高原地区急性期脑卒中后抑郁的危险因素分析

Risk factors of acute post-stroke depression at high altitude

目的探讨高原地区脑卒中患者急性期脑卒中后抑郁(PSD)的发生及危险因素。方法收集世居西宁地区(海拔约2200米,中海拔)、海南州地区(海拔约3000米,高海拔)住院的急性脑出血及动脉粥样硬化性脑梗死、且资料完整的汉族患者各100例和60例,分为抑郁组39例和非抑郁组121例,进行17项汉密尔顿抑郁量表(HDRS17)、美国国立卫生研究院卒中量表(NIHSS)及匹兹堡睡眠质量指数(PSQI)评分,分别用散射比浊法、ELISA法测血清高敏C反应蛋白(hs-CRP)和白细胞介素6(IL-6)及TNF-α水平。结果急性期PSD总发生率为24.4%,中海拔与高海拔地区PSD发生率比较无统计学差异(23.0%vs 26.7%,P>0.05)。PSD组患者NIHSS评分、血清hs-CRP、IL-6、TNF-α高于非PSD组(P<0.05,P<0.01)。女性、NIHSS、血清hs-CRP、IL-6、TNF-α是PSD发生的危险因素。PSD组高海拔地区患者血清hs-CRP、IL-6、TNF-α高于中海拔地区[(5.37±1.90)mg/L vs(3.93±1.53)mg/L,(18.34±3.21)ng/Lvs(16.33±2.77)ng/L,(81.94±9.63)ng/Lvs(74.70±8.05)ng/L,P<0.05];且HDRS17及PSQI评分高于中海拔地区[(18.62±3.54)分vs(15.21±4.85)分和(15.75±3.90)分vs(12.36±5.02)分,P<0.05]。结论高原地区脑卒中患者急性期PSD发生与国内平原相当,女性、NIHSS、血清hs-CRP、IL-6、TNF-α是PSD发生危险因素,炎性反应及睡眠质量在急性期PSD发生中发挥一定作用。

Objective To study the incidence and risk factors of acute post-stroke depression（PSD）in stroke patients at high altitude.Methods One hundred and sixty patients with acute cerebral hemorrhage and atherosclerotic ischemic stroke admitted to our hospital from different high altitudes were divided into PSD group（n=39）and PSD-free group（n=121）.Their HDRS17,NIHSS,PSQI scores were recorded.Their serum hs-CRP,IL-6and TNF-αlevels were measured by scattering turbidimetry and ELISA respectively.The risk factors of acute PSD at different high altitudes were analyzed.Results The total incidence of acute PSD was 24.4%,no significant difference was found in the incidence of acute PSD between 2200 and 3000 meters altitude.Female,NIHSS score,serum level of hs-CRP,IL-6and TNF-αwere the risk factors of acute PSD.The serum levels of hs-CRP,IL-6and TNF-αwere significantly higher in PSD patients from 3000 meters altitude than in those from 2200 meters altitude（5.37±1.90mg/Lvs 3.93±1.53mg/L,18.34±3.21ng/L vs 16.33±2.77ng/L,81.94±9.63ng/L vs 74.70±8.05ng/L,P〈0.05）.The HDRS17 and PSQI scores were significantly higher in PSD patients from 3000 meters altitude than in those from 2200 meters altitude（18.62±3.54 vs 15.21±4.85,15.75±3.90 vs 12.36±5.02,P〈0.05）.Conclusion The incidence of acute PSD at high altitude is similar to that in plain areas.Female,NIHSS score,serum hs-CRP,IL-6and TNF-αlevels are the risk factors of acute PSD.Inflammation and sleep quality play a certain role in the occurrence of acute PSD.