未破裂颅内动脉瘤患者血管内治疗前产生焦虑和抑郁情绪影响因素分析

目的 探究未破裂颅内动脉瘤(UIA)患者血管内治疗前后焦虑、抑郁状况,分析UIA患者血管内治疗前产生焦虑、抑郁情绪的影响因素.方法 前瞻性纳入2019年2月至2020年12月就诊于海军军医大学第一附属医院脑血管病中心的156例UIA患者,分别于血管内治疗前1～2 d(医师术前谈话后)以及血管内治疗后出院前行汉密尔顿焦虑...

Analysis of influencing factors of anxiety and depression in patients with unruptured intracranial aneurysm before endovascular treatment

Objective To explore the anxiety and depression of unruptured intracranial aneurysm(UIA)patients before and after endovascular treatment,and to analyze the influencing factors of the anxiety and depression of patients with UIA before endovascular therapy.Methods A total of 156 UIA patients admitted to the Cerebrovascular Disease Center,First Hospital Affiliated to Naval Military Medical University from February 2019 to December 2020 were prospectively enrolled.Hamilton anxiety scale(HAMA)and Hamilton depression scale(HAMD)were evaluated 1 to 2 days before endovascular treatment(after preoperative conversation)and before discharging after endovascular treatment,respectively.HAMA score≥7 indicated anxiety and HAMD score≥8 indicated depression.Demographic and clinical data were recorded,including gender,age,education level(primary school,junior middle school,senior high school,university and above),and annual family income(≤50000,>50000-100000,>100000-200000,>200000 yuan).Clinical data included hypertension,diabetes,myocardial disease,smoking history,drinking history,UIA discovery method(symptomsheadache,dizziness,tinnitus,etc.],occasionalphysical examination,etc.]),diagnosis time,aneurysm location(internal carotid artery,anterior cerebral artery,middle cerebral artery,vertebro-basilar artery,mixed typeincluding two or more parts of internal carotid artery,anterior cerebral artery,middle cerebral artery,vertebro-basilar artery]),maximum diameter and number of aneurysms(single and multiple aneurysms≥2]).HAMA and HAMD scores before and after endovascular treatment were analyzed by nonparametric sign rank test,and the proportion of anxiety and depression before and after endovascular treatment was analyzed by paired sample Chi-square test.Using demographic and clinical data as independent variables,multivariate binary Logistic regression was used to analyze the independent risk factors of anxiety and depression in UIA patients before endovascular treatment.Results(1)Anxiety:the proportion of patients with anxiety after endovascular treatment was lower than that before treatment(39.1%61/156]vs.51.3%80/156],χ²=5.7,P<0.05).After endovascular treatment,the scores of mental anxiety,somatic anxiety and HAMA anxiety scores were significantly lower than those before treatment(3.01.0,7.8]points vs.5.03.0,10.8],Z=-9.19;1.00.0,4.0]points vs.2.01.0,5.0]points,Z=-7.89;4.02.5,11.0]points vs.7.05.0,14.8],Z=-9.62;all P<0.01).(2)Depression:the proportion of patients with depression after endovascular treatment was lower than that before treatment(35.3%55/156]vs.46.8%73/156],χ²=4.3,P<0.05);there were statistically significant differences in somatization of anxiety,cognitive impairment,day-night change,block,sleep disturbance,despair score and HAMD score in UIA patients before and after endovascular treatment(before and after treatment:2.01.0,4.0]points and 1.00.0,2.0]point,Z=-6.4;1.00.0,2.0]point and 1.00.0,2.0]point,Z=-3.7;0.00.0,0.0]point and 0.00.0,0.0]point,Z=-2.3;1.00.0,3.0]point and 1.00.0,2.0]point,Z=-6.3;2.01.0,3.0]points and 1.00.0,2.0]point,Z=-4.9;1.00.0,1.0]point and 1.00.0,1.0]point,Z=-2.1;7.03.0,15.0]points and 4.01.0,10.8]points,Z=-8.9;all P<0.05);there was no significant difference in body mass change score before and after treatment(P>0.05).(3)Anxiety and depression before endovascular treatment were taken as dependent variables,the patient′s age(from low to high),male,smoking,drinking,education level(college and above for reference),annual family income(>200000 yuan for reference),having underlying diseases,the maximum diameter aneurysm(from small to large)and aneurysm location(mixed type for reference),single aneurysms and aneurysm discovery method(symptom)as the independent variable for Logistic regression analysis.The results showed that UIA diagnosed in the form of symptoms such as headache,dizziness and tinnitus was an independent risk factor for anxiety,compared with those found by chance in physical examination(OR,4.71,95%CI 1.63-13.62,P=0.004).Compared with patients with annual household income>200000 yuan,patients with annual income≤50000 yuan and>50000-100000 yuan had 20.69 times(95%CI 2.90-148.10,P=0.003)and 23.75 times(95%CI 3.97-142.10,P=0.001)of anxiety,respectively.The age,male,smoking,drinking,education level,annual family income>100000-200000 yuan,underlying diseases,aneurysm largest diameter,aneurysm location,single aneurysm were not associated with anxiety(all P>0.05).Compared with education level of university and above,the risk of depression was 5.79 times(95%CI 1.76-19.10,P=0.004)and 6.00 times(95%CI 1.92-18.52,P=0.002),respectively.Compared with patients with annual household income>200000 yuan,patients with annual household income≤50000 yuan had 5.06-fold risk of depression(95%CI 1.09-23.64,P=0.040).However,age,male,smoking,drinking,senior high school,annual family income(>50000-100000 yuan and>100000-200000 yuan),underlying diseases,aneurysm diameter,aneurysm location,single aneurysm,aneurysm discovery method(symptoms)were not associated with depression(all P>0.05).Conclusions UIA patients are prone to be anxiety and depression.After endovascular treatment,the prevalence and degree of anxiety and depression in patients are significantly lower than that before endovascular treatment.UIA patients with low education level,poor economic conditions and symptoms such as headache and dizziness are more prone to become anxiety and depression.The conclusions of this study need to be further verified.