不同脑梗死分型与脑卒中后抑郁和认知功能障碍的关系

Relationship of the post-stroke depression and cognitive impairment with different types of cerebral infarction

目的探讨不同脑梗死分型与脑卒中后抑郁(PSD)和认知功能障碍的关系。方法选择脑卒中急性期患者158例,脑出血35例,脑梗死123例(其中PSD患者55例,非PSD患者68例)。发病2周后采用汉密尔顿抑郁量表和简易智能状态检查量表(MMSE)进行评分,并进行TOAST和牛津郡社区脑卒中项目(OCSP)分型。结果与非PSD患者大动脉粥样硬化型和部分前循环梗死比较,PSD患者大动脉粥样硬化型和部分前循环梗死PSD发生率明显升高(P=0.002,P=0.000),小动脉闭塞型和腔隙性梗死患者PSD发生率明显降低(P=0.002,P=0.003)。与非小动脉闭塞型、非腔隙性梗死患者比较,小动脉闭塞型、腔隙性梗死患者MMSE评分明显升高(P=0.021,P=0.038)。脑出血患者发生认知功能障碍比率大于脑梗死患者(34.3%vs 14.6%,P=0.013)。结论大动脉粥样硬化型患者PSD发生率较高,小动脉闭塞型和腔隙性梗死患者PSD发生率较低、认知功能受损程度轻;部分前循环梗死患者PSD发生率较高、认知功能受损程度重。脑出血较脑梗死易发生认知功能障碍。

Objective To investigate the relationship of the post stroke depression（PSD） and cog- nitive impairment with different types of cerebral infarction. Methods 158 patients with acute stroke were chosen, of them, 35 suffered from cerebral hemorrhage and 135 suffered from cerebral infarction（of them, 55 had PSD, 68 did not have PSD）. They were examined with HAMD and MMSE to get the scores two weeks after stroke. Results In TOAST and Oxford Community Stroke Program（OCSP） classifications,the PSD patients with types of large artery atherosclerosis （LAA） and partial anterior circulation infarction（PACI） had higher PSD incidence （P = 0. 002, P = 0. 000） compared with non-PSD patients. The patients with types of small artery occlusion （SAO） and lacunar infarction（LACI） had low PSD incidence （P = 0. 002,P = 0. 003）. The pa- tients with types SAO and LACI had higher scores of MMSE than othertypes （P ： 0. 021,P = 0. 038）. Cerebral hemorrhage l^ad higher incidence（34.3%） of cognitive impairment than cerebral infarction（14.6%, P = 0. 013）. Conclusion The patients with types LAA and PACI have high PSD incidence. The patients with types SAO and LACI have low PSD incidence. The patients with type PACI have high PSD incidence and severe cognitive function damage. Cerebral hemorrhage has higher incidence of cognitive impairment than cerebral infarction.