急性卒中患者的躯体化症状：临床特征和影响因素

Somatic symptoms in patients with acute stroke： clinical features and influencing factors

目的探讨急性卒中患者躯体化症状的临床特征和影响因素。方法纳入急性卒中患者，应用90项症状清单（symptom checklist 90, SCL-90）躯体化因子部分评分将患者分为躯体化症状组（≥24分）和对照组（〈24分）。记录和比较其年龄、性别、经济水平、教育程度、基础疾病、汉密尔顿焦虑量表（Hamilton Anxiety Scale, HAMA）、汉密尔顿抑郁量表（Hamilton Depression Scale, HAMD）、大五人格量表评分、社会支持量表简体中文版评分、简易精神状态检查量表（Mini-Mental State Examination, MMSE）评分、美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale, NIHSS）评分。结果共纳入急性卒中患者70例，其中33例（47.1%）存在躯体化症状。躯体化症状组人口统计学特征、受教育程度、家庭经济收入、职业、婚姻状况、独居情况、居住地、医疗费用支付方式以及社会支持评分均与对照组无显著差异，卒中类型、病灶侧别以及基线NIHSS、MMSE和大五人格量表评分亦与对照组无显著差异。躯体化症状组病灶部位与对照组存在显著差异（χ2＝0.161，P＝0.006）。神经心理学测验结果比较显示，躯体化症状组伴发焦虑状态的患者比例显著高于对照组（24.2%对5.4%；χ2＝5.055，P＝0.025），但伴发抑郁状态的患者比例无显著差异；剔除符合焦虑和抑郁标准的病例后，躯体化症状组（n＝25）HAMA[（8.08±3.12）分对（5.58±3.06）分；t＝－3.059，P＝0.003]和HAMD[（10.80±4.81）分对（7.73±3.88）分；t＝－2.694，P＝0.009]评分均显著高于对照组（n＝33）。躯体化症状组躯体化症状数量显著多于对照组（Z＝－5.817，P〈0.001），而且更易出现疼痛症状（97.0%对73.0%；χ2＝7.584，P＝0.006）。相关性分析显示，患者SCL-90躯体化因子12项得分与HAMA（r＝0.494，P〈0.001）和HAMD（r＝0.369，P＝0.002）评分存在显著正相关联系。多变量logistic回归分析显示，HAMA评分为卒中后躯体化症状的独立危险因素（优势比1.286，95%可信区间1.060～1.560；P＝0.011）。结论 急性卒中后躯体化症状发生率高，尤其是皮质卒中患者。卒中后躯体化患者易出现疼痛症状。卒中后焦虑和抑郁状态患者易伴发躯体化症状，HAMA评分是急性卒中后出现躯体化症状的独立危险因素。

Objective To investigate the clinical features and influencing factors of somatic symptoms in patients with acute stroke. Methods Patients with acute stroke were enrolled in the study. Using the scores of symptom checklist 90 （SCL-90）-somatization factor part, the patients were divided into either a somatic symptom group （≥24） or a control group （〈24）. Their age, gender, economic level, education level, underlying diseases, Hamilton Anxiety Scale （HAMA）, Hamilton Depression Scale （HAMD）, NEO Five- Factor Inventory scores, Social Support Rating Scale scores-simplified Chinese version, Mini-Mental State Examination （MMSE） scores, National Institute of Health Stroke Scale （NIHSS） scores were documented and analyzed. Results A total of 70 patients with acute stroke were enrolled, and 33 （47.1%） of them had somatic symptoms. There were no significant differences in demographic characteristics, education level, family income, occupation, marital status, living alone, residence, medical expenses payment methods and social support scores between the somatic symptom group and the control group. There were also no significant differences in the types of stroke, lesion side, baseline NIHSS score, MMSE score, and NEO Five-Factor Inventory score between the 2 groups. There was significant difference in lesion side between the somatic symptom group and the control group （χ2 = 0.161, P= 0.006）. The comparison of neuropsychological test results showed that the proportion of patients with an anxiety state of the somatic symptom group was significantly higher than that of the control group （24. 2% vs. 5.4% ;χ2 =5. 055, P = 0. 025）, but there was no significant difference in the proportion of patients with depression status; after excluding the cases who met the anxiety and depression criteria, HAMA （8.08 ± 3.12 vs. 5.58± 3.06; t = - 3. 059, P = 0. 003） and HAMD （10. 80 ± 4. 81 vs. 7.73 ± 3.88; t = - 2. 694, P = 0. 009） scores of the somatic symptom group （n = 25） were significantly higher than those of the control group （n = 33）. The number of somatic symptoms of the somatic symptom group was significantly more than that of the control group （Z = - 5.817, P 〈 0. 001 ）, and was more likely to have pain symptoms （97. 0% vs. 73.0% ; χ2 = 7. 584, P =0. 006）. The correlation analysis showed that there was a significant positive correlation in the 12-item scores of the SCL-90 somatic factors and HAMA （r = 0. 494, P 〈 0. 001） and HAMD （r = 0. 369, P=0. 002） scores in patients. Multivariate logistic regression analysis showed that HAMA score was an independent risk factor for somatic symptoms after stroke. （odds ratio 1. 286, 95% confidence interval 1. 060-1.560; P=0.011）. Conclusions The incidence of somatic symptoms is high after acute stroke, especially in patients with cortical stroke. The somatic patients after stroke are prone to have pain-related symptoms. The patients with anxiety and depression status after stroke are prone to have somatic symptoms after stroke; HAMA score is an independent risk factor for having somatic symptoms after stroke.