缺血性脑卒中后抑郁患者临床预后的相关因素研究

目的 探索并明确影响缺血性脑卒中后抑郁（post-ischemic stroke depression,PISD）临床预后的相关因素。方法 连续性收集曾于2016年1月1日—12月31日在海南医学院第一附属医院神经内科住院治疗,且符合纳入标准的PISD患者,采集所有患者的一般信息、临床检验资料以及梗死病灶部位情况。随访1年后,由心理专业医师再次采用17项汉密尔顿抑郁量表（17-items Hamilton Rating Scales of Depression,HAMD）进行抑郁情况评估,根据患者HAMD评估得分,将患者分为无抑郁的痊愈组（Cured group）及未痊愈组（Uncured group）两组,对两组患者间差异具有统计学意义的相关因素进行Logistic回归统计分析。结果 本次研究共纳入PISD患者148例,最终完成随访者132例。1年痊愈率为66.67%（88/132）,轻度抑郁（mild depression, miD）患者23例（17.42%）,中度抑郁（moderate depression,moD）患者13例（9.85%）以及重度抑郁（severe depression,SD）患者8例（6.06%）。痊愈组患者的平均动脉压（mean arterial pressure,MAP,t=-3.04）及肌酐水平（t=-2.14）均较未痊愈组患者低,且两组间差异均具有统计学意义（P<0.05）,两组间基底节病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,MAP与基底节（basal ganglia,BG）病灶是PISD预后的相关因素（OR值分别为2.18、10.33）。结论 MAP及基底节病灶可能是PISD预后的相关危险因素,因此,早期干预及认识该因素,将有助于改善PISD患者的预后情况。

Related factors of clinical prognosis in patients with post-ischemic stroke depression

Objective To explore and identify the related factors that affect the prognosis of post-ischemic stroke depression (PISD). Methods The patients hospitalized in the Department of Neurology in the First Affiliated Hospital of Hainan Medical University and diagnosed with PISDfrom January 1, 2016 to December 31, 2016 were included. General information, clinical test data, and lesion locations were collected from all patients. After one year of follow-up, 17-item version of the Hamilton Rating Scales of Depression (HAM-D17) was used by psychologists to assess depression. According to the score of HAM-D17 assessment, the patients were divided into the cured group and the uncured group. Logistic regression analysis was used to analyze the related factors which had statistically significant difference between the two groups. Results In this study, 148 cases of PISD were included, and finally 132 patients completed the follow-up. The cured rate of one years was 66.67% (88/132), of which 23 cases (17.42%) of mild depression (miD), 13 patients (9.85%) with moderate depression (moD) and 8 patients (6.06%) with severe depression (SD). The levels of mean arterial pressure (MAP) (t=-3.04) and creatinine (t=-2.14) in the cured group were significantly lower than those in the uncured group (P<0.05). The difference of basal ganglia (BG) between the two groups was statistically significant (P<0.05). In addition, multivariate logistic regression analysis showed that MAP and BG were prognostic factors of PISD (OR values were 2.18, 10.33, respectively). Conclusions MAP and BG may be the related risk factors of PISD prognosis. Therefore, the early intervention and understanding of this factor will help to improve the prognosis of PISD patients.