卒中后抑郁障碍患者再发卒中的相关影响因素研究

CORRELATIVE FACTORS AFFECTING RECURRENCE OF STROKE IN PATIENTS WITH POST- STROKE DEPRESSION

目的探讨缺血性脑卒中2周后抑郁障碍患者（Post-stroke Depression,PSD）随访1年再发卒中的危险因素。方法随机选取2009年10月~2012年10月我院的缺血性脑卒中患者500例,对其临床资料（包括基线情况、脑卒中的治疗情况、2周后发生抑郁情况和干预治疗情况、出院后的随访情况）进行回顾性分析,观察缺血性脑卒中2周后出现抑郁障碍患者随访1年再发卒中的相关影响因素,明确对卒中复发起关键作用的危险因素。结果随访信息完整者380例（76.00%）,其中发生PSD患者280例（73.68%）,未发生PSD患者100例（26.32%）;发生PSD患者中出现卒中复发者50例（17.86%）,明显高于未发生PSD患者中出现卒中复发者8例（8.00%）,差异有统计学意义（χ2=5.536,p=0.019）。与未发生PSD患者比较,PSD患者中女性、心脏病史、使用抗抑郁药所占比例更高;年龄更大;入院首次脑卒中评分更高,差异有统计学意义（p〈0.05）。多因素Logistic回归分析显示,患者的年龄（OR=1.667,p=0.007）、入院首次脑卒中评分（OR=0.981,p=0.022）、心脏病史（OR=1.071,p=0.014）均是PSD患者发生卒中复发的独立危险因素。结论发生脑卒中2周后出现抑郁障碍者会明显增加脑卒中的复发率,其中年龄、心脏病史、入院首次脑卒中评分,是PSD患者再发脑卒中的独立危险因素,合理纠正这些危险因素带来的影响,将有助于脑卒中复发的预防。

Objective To explore risk factors affecting recurrence of stroke in 1 - year follow - up of patients with post - stroke depression （PSD） after 2 weeks of ischemic stroke. Methods 500 cases with ischemic stroke ad- mitted to our hospital from February 2009 to February 2012 were randomly selected. Their clinical data including con- ditions of baseline, stroke and recurrence of depression after 2 weeks and its intervention treatment, and follow - up after discharge were retrospectively analyzed. The correlative factors of recurrence of stroke were observed and clearly defined. Results The follow - up information was complete in 380 cases （76.00%） , 280 of which （73.68%） con- tracting PSD. 50 cases （ 17.86% ） developed withrecurrent stroke among PSD patients, the incideneesignificantly higher than that of thosewithout PSD （8 eases, 8.00% ）（ χ2 = 5. 536, p = 0.019）. Compared with the groupwithont PSD, the proportions of females, heart disease history and antidepressant usein PSD patients were higher; the ages in PSD patients were older;the first scores for stroke in hospitalwere higher（p 〈 0.05 ）. Multivariate logistic regression showed that the age（ OR = 1. 667, p = 0. 007 ）, the first score on stroke in hospital （ OR = 0. 981, p = 0. 022） and heart disease history （ OR = 1. 071, p = 0. 014） were independent risk factors affecting recurrent stroke in PSD pa- tients. Conclusion The recurrence rate of stroke in PSD patients after 2 weeks of stroke is significantly increased. Age, first score on stroke in hospital, heart disease history are the independent risk factors for recurrent stroke in PSD patients. Reasonably rectifying the impact of these risk factors will help to prevent stroke recurrence.