老年脑卒中后抑郁与血管事件的相关性分析

Association of Post- stroke Depression with Vascular Events in Elderly Patients

目的探讨老年脑卒中后抑郁(PSD)的相关因素及PSD与血管事件发生的相关性。方法选择2011年7月—2014年4月兵团七师医院神经内科收治的326例老年脑卒中患者为研究对象,收集患者临床资料,根据汉密尔顿抑郁量表进行评分,分为PSD组(83例)和非PSD组(243例),出院随访至2014年7月,分析老年PSD发病相关因素及其与血管事件的相关性。结果 PSD组高血压、糖尿病、冠心病患病率高于非PSD组(χ2=6.374、6.481、7.096,P<0.05),PSD组NIHSS评分高于非PSD组(u=3 724,P<0.001)。PSD组血管事件发生率为16.9%(14/83),高于非PSD组的8.2%(20/243)(χ2=4.374,P<0.05)。Logistic回归分析显示,糖尿病〔OR=2.961,95%CI(1.192,7.358),P<0.05〕、血脂〔OR=2.383,95%CI(1.134,5.007),P<0.05〕和PSD〔OR=4.592,95%CI(1.823,11.567),P<0.05〕是血管事件发生的危险因素。结论老年脑卒中患者合并高血压、糖尿病、冠心病或神经功能缺损严重易并发PSD,糖尿病、血脂、PSD是随访期发生血管事件的独立危险因素。

Objective To investigate the risk factors of post- stroke depression（ PSD） and its relationship to vascular events. Methods From July 2011 to April 2014, in the Seventh Agricultural Division Hospital of Xinjiang Production and Construction Corps,326 elderly PSD patients were enrolled in this study. Their clinical data were divided, according to Hamilton Depression Rating Scale into PSD group（ 83 cases）,and non- PSD group（ 243 cases）. The follow- up lasted to July 2014. The PSD- related factors and their relationship to vascular events were analyzed. Results The detection rates of hypertension,diabetes,coronary heart disease（ CHD） were higher in PSD group than in non- PSD group（ χ^2= 6. 374,6. 481,7. 096,P〈0. 05）,and NIHSS scores higher,the difference was significant（ u = 3 724,P〈0. 001）. The incidence of vascular events was 16. 9%（ 14 /83） in PSD group,8. 2%（ 20 /243） in non- PSD group,the difference was significant（ χ^2= 4. 374,P〈0. 05）. Logistic regression analysis showed that diabetes 〔OR = 2. 961,95% CI（ 1. 192,7. 358）, P〈0. 05〕,hyperlipidemia 〔OR = 2. 383,95% CI（ 1. 134,5. 007）, P〈0. 05 〕 and PSD 〔OR = 4. 592,95% CI（ 1. 823,11. 567）,P〈0. 05 〕were risk factors of vascular events. Conclusion Elderly stroke patients with hypertension, diabetes,CHD or severe neurologic impairment are easy to be complicated by PSD. Diabetes,hyperlipidemia,PSD are independent risk factors of vascular events during follow up.