脑卒中后早期抑郁发病率及影响因素分析

Analysis of the morbidity and associated factors of early onset post-stroke depression

目的探讨急性缺血性卒中后早期抑郁发生率及其影响因素。方法共150例急性缺血性卒中患者,采用汉密尔顿抑郁量表17项(HAMD-17)评价抑郁症状,评分≥7分为脑卒中后抑郁。记录患者性别、年龄、受教育程度、实验室指标、易感因素、脑卒中分型[TOAST分型和英国牛津郡社区脑卒中项目(OCSP)分型]、美国国立卫生研究院卒中量表(NIHSS)评分、合并颈动脉狭窄等各项临床资料。单因素和多因素Logistic回归分析评价脑卒中后早期抑郁的影响因素。结果脑卒中后早期(2周时)抑郁发生率为18%(27/150)。单因素和多因素Logistic回归分析显示,甘油三酯(P=0.042)、神经功能缺损程度(P=0.001)、合并颈动脉狭窄(P=0.003)是脑卒中后早期抑郁的独立危险因素,进一步亚组分析提示,合并颈动脉狭窄是非轻型缺血性卒中后早期抑郁的独立危险因素(P=0.014)。结论神经功能缺损程度重且合并颈动脉狭窄的患者更易发生脑卒中后早期抑郁。

Objective To investigate the morbidity and associated factors of early onset depression after acute ischemic stroke,in order to improve its diagnostic rate and cure rate.Methods The depression symptoms of 150 patients with acute ischemic stroke were evaluated by using Hamilton Depression Rating Scale- 17(HAMD- 17) 2 weeks after onset.According to Diagnostic and Statistical Manual of Mental Disorders Fourth Edition(DSM- Ⅳ) criteria,patients with HAMD-17 score ≥7 were diagnosed as post-stroke depression(PSD).Clinical data of those patients,including gender,age,education,laboratory indexes,predisposing factors,National Institute of Health Stroke Scale(NIHSS) score,Trial of Orgl0172 in Acute Stroke Treatment(TOAST) type,Oxfordshire Community Stroke Project(OCSP)classification,and concurrent carotid artery stenosis were recorded.Univariate and multivariate Logistic regression analysis was used to investigate the related factors of PSD.Results The morbidity of PSD in patients 2 weeks after stroke onset was 18%(27/150).Univariate and multivariate Logistic regression analysis showed triglyceride level(P = 0.042),neural function deficiency(P = 0.001) and concurrent carotid artery stenosis(P = 0.003) were independent risk factors for early onset PSD.Further subgroup analysis indicated concurrent carotid artery stenosis was the independent risk factor for PSD in non-minor stroke patients(P = 0.014).Conclusions Stroke patients with severe neurological deficits and carotid artery stenosis are susceptible to early onset PSD.