老年轻型急性缺血性卒中后抑郁相关因素及其预测价值  

Factors associated with depression after mild acute ischaemic stroke in the elderly and their predictive value

作　　者：邹永明[1] 舒睿 王娜[1] 边际 乔凌亚[1] 徐小林 Zou Yongming;Shu Rui;Wang Na;Bian Ji;Qiao Lingya;Xu Xiaolin(Department of Neurology,Tianjin Huanhu Hospital Affiliated to Nankai University,Tianjin Institute of Dementia,Tianjin 300350,China)

机构地区：[1]南开大学附属天津市环湖医院神经内科天津市痴呆研究所,天津300350

出　　处：《中华老年医学杂志》2024年第3期291-296,共6页Chinese Journal of Geriatrics

基　　金：天津市医学重点学科(专科)建设项目资助(TJYXZDXK-052B);天津市卫生健康科技项目(QN20016)。

摘　　要：目的探讨老年轻型急性缺血性卒中后抑郁的危险因素及其预测价值,便于早期识别和干预,以改善预后。方法病例对照研究,纳入符合入组条件的老年轻型急性缺血性卒中患者988例,收集患者的一般人口社会学资料,临床相关化验资料血糖、血脂、尿中阿尔茨海默病相关神经丝蛋白(AD7C-NTP)等,并进行蒙特利尔认知评价量表(MoCA)、美国国立卫生研究院卒中量表(NHISS)评分、Barthel指数(BI)、汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分。根据HAMD抑郁量表评分分成无卒中后抑郁(NPSD)组和卒中后抑郁(PSD)组,分析PSD的相关危险因素及其预测价值。结果纳入符合入组条件的患者988例,其中排除132例,最终纳入856例,NPSD和PSD组在年龄、高血压、吸烟史、受教育程度和卒中史方面差异有统计学意义(均P<0.05)。在临床资料方面,两组患者在总胆固醇、三酰甘油、高密度脂蛋白胆固醇、尿AD7C-NTP、MoCA、HAMA评分方面差异有统计学意义(均P<0.05)。多因素Logistics回归分析显示性别(OR=1.975,95%CI:1.223~3.190,P=0.005)、卒中史(OR=1.352,95%CI:0.877~2.086,P=0.042)、HAMA评分(OR=1.216,95%CI:0.932~1.526,P=0.043)为老年轻型急性缺血性卒中后抑郁的独立危险因素,MoCA评分(OR=0.873,95%CI:0.814~0.937,P<0.001)是独立保护因素。ROC曲线分析显示HAMA评分(AUC=0.892,灵敏度:0.721,特异度:0.854,截断点:9.5)具有较好的预测价值,其他指标预测价值较小。结论性别、卒中史、HAMA评分可能为老年轻型急性缺血性卒中后抑郁的独立危险因素,MoCA评分可能是独立保护因素。HAMA评分对PSD具有较好的预测能力。早期识别这些相关因素,并进行干预,可能有助于改善预后。Objective To examine the risk factors and predictive value of depression following mild acute ischemic stroke in elderly individuals.The aim is to enhance early identification and intervention,ultimately leading to improved prognosis.Methods A case-control study was conducted on 988 elderly patients with mild acute ischemic stroke.The study collected general population and social data,as well as clinical laboratory data such as blood glucose,blood lipids,and AD7C-NTP in urine.Additionally,the patients underwent assessments using the Montreal Cognitive Assessment Scale(MoCA),National Institutes of Health Stroke Scale(NHISS),Barthel index(BI),Hamilton Anxiety Scale(HAMA),and Hamilton Depression Scale(HAMD).Based on the HAMD depression scale score,the patients were divided into a nopost-stooke depression(NPSD)group and a post-stooke depression(PSD)group.The study then analyzed the related risk factors and predictive value of PSD.Results A total of 988 patients were eligible for inclusion,with 132 being excluded and 856 being included.The NPSD and PSD groups showed significant differences in age,hypertension,smoking history,education level,and stroke history(all P<0.05).Regarding clinical data,there were statistically significant differences between the two groups in total cholesterol(TC),triacylglycerol(TG),HDL,urinary AD7C-NTP,MoCA,and HAMA scores(all P<0.05).The results of the multi-factor logistic regression analysis revealed that gender(OR=1.975,95%CI:1.223-3.190,P=0.005),stroke history(OR=1.352,95%CI:0.877-2.086,P=0.042),and HAMA score(OR=1.216,95%CI:0.932-1.526,P=0.043)were identified as independent risk factors for post-stroke depression in the elderly.Conversely,MoCA score(OR=0.873,95%CI:0.814-0.937,P<0.001)was found to be an independent protective factor.Furthermore,the ROC curve analysis demonstrated that the HAMA score(AUC=0.892,sensitivity:0.721,specificity:0.854,cut-off value:9.5)exhibited significant predictive value,while the other indexes had limited predictive value.Conclusions Gender,stroke history

关 键 词：卒中 抑郁 认知 危险因素 预测 轻型急性缺血性卒中 

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]