卒中后抑郁治疗的新进展  

New progress in the treatment of post-stroke depression

作　　者：马腾 李汉斌 陈雯 MA Teng;LI Hanbin;CHEN Wen(Department of Neurology,Affiliated Central Hospital of Shandong First Medical University,Jinan 250013,China)

机构地区：[1]山东第一医科大学附属中心医院神经内科,山东济南250013

出　　处：《山东第一医科大学(山东省医学科学院)学报》2025年第1期47-53,共7页Journal of Shandong First Medical University & Shandong Academy of Medical Sciences

基　　金：中国卒中学会脑血管病全程管理启航基金(20220701)。

摘　　要：卒中后抑郁(post-stroke depression,PSD)是卒中患者最常见的神经精神并发症之一,发病率高达30%,对患者康复和生活质量都有显著负面影响。PSD发病机制复杂,涉及神经递质失衡、神经炎症反应、神经营养因子减少及下丘脑-垂体-肾上腺(hypothalamic-pituitary-adrena,HPA)轴功能异常等多种因素。治疗PSD的方法包括药物治疗、心理治疗、神经调节技术、中药治疗、运动疗法和社会经济支持等。药物治疗中,选择性5-羟色胺再摄取抑制剂是首选,但需注意药物副作用;心理治疗如认知行为治疗(cognitive behavior therapy,CBT)和人际心理治疗(interpersonal psychotherapy,IPT)通过调整认知和改善人际关系来缓解症状;重复经颅磁刺激(repeated transcranial magnetic stimulation,rTMS)和经颅直流电刺激(transcranial direct current stimulation,tDCS)等神经调节技术显示出显著疗效;脑深部电刺激(deep brain stimulation,DBS)在难治性抑郁症中疗效较好,为PSD治疗提供参考。此外,脑机接口(brain-computer interface,BMI)结合功能性电刺激(functional electrical stimulation,FES)在促进神经可塑性和功能恢复方面具有显著效果,中药和运动疗法也在改善PSD症状方面显示出潜力。影像学生物标志物在评估和优化治疗方案方面具有潜力。综合治疗策略结合多种方法,可为PSD患者提供更全面和有效的治疗方案。未来研究应继续探索这些方法的优化和个性化应用,以提高PSD患者的治疗效果和生活质量。本研究围绕PSD治疗的最新进展进行综述,为临床治疗PSD提供新思路和理论依据。Post stroke depression(PSD)is one of the most common neuropsychiatric complications in stroke patients.The incidence rate is as high as 30%,which has a significant impact on patients'rehabilitation and quality of life.Its pathogenesis is complex,involving multiple factors such as neurotransmitter imbalance,neuroinflammatory response,decreased neurotrophic factors,and abnormal HPA axis function.The methods for treating PSD include drug therapy,psychotherapy,neuromodulatory techniques,traditional Chinese medicine treatment,exercise therapy,and socio-economic support.In drug therapy,selective serotonin reuptake inhibitors are the first choice,but side effects should be noted.Psychological therapy such as cognitive-behavioral therapy and interpersonal psychotherapy improve symptoms by regulating cognition and interpersonal relationships.Neuroregulatory techniques such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation have shown significant therapeutic effects.The success of deep brain electrical stimulation in refractory depression provides a reference for PSD treatment.Additionally,brain-computer interface(BCI)combined with functional electrical stimulation(FES)has significant effects in promoting neural plasticity and functional recovery,and traditional Chinese medicine and exercise therapy have also shown potential in improving PSD symptoms.Imaging biomarkers have the potential to evaluate and optimize treatment plans.A comprehensive treatment strategy combined with multiple methods will provide a more comprehensive and effective treatment plan for PSD patients.Future research should continue to explore the optimization and personalized application of these methods to improve the treatment effectiveness and quality of life of PSD patients.This article reviews the latest progress in the treatment of PSD,providing new ideas and theoretical basis for clinical treatment of PSD.

关 键 词：卒中后抑郁 药物疗法 心理治疗 重复经颅磁刺激 经颅直流电刺激 脑深部电刺激 

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]