急性期首发脑卒中后抑郁状态与认知功能障碍的相关危险因素研究

Risk factors for depression and cognitive impairment after first acute ischemic stroke

目的探讨急性期首发脑卒中后抑郁状态(post-stroke depression,PSD)与脑卒中后认知功能障碍(poststroke cognitive impairment,PSCI)的相关危险因素分析。方法选择2015年1月~2016年7月在北京市海淀医院神经内科住院的急性期首发缺血性脑卒中患者103例,根据汉密尔顿抑郁量表评分分为非PSD组77例,PSD组26例。又根据蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分分为非PSCI组30例,PSCI组73例,评估抑郁情绪和认知功能损伤,记录人口学资料和临床指标。多元logistic回归分析PSD和PSCI的各种危险因素。结果 PSD组冠心病、同型半胱氨酸、前部病灶、汉密尔顿焦虑量表(HAMA)、MoCA<21分比例明显高于非PSD组[38.5%vs 19.5%,P=0.04;(20.12±12.96)μmol/L vs(14.73±6.41)μmol/L,P=0.01;84.6%vs61.0%,P=0.02;(12.04±9.95)分vs(3.35±2.79)分,P=0.00;65.4%vs 42.9%,P=0.04]。PSCI组年龄、独居比例明显高于非PSCI组,男性、中学以上教育程度、吸烟、饮酒、血红蛋白水平明显低于非PSCI组,差异有统计学意义(P<0.05)。多元logistic回归分析显示,HAMA、同型半胱氨酸为PSD的独立危险因素,年龄是PSCI的独立危险因素(P<0.05)。结论急性期首发PSD和PSCI的相关性不明确,两者有各自独立的危险因素。

Objective To study the risk factors for PSD and post-stroke cognitive impairment（PSCI）after first AIS.Methods One hundred and three AIS patients were divided into non PSD group（n=77）and PSD group（n=26）according to their HAMD score and into non-PSCI group（n=30）and PSCI group（n=73）according to their MoCA score.Their depression and congnitive impairment were assessed,their demographic and clinical data were recorded.Risk factors for PSD and PSCI were analyzed by multivariate logistic regression analysis.Results The incidence of CHD,serum homocysteine level,rate of foci in front of head,HAMA score and rate of MoCA score21 were significantly higher in PSD group than in non PSD group（38.5%vs 19.5%,P=0.04;20.12±12.96μmol/L vs 14.73±6.41μmol/L,P=0.01;84.6%vs 61.0%,P=0.02;12.04±9.95 vs 3.35±2.79,P=0.00;65.4% vs 42.9%,P=0.04）.The age was significantly older,the rate of solitudianrians was significantly higher,the number of males was significantly greater,the middle school education level was significantly higher,the history of smoking and alcohol comsumption was significantly longer,the serum hemoglobulin level was significantly higher in PSCI group than in non PSCI group（P〈0.05）.Multivariate logistic regression analysis showed that anxiety and hyperhomocysteinemia were the independent risk factors for PSD and age was the independent risk factor for PSCI（P〈0.05）.Conclusion The relationship between first acute PSD and PSCI is uncertain.PSD and PSCI are characterized by their own independent risk factors.