缺血性脑卒中患者远期抑郁症状的发生率及相关因素分析

Analysis of the morbidity and related factors of long-term depressive symptoms in patients with ischemic stroke

目的探讨首发缺血性脑卒中(IS)偏侧肢体功能障碍患者远期抑郁症状(DS)的发生率及影响因素。方法前瞻性研究连续入选商丘市第一人民医院神经内科2012-11—2013-07收治的首发IS偏侧肢体功能障碍患者126例,入组后收集患者一般资料并采用美国国立卫生研究院卒中量表(NIHSS)、改良Rankin Scale(MRS)评分进行评估,发病后2~3a采用NIHSS、MRS评分、Barthel指数(BI)、脑卒中专用生活质量量表(SS-QOL)、汉密尔顿抑郁评分量表(HDRS)再次随访。通过单因素分析筛选出与远期抑郁症状(DS)具有显著性联系的因素后,使用非条件Logistic回归分析DS的影响因素。结果首发IS偏侧肢体功能障碍患者中远期抑郁症状发生率38.6%(44/114),其中轻、中、重度分别占19.3%(22/114)、11.4%(13/114)、7.9%(9/114)。多因素非条件Logistic回归分析结果显示,首发IS偏侧肢体功能障碍患者远期DS的影响因素包括文化程度(OR=2.847,95%CI=1.241~6.532)、BI(OR=0.763,95%CI=0.648~0.916)、SS-QOL评分(OR=0.970,95%CI=0.937~0.989)。且轻、中、重度抑郁症状患者的远期BI评分(F=29.426,P<0.01)和SS-QOL评分(F=21.379,P<0.01)的总体均数不同。结论 IS偏侧肢体功能障碍患者远期DS的危险因素为文化程度高,保护因素为远期BI评分高、生活质量高。其中远期BI评分、SS-QOL评分越低,IS偏侧肢体功能障碍患者的远期抑郁症状越重。日常生活能力的恢复及生活质量的提高等可能是改善IS偏侧肢体功能障碍患者远期抑郁症状的重要措施。

Objective To estimate the prevalence rate and related risk factors of long-term depressive symptoms （DS） in first-episode ischemic stroke （IS） patients with unilateral limb disorder. Methods After our prospective research having consecu- tively collected 126 patients who suffered from first-episode IS and unilateral limb disorder from November 2012 to July 2013 ,we gathered all patients＇ general information and used NIHSS and modified Rankin Scale （MRS） to assess patients＇ disease states. 2~3 years after stroke, a follow-up research continued to use NIHSS, MRS,Barthel Index （BI）, stroke specific quality of life （SS- QOL） and the Hamilton Depression Rating Scale （HDRS） to evaluate body and function impairment. The related factors for af- fecting long-term DS were identified by univariate analysis and were further researched by unconditioned Logistic regression analy- sis. Results Of the selected 126 patients, the occurrence rate of long-term DS was 38.60 % （44/114）. Mild, moderate and severe DS patients accounted for 19.30% （22/114）, 11.40% （13/114） and 7.90% （9/114）, respectively. Multivariate unconditioned Lo- gistic regression showed that education level （OR = 2. 847,95 % CI ： 1. 241 to 6. 532）, BI scores （OR= 0. 763,95 % CI ： 0. 648 to 0. 916） and SS-QOL scores （OR=0. 970,95% CI：0. 937 to 0. 989） were the influencing factors of long-term DS. As for popula- tion mean,the long-term BI scores of mild, moderate and severe DS patients （F = 29. 426, P〈0. 01） differed from SS-QOL scores （F=21. 379,P〈0.01）. Conclusion The risk factor of long-term DS in first-episode ischemic stroke patients is high education level and the protective factors are high long-term BI scores and high quality of life. The less scores the long-term BI and SS-QOL present,the severer depressive symptoms patients suffer. Our study suggests that the important measures of improving long-term DS in IS patients may recover daily living ability and improve the quality of life.