疗前与治疗后出院前的HAMA、HAMD分值,采用配对样本χ^(2)检验分析血管内治疗前与治疗后出院前患者存在焦虑、抑郁情绪的占比。将人口学、临床资料中的项目作为自变量,采用多因素二元Logistic回归分析血管内治疗前UIA患者存在焦虑、抑郁情绪的独立危险因素。结果(1)焦虑状况:血管内治疗后存在焦虑情绪占比低于治疗前[39.1%(61/156)比51.3%(80/156),χ^(2)=5.7,P<0.05];血管内治疗后精神性焦虑评分、躯体性焦虑评分和HAMA总分均较治疗前明显降低[3.0(1.0,7.8)分比5.0(3.0,10.8),Z=-9.19;1.0(0.0,4.0)分比2.0(1.0,5.0)分,Z=-7.89;4.0(2.5,11.0)分比7.0(5.0,14.8),Z=-9.62;均P<0.01]。(2)抑郁状况:血管内治疗后存在抑郁情绪占比低于治疗前[35.3%(55/156)比46.8%(73/156),χ^(2)=4.3,P<0.05];UIA患Objective To explore the anxiety and depression of unruptured intracranial aneurysm(UIA)patients before and after endovascular treatment,and to analyze the influencing factors of the anxiety and depression of patients with UIA before endovascular therapy.Methods A total of 156 UIA patients admitted to the Cerebrovascular Disease Center,First Hospital Affiliated to Naval Military Medical University from February 2019 to December 2020 were prospectively enrolled.Hamilton anxiety scale(HAMA)and Hamilton depression scale(HAMD)were evaluated 1 to 2 days before endovascular treatment(after preoperative conversation)and before discharging after endovascular treatment,respectively.HAMA score≥7 indicated anxiety and HAMD score≥8 indicated depression.Demographic and clinical data were recorded,including gender,age,education level(primary school,junior middle school,senior high school,university and above),and annual family income(≤50000,>50000-100000,>100000-200000,>200000 yuan).Clinical data included hypertension,diabetes,myocardial disease,smoking history,drinking history,UIA discovery method(symptoms[headache,dizziness,tinnitus,etc.],occasional[physical examination,etc.]),diagnosis time,aneurysm location(internal carotid artery,anterior cerebral artery,middle cerebral artery,vertebro-basilar artery,mixed type[including two or more parts of internal carotid artery,anterior cerebral artery,middle cerebral artery,vertebro-basilar artery]),maximum diameter and number of aneurysms(single and multiple aneurysms[≥2]).HAMA and HAMD scores before and after endovascular treatment were analyzed by nonparametric sign rank test,and the proportion of anxiety and depression before and after endovascular treatment was analyzed by paired sample Chi-square test.Using demographic and clinical data as independent variables,multivariate binary Logistic regression was used to analyze the independent risk factors of anxiety and depression in UIA patients before endovascular treatment.Results(1)Anxiety:the proportion of patients with a

关 键 词：颅内动脉瘤 焦虑 抑郁 影响因素 未破裂颅内动脉瘤 血管内治疗 

分 类 号：R743.4[医药卫生—神经病学与精神病学]