卒中后情感失禁的临床及神经心理学相关因素研究

Correlates of poststroke emotional incontinence in patients with ischemic stroke

目的探讨缺血性脑卒中患者情感失禁(PSEI)的临床及神经心理学相关因素。方法纳入207例急性缺血性脑卒中患者,在卒中后3个月进行神经心理学评估。PSEI的诊断使用House的诊断标准。抑郁及焦虑症状分别采用汉密尔顿抑郁量表(HAMD)及焦虑量表(HAMA)进行评估。总体认知功能采用简易智能评分(MMSE)进行评估。患者的生存质量采用脑卒中专门生存质量量表(SSQOL)测定。比较PSEI及非PSEI组间临床因素及神经心理学因素的差异,应用Logistic回归分析PSF的影响因素。结果 23例(11.1%)患者存在PSEI。PSEI患者具有较高的入院NIHSS评分、HAMD、HAMA及MMSE评分(P<0.05)。Logistic回归分析显示,仅NIHSS评分(OR=1.161,95%CI=1.024-1.318,P=0.021)为PSEI有统计学意义的危险因素。PSEI组SSQOL显著低于非PSEI组,这种差异在校正入院NIHSS评分、HAMD、HAMA及MMSE评分后仍然存在。结论 PSEI在中国缺血性脑卒中患者中常见,神经功能缺损的严重程度是PSEI的主要相关因素。

Objective To investigate the frequency, as well as the clinical and psychological correlates of poststroke emotional incontinence （PSEI） in patients with ischemic stroke. Methods A total of 207 patients with acute ischemic stroke participated in this study. At three months after the index stroke, all participants received comprehensive neuropsychological assessments. Depressive and anxious symptoms were measured by the Hamilton depression and anxiety scales（HAMD and HAMA）. The global cognitive function was measured by the mini-mental status examination （MMSE）. Clinical and psychological varia- bles were compared between the PSEI and non-PSEI group. Logistic regressions were performed to find the correlates of PSEI. Results Twenty-three（11.1%）of participants had PSEI. Patients in the PSEI group had a significant higher NIH stroke score （NIHSS） on admission, higher HAMD and HAMA scores, as well as higher MMSE score（P〈0.05）, compared with the ones in the non-PSEI group. NIHSS on admission（OR = 1.16 1, 95 % CI= 1. 024-1.318, P = 0.021） was the only significant correlate of PSEI in logistic regression. SSQOL was significantly lower in the PSEI than in the non-PSEI subjects, even adjusted by NIHSS on admission, HAMD, HAMA and MMSE score. Conclusion PSEI is common in Chinese patients with mild-tomoderate ischemic stroke. The severity of neurological deficits is the major determinant of PSEI.