首次脑梗死后抑郁障碍的临床研究

Clinical study of depressive disorder after first-ever cerebral infarction

目的本研究旨在对首次脑梗死后抑郁障碍的相关危险因素及发病机制进行探讨。方法前瞻性分析202例患者首次脑梗死后6个月抑郁障碍的发生率及其与卒中临床类型(OCSP分型)、神经功能缺损严重程度的关系。通过Logistic多元回归分析抑郁障碍的相关危险因素。结果首次脑梗死后抑郁障碍的发生率为18.8%。老年患者易出现抑郁障碍(P=0.024)。完全前循环脑梗死(TACI)患者抑郁障碍的发生率及严重程度明显高于其他三种临床亚型(P=0.000)。Logistic多元回归分析发现抑郁障碍的发生与女性(P=0.048)、同时存在多种脑血管疾病危险因素(高血压、糖尿病、家族卒中史)(P=0.018)、失语(P=0.005)及神经功能缺损或日常生活能力受累的严重程度(P=0.000)独立相关。未证实抑郁障碍与优势半球梗死或前后循环区域性梗死的相关性。结论抑郁障碍是首次脑梗死后一个重要并发症,与神经功能缺损或日常生活能力受累的严重程度密切相关。生物-心理-社会医学模式可能在卒中后抑郁的形成中发挥重要作用。

Objective To study the risk factors and pathogenesis for depression,a common complication among stroke patients,after first-ever cerebral infarction.Methods Two hundred and two patients after first-ever ischemic stroke were investigated prospectively to evaluate the prevalence of depressive disorder,the relationship between depression and stroke subtypes and severity of neurological function deficits.Risk factors of depressive disorder were studied by Logistic regression.Results Prevalence of depressive disorder after first-ever cerebral infarction was 18.8%.Old patients were likely to the develop depression（P=0.024）.Patients with total anterior cerebral infarction（TACI） showed a higher occurrence and severity score of depressive disorder than those with other oxfordshire community stroke project（OCSP） subtypes.Some risk factors,including female（P=0.048）,many coexisting risk factors of stroke（P=0.018）,dysphasia（P=0.005）and severity of neurological function deficits（P=0.000） were considered as independent predictors of depression occurrence by Logistic regression.It showed no association between depression and territorial infarction in dominant hemisphere or in two different cerebral artery systems.Conclusions Depressive disorder associated with severity of neurological function deficits is found to be an important complication in patients with first-ever cerebral infarction.Biopsychosocial medical model may play an important role in the development of poststroke depression.