高血压脑出血患者术后抑郁状况调查与风险预测模型构建研究  

Investigation of pos depression in patients with hypertensive intracerebral hemorrhage and establishment of a risk prediction model

作　　者：陈果[1] 王亮[1] CHEN Guo;WANG Liang(Department of Neurosurgery,The Fifth People’s Hospital of Chongqing,Chongqing 400064,China)

机构地区：[1]重庆市第五人民医院神经外科,重庆400064

出　　处：《国际精神病学杂志》2025年第1期181-185,共5页Journal Of International Psychiatry

基　　金：重庆市自然科学基金面上项目(编号:cstc2021jcyj-msxmX0773)。

摘　　要：目的 调查高血压脑出血患者术后抑郁的发生情况,并建立风险预测模型。方法 收集2022年1月~2024年1月本院收治的118例高血压脑出血患者临床资料,并进行回顾性研究。记录术后抑郁发生情况,采用Logistic多因素回归模型分析术后抑郁的相关因素,并基于此构建风险预测模型,同时,采用受试者工作曲线(receiver operating characteristic,ROC)评估该模型对术后抑郁的预测价值。结果 118例患者术后抑郁32例,发生率为27.12%。Logistic多因素分析显示,失语(β=1.431,95%CI=2.573-6.794,P<0.001)、美国国立卫生院神经功能缺损评分(national institutes of health stroke scale,NIHSS)(β=1.031,95%CI=1.364-5.768,P=0.005)、血清谷氨酸水平升高(β=0.686,95%CI=1.102-3.576,P=0.022)是术后抑郁的高危因素,血清脑源性神经营养因子水平升高(β=-0.491,95%CI=0.493-0.760,P<0.001)是术后抑郁的保护因素。术后抑郁的风险预测模型为Y=1.431×(X3)+1.031×(X5)+0.686×(X6)-0.491×(X7),ROC分析结果显示,该模型判断术后抑郁的曲线下面积为0.812(SE=0.070,95%CI=0.675-0.948,P<0.001),敏感度为0.813,特异度为0.721。结论 高血压脑出血术后存在抑郁风险而术后失语、NIHSS评分和血清谷氨酸水平异常升高、血清脑源性神经营养因子水平降低将增加术后抑郁风险,据此建立预测模型对判断术后抑郁准确性高。Objective To investigate the incidence of postoperative depression in patients with hypertensive intracerebral hemorrhage and establish a risk prediction model.Method The clinical dataes of 118 patients with hypertensive intracerebral hemorrhage admitted in our hospital from January 2022 to January 2024 were collected,and conduct a retrospective comparative research.The occurrence of postoperative depression were recorded,the logistic multiple regression model were used to analyze the related factors of postoperative depression,a risk prediction model was established,and the receiver operating characteristic(ROC)was used to determine the value of postoperative depression.Results There were 32 cases of postoperative depression in the 118 patients,the incidence rate was 27.12%.Logistic multiple factor analysis showed that the aphasia(β=1.431,95%CI=2.573-6.794,P<0.001),national institutes of health stroke scale(NIHSS)score(β=1.031,95%CI=1.364-5.768,P=0.005),serum glutamic acid(β=0.686,95%CI=1.102-3.576,P=0.022)were high-risk factor for postoperative depression,the serum brain derived neurotrophic factors(β=-0.491,95%CI=0.493-0.760,P<0.001)was protective factor for postoperative depression.The risk prediction model for postoperative depression Y=1.431×(X3)+1.031×(X5)+0.686×(X6)-0.491×(X7),the ROC analysis results showed that the area under curve of the model for predicting postoperative depression was 0.812 (SE=0.070,95%CI=0.675-0.948,P<0.001),the sensitivity and specificity were 0.813 and 721. ConclusionThere is a risk of depression after surgery for hypertensive intracerebral hemorrhage. The postoperative aphasia,abnormalincrease in NIHSS score and serum glutamate levels,and decrease in serum brain derived neurotrophic factors willincrease the risk of postoperative depression. The clinical prediction models based on this will has high accuracy in predictingpostoperative depression.

关 键 词：高血压脑出血 术后抑郁 危险因素 预测模型 

分 类 号：R749.1[医药卫生—神经病学与精神病学]