脑小血管病总体负担预测卒中后抑郁的价值分析

Value of total burden of cerebral small vessel disease in predicting post stroke depression

目的 评估脑小血管病(cerebral small vessel disease,CSVD)总体负担预测急性缺血性卒中患者发生卒中后抑郁(post stroke depression,PSD)的价值。方法 以317例急性缺血性卒中患者为研究对象,根据卒中发病后3个月时是否发生PSD分为PSD组和非PSD组,通过单因素和多因素分析明确CSVD总体负担与PSD的独立相关性,并采用接收者工作特征(receiver operating characteristics,ROC)曲线评估预测价值。结果 87例患者(27.4%)发生PSD,调整年龄、糖尿病、空腹血糖、卒中分布和高血压后,CSVD总体负担(OR:1.297,95%CI:1.104-1.583,P=0.012)和NIHSS评分(OR:1.185,95%CI:1.079-1.376,P=0.007)是PSD的独立危险因素。ROC曲线显示,CSVD总体负担预测PSD的AUC为0.780(SE:0.029,P <0.001,95%CI:0.723-0.837)。最佳截断值为2,灵敏度和特异度分别为79.3%和66.5%。结论 CSVD总体负担具有应用于PSD预测的潜力。

Objective To evaluate the value of total burden of cerebral small vessel disease(CSVD)in predicting post stroke depression(PSD)among acute ischemic stroke patients. Methods A total of 317 patients undergoing acute ischemic strokewere included in this study and were divided into PSD group and non-PSD group according to occurrence of PSD at three months after stroke onset. Univariate and multivariate analysis were performed to identify the independent association between total burden of CSVD and PSD. Receiver operating characteristics(ROC)curve was used to evaluate the value of total burden of CSVD in predicting PSD.Results Eighty-seven cases occurred PSD(accounting for 27.4%). Total burden of CSVD(OR:1.297, 95% CI:1.104-1.583, P =0.012)and NIHSS score(OR:1.185, 95% CI:1.079-1.376, P = 0.007)were independent risk factors of PSD after adjusting for age,diabetes, fasting blood glucose, stroke distribution and hypertension. The ROC curve showed that the area under curve(AUC)of total burden of CSVD was 0.780(SE:0.029, P < 0.001, 95% CI:0.723-0.837)when applied in predicting PSD. The optimal cutoff was 2,and sensitivity and specificity were 79.3% and 66.5%, respectively. Conclusion Total burden of CSVD had potential to predict PSD.