抑郁症患者脑小血管病共患率及相关因素

Comorbidity rate of cerebral small vessel disease in patients with depression and its related factors

目的:了解抑郁症患者脑小血管病的患病情况,探讨抑郁症与脑小血管病的关联性,为早期防治提供依据。方法:纳入病情稳定且符合疾病及有关健康问题的国际统计分类第十次修订本(ICD-10)抑郁发作和复发性抑郁障碍诊断标准的患者80例,正常对照97例,采用蒙特利尔认知评估量表(Mo-CA)、简明精神状况测查(MMSE)、汉密顿抑郁量表、汉密顿焦虑量表测评两组被试的认知功能和情绪状态,并收集相关病史资料。用头颅磁共振成像(MRI)数据评估脑小血管病阳性检出率和MRI诊断特征,采用logistic回归分析抑郁症与脑小血管病的关联关系。结果:抑郁症组与正常对照组年龄分别为(59±9)岁和(58±8)岁(P>0.05)。抑郁症组有高血压病史者比例高于正常对照组,MoCA总分低于正常对照组(均P<0.05)。抑郁症组符合脑小血管病诊断者比例高于正常对照组(83.8%vs.64.9%,P<0.01)。Logistic回归结果显示腔隙性脑梗死(OR=4.4,95%CI:1.07~18.23)、额叶脱髓鞘(OR=2.4,95%CI:1.05~5.42)及MoCA<26分(OR=2.3,95%CI:1.16~4.47)是抑郁症的危险因素。结论:共患脑小血管病在中老年抑郁症患者中较常见,腔隙性脑梗死和额叶脱髓鞘可能是中老年抑郁的危险因素。

Objective:To explore the correlation between depression and comorbidity of cerebral small vessel disease(CSVD)in patients with depression,so as to provide evidence for early prevention and treatment Methods:Totally 80 patients with stable depressive episode and recurrent depressive disorder according to the International Statistical Classification of Diseases and Related Health Problems,Tenth Revision(ICD-10),as well as 97 normal controls were included.Medical history was collected,and cognitive function and mental status were assessed using Montreal Cognitive Assessment MoCA),Mini-Mental State Examination MMSE),Hamilton Depression Scale and Hamilton Anxiety Scale.Positive rate of CSVD diagnosis and the relevant magnetic resonance imaging(MRI)diag­nostic features were evaluated by cranial MRL Logistic regression analysis was used to analyze the correlation be­tween depression and CSVD.Results:The age of depression group and normal control group were(59±9)years and(58±8)years,respectively(P>0.05).Higher proportion of hypertension and lower MoCA total scores were seen in the depression group than in the normal control group(Ps<0.05).The proportion of CSVD was higher in the depression group than in the normal control group(83.8%vs.64.9%,P<0.01).Logistic regression analysis showed that lacunar cerebral infarction(OR=4.4,95%Cl:1.07-18.23),frontal lobe demy eh nation(OR=2.4.95%Cl:1.05-5.42)and MoCA<26(OR=2.3,95%Cl:1.16-4.47)were the risk factors of depression.Conclusion:Co morbid CSVD is common in the middle-aged and elderly patients with depression,for whom lacunar cerebral infarction and frontal lobe demyelination maybe the risk factors.