脑卒中后抑郁及抗抑郁治疗对患者神经功能恢复影响的Meta分析

Effects of post-stroke depression and anti-depression therapy on rehabilitation of neurological function in patients with Meta method

目的:了解脑卒中后抑郁(post-strokedepression,PSD)及抗抑郁治疗对脑卒中患者神经功能恢复的影响,以进一步认识PSD与脑卒中患者神经功能的关系。方法:应用Meta分析对20项研究中PSD及抗抑郁治疗对脑卒中患者神经功能康复影响的对照研究进行再分析,评价其综合显著性差异和效应大小。结果:①脑卒中患者中抑郁组与非抑郁组的CSS评分比较:综合检验Z=8.0628,自由度16,P<0.001;效应大小:d平均=0.7031。②抑郁组抗抑郁治疗前后抑郁症状的改善情况比较:综合检验Z=51.8899,自由度26,P<0.001;效应大小:d平均=3.6761。③抑郁组抗抑郁治疗前后神经功能的改善情况比较:Z=30.3631,自由度30,P<0.001;效应大小:d平均=1.868。④抑郁治疗组与对照组抑郁症状改善程度的组间比较:Z=24.7187,自由度26,P<0.001;效应大小:d平均=2.3253。⑤抑郁治疗组与对照组神经功能改善程度的组间比较:Z=11.5910,自由度30,P<0.001;效应大小:d平均=0.80。结论:PSD与脑卒中患者神经功能的缺损程度相关;抗抑郁治疗不仅能改善患者的抑郁症状,而且有利于患者神经功能的康复。

AIM:To investigate the effects of post-stroke depression(PSD) and anti-depression therapy on the rehabilitation of neurological function in patients with stroke,so as to further recognize the relationship between PSD and neurological function in stroke patients. METHODS:The effects of PSD and anti-depression therapy on the rehabilitation of neurological function in stroke patients in 20 controlled studies were analyzed by meta-analysis again in order to assess the comprehensively significant differences and the effect size(ES). RESULTS:①The scores of CSS in stroke patients in depression group and non-depression group:comprehensive test Z=8.062 8,free degree 16,P< 0.001;ES:dmean=0.703 1.②Improvements of depression symptom before and after anti-depression therapy in depression group:comprehensive test Z=51.889 9,free degree 26,P< 0.001;ES:dmean=3.676 1.③Improvements of neurological functional defect before and after anti-depression therapy in depression group:Z=30.363 1,free degree 30,P< 0.001;ES:dmean=1.868.④Improving degrees of depression symptom between depression group and control group:Z=24.718 7,free degree 26,P< 0.001;ES:dmean=2.325 3.⑤Improving degrees of neurological functional defect between depression group and control group:Z=11.591 0,free degree 30,P< 0.001;ES:dmean=0.80. CONCLUSION:A correlation exists between PSD and degrees of neurological impairment in stroke patients.Anti-depression therapy can not only improve depression symptom but also help for neurological function.