急性和慢性期缺血性脑卒中患者抑郁障碍及相关影响因素

Depressive disorder and its related factors of patients with acute or chronic ischemic stroke

目的:分析急性和慢性缺血性脑卒中患者抑郁障碍的发生率及其与发病部位、脑血流量及神经功能缺陷的关系。方法:选择1999-01/2003-12原沈阳铁路局中心医院南院区神经内科及泉州市第一医院神经科内科收治的脑梗死患者为观察对象。急性组为首次发病住院,脑卒中后即日～2个月的缺血性脑卒中患者142例,慢性组为脑卒中后3个月～1年的缺血性脑卒中患者102例。急性组在住院后两三周、慢性组在病情稳定时应用老年抑郁自评量表进行抑郁评估,以加拿大神经功能缺陷量表进行神经功能缺陷评估,采用经颅超声彩色多普勒经颞窗探索大脑中动脉、大脑前动脉和大脑后动脉的脉冲频谱和血流参数。重点观察急性组和慢性组脑卒中后抑郁障碍者与非抑郁障碍者脑底干动脉平均血流速度和阻力指数。同时通过脑CT或MRI确定脑卒中发病部位,分析不同发病部位抑郁障碍的发生情况。抑郁障碍判定标准:符合中国精神疾病分类方案与诊断标准第2版修订本(CCMD-Ⅱ-R)。以老年抑郁自评量表评分作为抑郁障碍严重程度的评定标准,11～20分为轻度抑郁障碍;21～30分为中、重度抑郁障碍。结果:两组患者均完成经颅超声彩色多普勒检测、神经功能缺陷量表以及抑郁量表测评,全部进入结果分析。①急性组有抑郁障碍症状者占36.6%(52/142),男23例,女29例;慢性组有抑郁障碍症状者占45.1%(46/102),男22例,女24例;慢性组高于急性组,女性略高于男性。②慢性组抑郁自评量表评分显著高于急性组,差异有显著性意义[(22.82±2.66),(18.72±1.63),t=1.981,P<0.05]。③不同脑卒中发病部位抑郁障碍的发生情况不同,单一类型中脑卒中发病部位为额叶、颞叶、基底节时抑郁障碍发生率较高。④急性和慢性缺血性脑卒中患者中抑郁障碍患者的大脑中动脉、大脑前动脉平均血流速度低于非抑郁障碍患者,阻力指数高于非抑郁障碍患者。结论:脑卒中后抑郁障碍的发生与发病部位有关,抑郁障碍影响脑血流速度,脑卒中慢性期抑郁障碍更明显。

AIM： To analyze incidence of depressive disorder （DD） and its relation with lesion location, cerebral blood flow and neurological defect in patients with acute or chronic ischemic stroke. METHODS： The patients with cerebral infarction were selected from the Department of Neurology, Southern Section of Shenyang Railway Bureau Central Hospital and the Department of Neurology, Quanzhou Municipal First Hospital between January 1999 and December 2003. They were divided into acute group （142 patients, first episode with the course of disease was less than 2 months） and chronic group （102 patients with course of 3-12 months after stroke）. All the patients were assayed with gerontism self-rating depression scale （SDS, mild DD of 11-20 scores and moderate or severe DD of 21-30 scores） for depression evaluation and Canadian neurological defect scale （CNDS） for neurological defect evaluation. In addition, transcranial Doppler （TCD） ultrasound was performed through temporal windows to detect the impulse spectrum and parameter of blood flow in middle cerebral artery （MCA）, anterior cerebral artery （ACA） and posterior cerebral artery. Mean velocity .（Vm） and resistant index （RI） were mainly observed in patients with or without DD in both groups. Meanwhile, CT and MRI were applied to localize the lesion of stroke, and the occurrences of DD on different locations were also estimated. Diagnosed criteria： Chinese Classification of Mental Disorders- Ⅱ -Revised （CCMD- Ⅱ -R）. RESULTS： All the patients completed the detections by TCD, CNDS and SDS, and entered into the result analysis. ①DD symptom existed in 52 eases （23 males and 29 females, 36.6%） of acute group and 46 cases （22 males and 24 females, 45.1%） of chronic group. The percentage was higher in chronic group than in acute group, and also a little higher in females than in males. ②The scores of SDS were higher in chronic group than in acute group, with the significant difference [（22.82±2.66）, （18.72±1.63）, t=1.981, P 〈 0.05].③There were different occurrences of DD on different lesion locations of stroke. And the incidences of DD were comparatively higher in the frontal lobe, temporal lobe and basal ganglion. ④The Vm of MCA and ACA was lower in patients with DD, however, RI was higher than in patients without DD. CONCLUSION： The occurrence of post-ischemic-stroke DD is related to lesion location, and DD, especially at chronic stroke period, can make great impact on Vm.