缺血性脑卒中后抑郁的临床特点及相关因素分析

The characteristics and correlates of post-ischemic stroke depression

目的探索缺血性脑卒中后抑郁(post-ischemic stroke depression,PISD)的临床特点及发病的相关因素。方法 2016年1月—2017年12月于海南医学院第一附属医院神经内科就诊的急性缺血性脑卒中(acute ischemicstroke,AIS)患者487例,于第3个月月底进行随访及抑郁评估,根据是否合并抑郁诊断,将其分为缺血性脑卒中后无抑郁组(non-post-ischemic stroke depression,NPISD)和抑郁组(PISD),采集两组患者的人口学资料、既往病史及相关临床指标并进行比较统计分析。结果本研究共纳入487例急性缺血性脑卒中患者,其中PISD组232例,PISD发生率为47.64%(232/487);PISD组患者年龄[(62.52±11.57)岁]低于NPISD组患者[(67.95±11.63)岁](P<0.05);两组患者血小板计数(platelet count,PLT)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、球蛋白、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)及超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)等差异均具有统计学意义(P<0.05);另外,两组患者额叶、顶叶、枕叶、岛叶、脑干及基底节梗死灶差异具有统计学意义(P<0.05)。此外,多因素Logistic回归分析结果表明,中年、女性、脑干及基底节病灶是PISD发生的相关危险因素(OR值分别为2.71、3.27、3.46、3.82)。结论 PISD患者发生率较高,中年、女性、脑干及基底节病灶可能是PISD发生的相关危险因素,因此,认识其临床特点,将有助于早期识别并诊断PISD。

Objective To explore the clinical characteristics and related factors of post-ischemic stroke depression（PISD）. Methods The 487 patients with acute ischemic stroke（AIS） in the Department of Neurology in the First Affiliated Hospital of Hainan Medical University from January 2016 to December 2017 were included, and a depression assessment were been in progress at the end of third months. According to the diagnosis of depression, the patients were divided into the non-PISD（NPISD） and the PISD group. Demographics, history, clinical features of two groups were collected and analyzed statistically. Results A total of 487 patients with AIS were included in this study. Among them, 232 cases in group PISD, the incidence of PISD was 47.64%（232/487）. Patients in group PISD [（62.52± 11.57） years] were younger than those in group NPISD [（67.95±11.63） years]（P〈0.05）. The differences of platelet count（PLT）, alanine aminotransferase（ALT）, globulin, high-density lipoprotein cholesterol（HDL-C） and hypersensitive C-reactive protein（hs-CRP） between the two groups were statistically significant（P〈0.05）.Compared of NPISD group, ischemic stroke in frontal lobe, parietal lobe, occipital lobe,insula, brain stem and basal ganglia were significantly different in PISD group（P〈0.05）. Multivariate Logistic regression analysis showed that middle-aged, female, stroke in brain stem and basal ganglia were risk factors of PISD（OR values were 2.71, 3.27, 3.46, 3.82, respectively）. Conclusion The incidence of PISD is high, and middle-aged, female, stroke in brain stem and basal ganglia may be the risk factors of PISD. Recognizing its clinical characteristics will help to identify and diagnose PISD early.