盐酸舍曲林预防性治疗卒中后抑郁的多中心研究  

Efficacy of Sertraline Hydrochloride for Post-stroke Depression:A Multicenter Study

作　　者：沈蓉[1] 周华[1] 赵中[1] SHEN Rong;ZHOU Hua;ZHAO Zhong(Department of Neurology,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215000,China)

机构地区：[1]南京医科大学附属苏州医院神经内科,苏州215000

出　　处：《中国卒中杂志》2022年第5期510-515,共6页Chinese Journal of Stroke

摘　　要：目的探讨缺血性卒中后早期应用盐酸舍曲林对卒中后抑郁(post-stroke depression,PSD)和认知功能障碍的影响。方法前瞻性连续入组2016年2月-2017年8月苏州市6家三级医院神经内科住院的首发急性缺血性卒中患者。将其随机分为3组,对照组给予常规治疗,低剂量治疗组在常规治疗基础上加用盐酸舍曲林50 mg/d,高剂量治疗组在常规治疗基础上加用盐酸舍曲林100 mg/d,疗程均为3个月。分别于卒中后1个月、3个月、6个月和1年对患者进行汉密尔顿抑郁量表(Hamilton depression scale,HAMD)、MMSE、mRS评定,比较3组上述随访时间点的PSD发生率、认知功能和预后情况,以及1年缺血性卒中的复发率。结果最终完成随访的患者为404例,其中对照组136例,低剂量治疗组140例,高剂量治疗组128例。(1)3组间1年缺血性卒中复发率差异无统计学意义,不同随访时间mRS差异均无统计学意义;(2)卒中后3个月时低剂量治疗组(22.9%vs.44.1%,P<0.001)和高剂量治疗组(18.8%vs.44.1%,P<0.001)的PSD发生率均低于对照组;卒中后6个月时低剂量治疗组(5.7%vs.44.1%,P<0.001)和高剂量治疗组(4.7%vs.44.1%,P<0.001)的PSD发生率均显著低于对照组;(3)卒中后3个月、6个月和1年时低剂量治疗组和高剂量治疗组的HAMD评分均低于对照组,差异有统计学意义;(4)卒中后3个月时高剂量治疗组的MMSE评分高于对照组,6个月与12个月时低剂量治疗组和高剂量治疗组的MMSE评分均高于对照组,差异有统计学意义。结论盐酸舍曲林早期干预急性缺血性卒中患者可降低3个月和6个月时PSD的发生率,改善患者发病1年的认知功能,但对缺血性卒中的复发率和功能预后无影响。Objective To investigate the effect of early application of sertraline on post-stroke depression(PSD)and cognitive dysfunction after ischemic stroke.Methods Patients with first acute ischemic stroke who were hospitalized in neurology department of 6 hospitals in Suzhou from February 2016 to August 2017 were randomly divided into 3groups:the control group was given conventional treatment,the low-dose treatment group was given sertraline hydrochloride 50 mg/d on the basis of conventional treatment,and the high-dose treatment group was given sertraline hydrochloride 100 mg/d on the basis of conventional treatment,with the treatment course for 3 months.At 1 month,3 months,6 months and 1 year after stroke,the patients were evaluated by Hamilton depression scale(HAMD),MMSE and mRS.The incidence of PSD,cognitive function and prognosis at the above point-in-time and ischemic stroke recurrence within one year were compared among the 3 groups.Results A total of 404 patients were included in the final analysis,including 136 in control group,140 in the low-dose treatment group,and 128 in the high-dose treatment group.(1)There were no statistical difference in the incidence of 1-year ischemic stroke among the 3 groups;(2)The incidence of PSD in the low-dose(22.9%vs.44.1%,P<0.001)and high-dose treatment groups(18.8%vs.44.1%,P<0.001)were lower than that in the control group at 3 months,and the incidence of PSD in the low-dose(5.7%vs.44.1%,P<0.001)and high-dose treatment groups(4.7%vs.44.1%,P<0.001)were lower than that in the control group at 6 months,all with statistical differences;(3)The HAMD scores of the low-dose and high-dose treatment groups were lower than those of the control group at 3,6 months and 1 year,all with statistical differences;(4)The MMSE score of the high-dose treatment group was higher than that of the control group at 3 months,and the MMSE scores of the low-dose and the high-dose treatment groups were higher than that of the control group at 6 and 12 months,all with statistical differences.Conclusions Ear

关 键 词：盐酸舍曲林 早期干预 缺血性卒中 卒中后抑郁 认知 

分 类 号：R743.3[医药卫生—神经病学与精神病学]