早期卒中后抑郁与病灶孤立的急性脑梗死的关系

Relationship between early post stroke depression and isolated lesion of acute cerebral infarction

目的探究病灶孤立的急性脑梗死与早期卒中后抑郁(post stroke depression,PSD)发生及严重程度的关系。方法纳入2018年12月~2020年12月哈尔滨医科大学附属第二医院神经内科住院治疗的病灶孤立的急性脑梗死患者215例,收集患者的临床及影像学资料。将脑梗死部位按照影像学脑部功能结构划分。采用精神障碍诊断及统计手册来判断是否发生抑郁,分为抑郁组(PSD组)45例和非抑郁组(N-PSD组)170例。根据美国国立卫生院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分和改良Rankin评分量表(modified Rankin scale,MRS)评分对脑梗死患者的疾病严重程度以及预后进行评估。依据汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评估抑郁的严重程度,并记录相应量表各因子得分。结果PSD患者中女性比例、NIHSS评分、MRS评分、病灶体积及额叶梗死比例均高于N-PSD组(P<0.05)。回归分析得到女性(P<0.001)、病灶体积(P=0.001)及额叶梗死(P<0.001)是PSD发生的独立危险因素。额叶梗死、性别及病灶体积与早期抑郁症状的严重程度无明显相关性(P>0.05)。PSD患者中,额叶梗死组在焦虑/躯体化、阻滞的评分高于非额叶梗死组(P<0.05)。结论女性、病灶体积及额叶梗死是病灶孤立的急性脑梗死早期PSD发生的独立危险因素,但与其早期抑郁症状的严重程度无明显相关性。

Objective To study the relationship between early post stroke depression(PSD)and the occurrence and severity of isolated lesion of acute cerebral infarction.Methods A total of 215 patients with isolated lesion of acute cerebral infarction in the Second Affiliated Hospital of Harbin Medical University from December 2018 to December 2020 were included,and the clinical and imaging data were collected.The location of cerebral infarction was divided according to the functional structure of brain of imaging data.Patients were divided into PSD group(n=45)and N-PSD group(n=170)by Diagnostic and Statistical Manual of Mental Disorders.The severity of the disease and prognosis of the patients with cerebral infarction were evaluated according to the National Institute of Health Stroke scale(NIHSS)and the modified Rankin score scale(MRS).The severity of depression was assessed according to the Hamilton Depression Scale(HAMD)and the score of each factor of the scale was recorded.Results The proportion of female,NIHSS,MRS,lesion volume and the proportion of frontal lobe infarction in PSD group were higher than those in N-PSD group(P<0.05).Regression analysis showed that female(P<0.001),lesion volume(P=0.001)and frontal lobe infarction(P<0.001)were independent risk factors for PSD.There was no significant correlation between frontal lobe infarction,sex,lesion volume and the severity of early depressive symptoms(P>0.05).In patients with PSD,the scores of anxiety/somatization and retardation in frontal lobe infarction group were higher than those in non-frontal lobe infarction group(P<0.05).Conclusion Female,lesion volume and frontal lobe infarction are independent risk factors for early PSD in isolated lesion of acute cerebral infarction,but had no significant correlation with the severity of early depressive symptoms.