无卒中晚发型抑郁患者危险因素及临床特征分析

Analysis of vascular risk factors and clinical features in patients with non stroke late onset depression

目的探讨晚发型抑郁患(LOD)者的临床特征及其与动脉粥样硬化危险因素、颅内外血管病变情况及脑白质损害之间的关系。方法选取2015年11月-2016年4月于同济医院神经内科就诊的年龄大于50岁、无卒中的抑郁患者60例,同时选取年龄、性别相匹配的无卒中、无抑郁的患者58例为对照。两组患者分别行头颅磁共振(MRI)、头颅CT血管成像(CTA)、颈部动脉超声检查,并进行认知及抑郁相关症状的评估。结果 LOD患者最易出现的抑郁障碍因子为焦虑躯体化因子、全身性症状、自知力差、睡眠障碍,尤其中期睡眠障碍为突出临床特征。LOD患者认知障碍发生率高于无抑郁组,视空间/执行和注意力这两方面的异常最为明显,尤其是连线、画图、倒背数字这三项能力下降明显。LOD患者与同龄对照相比,并没有更高比率的动脉粥硬化危险因素。LOD患者脑白质损害发生率及中重度度白质损害发生率均明显高于无抑郁组。LOD患者颈动脉内膜损害的比率及颈动脉严重狭窄(≥50%及以上)的比率高于无抑郁组。颅内动脉狭窄及Willis环发育不全的比率在2组之间没有明显差异。结论 LOD患者以焦虑躯体化因子、全身性症状、睡眠障碍为突出临床表现,伴随认知障碍较为常见。LOD与脑白质损害、颈动脉内膜损害可能相关。而血管性危险因素、颅内动脉狭窄与LOD无明显相关性。

Objective To explore the clinical features of the patients with late onset depression(LOD)and their relationship with atherosclerosis risk factors,intracranial vascular disease and cerebral white matter damage.Method From November 2015 to April 2016 year in Tongji Hospital Affiliated Hospital of older than 50 years and no stroke patients with depression in sixty cases,and selected age and sex matched no stroke,no depression patients fifty-eight cases as control.Two groups of patients were underwent brain MRI,head CT angiography(CTA),carotid artery ultrasound,and evaluate the cognitive and depressive symptoms.Results Depression disorder factors in the patients with LOD were the most likely to be anxiety physical factors,systemic symptoms,poor insight,sleep disorders,especially middle sleep disorders.The incidence of cognitive impairment in patients with LOD was higher than that in the non depres sion group,the most obvious in the two aspects of the visual space/executive and attention,especially in the line,drawing,down the back number three ability decreased significantly.Compared with the same age group,there was no higher rate of atherosclerosis risk factors in patients with LOD.The incidence of white matter damage and the incidence of moderate and severe white matter damage in the patients with LOD were significantly higher than that in the non depression group.Severe stenosis of carotid artery and the ratio of LOD in patients with carotid artery intimal damage(aged 50%and above)rate is higher than the non depression group.There was no significant difference between the two groups in the rate of intracranial arterial stenosis and Willis ring development.Conclusion In patients with LOD,anxiety,somatic symptoms and sleep disorders are the prominent clinical manifestations.LOD may be associated with brain white matter damage and carotid artery intimal lesion.There was no significant correlation between vascular risk factors,intracranial artery stenosis and late onset depression.