卒中后抑郁病理机制及药物治疗进展

Pathological Mechanism and Drug Therapy for Post Stroke Depression

卒中后抑郁(post stroke depression,PSD)是卒中后神经精神并发症中最常见的一种,在中国大陆卒中患者中的发病率>40%,对卒中患者的肢体功能恢复、脑功能改善、生活质量等均有不利的影响,同时增加了卒中的致残率和致死率。但迄今为止针对PSD的发病机制尚无明确定论,其过程可能涉及到了炎症免疫系统、单胺类神经递质系统、氧化应激和神经营养因子等诸多因素。临床发现药物干预对PSD的治疗、预防均有较好的效果,并且可能有助于卒中患者肢体功能和认知水平的恢复,但研究证据仍不足以支持常规使用药物对PSD进行预防。由此,PSD进一步的发病机制研究及相关的生物标志物筛查将为制定合理的药物治疗方案提供依据。本文对PSD的发病机制、药物治疗现状以及PSD潜在生物标志物等的研究进展进行综述。

Post-stroke depression（PSD） is the most common complication of post-stroke neuropsychiatric disorders with a prevalence of above 40% in patients with stroke in China's Mainland. PSD has a detrimental impact on the recovery of physical function, cognition and the quality of life in stroke patients, exaggerating the disability and mortality of stroke. However, the pathological mechanism of PSD remains unclear, possibly involving the disturbance of inflammatory immune system, monoamine neurotransmitter system, oxidative stress and neurotrophic factors. It has been found that drug therapy has a benefit effect on the recovery of physical function and cognition in stroke patients with PSD, but the evidence is still insufficient to support the routine drug strategy to prevent PSD. Thus, further research on PSD pathological mechanisms and related biomarker screening will provide a basis for the development of a reasonable drug treatment strategy. In this paper, the potential pathological mechanisms of PSD, the advances of clinical drug treatment and the research progress of PSD biomarkers have been reviewed and summarized.