中老年抑郁障碍与脑白质疏松的相关性及阿司匹林干预研究

Study on relationship between depressive disorder and leukoaraiosis in middle-aged and elder patients and its interference with aspirin

目的分析中老年抑郁障碍与脑白质疏松(LA)的相关性,并探讨阿司匹林干预对抑郁障碍的改善作用。方法选择2014年8月至2015年4月收治的中老年抑郁障碍患者80例,根据MRI检查结果,将患者分为非LA组和LA组,LA组再分为干预组和对照组。评估LA的发病情况及程度,观察不同LA程度患者的HAMD-24评分。所有患者均给予盐酸舍曲林片50 mg/d,干预组同时给予阿司匹林肠溶片0.1 g/d口服。分别在治疗前、治疗后6个月、12月进行HAMD-24量表、血清学[胆固醇、空腹血糖(FBG)、同型半胱氨酸(Hcy)、C反应蛋白(CRP)等]检测;于治疗前、治疗后12月进行头颅MRI、颈动脉超声等检测,并记录脑卒中及不良心血管事件(MACE)情况。结果中老年抑郁障碍患者LA的发生率为60.0%,随着LA程度的增加,HAMD-24评分显著升高(P<0.05);非LA组HAMD-24评分、AS斑块评分显著低于干预组和对照组(P<0.05);治疗后6个月、12个月,干预组HAMD-24评分、C反应蛋白、同型半胱氨酸、稳定和不稳定AS斑块积分均显著低于对照组(P<0.05);干预组随访12个月内脑卒中、MACE的总发生率明显低于对照组(P<0.05)。结论中老年抑郁患者LA的发生率较健康人群明显增加,且与LA程度关系密切,对合并LA患者给予抗血小板聚集干预可减缓甚至逆转LA病变的发展,同时改善抑郁症状。

Objective To analyze the relationship between depressive disorder and leukoaraiosis （LA） in middle - aged and elder pa- tients, and to explore the effect of aspirin in improvement of depressive disorder. Methods A total of 80 middle - aged and elder patients with de- pressive disorder in this hospital during August 2014 to April 2015 were selected. All these patients were divided into non LA group and LA group according to the results of MRI, patients in LA group were further divided into intervention group and control group, the incidence and degree of LA were evaluated, and the HAMD - 24 scores among different degrees of LA were observed. All these patients were given with dispersible sertra- line hydrochloride 50 rag/d, and patients in intervention group were orally given with aspirin enteric - coated tablets 0. lg/d. The HAMD - 24 scale, serological indexes including levels of cholesterol, fasting blood glucose （ FBG）, homoeysteine （Hey） and C - reactive protein （CRP） were detected before and after treatment for 6 months. MRI and carotid ultrasound were performed before and after treatment for 6 months, and the inci- dence of-stroke and adverse cardiovascular events （MACE） were recorded. Results The incidence of LA in middle - aged and elder patients with depressive disorder was 60.0%, HAMD - 24 scores were significantly increased with the increase of LA degrees （ P 〈 0.05 ）. The HAMD - 24 scores, the AS plaque scores in patients of non LA group were significantly lower than those of patients in intervention group and control group （ P 〈 0.05 ）. In 6 and 12 months after the treatment, the HAMD - 24 scores, CLIP, Hey, stable and unstable AS plaque scores in patients of inter- vention group were significantly lower than those of control group （ P 〈 0.05 ）. During the follow - up period of 12 months, the incidence rates of stroke and MACE in patients of intervention group were markedly lower than those of patients in control group （ P 〈 0.05 ）. Conclusion The in- cidence of LA in middle - aged and elder patients with depressive disorder is markedly increased, and it is closely correlated with the degree of LA. Antiplatelet agglutination medication for depressive disorder associated with LA can slow down or even reverse the development of lesions of LA, and at the same time it may improve the symptoms of depression.