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| 老年急性缺血性脑卒中患者衰弱与卒中后抑郁的相关性研究 | |
| 引用本文： | 尚晓峰,张莹,李虹,王苏,冉秀荣,王潭. 老年急性缺血性脑卒中患者衰弱与卒中后抑郁的相关性研究[J]. 中国全科医学, 2020, 23(30): 3834-3838. DOI: 10.12114/j.issn.1007-9572.2020.00.462 |
| 作者姓名： | 尚晓峰 张莹 李虹 王苏 冉秀荣 王潭 |
| 作者单位： | 1.476100河南省商丘市第一人民医院全科医学科 2.476100河南省商丘市第一人民医院神经内科 3.250012山东省济南市，山东大学齐鲁医院老年神经内科 *通信作者：尚晓峰，主治医师；E-mail：xiaofeng8435@163.com Stroke；Brain ischemia；Frailty；Aged；Depression；Root cause analysis |
| 基金项目： | 基金项目：河南省医学科技攻关计划项目（2011030040） |
| 摘 要： | 背景 随着我国人口老龄化进程的不断加剧，老年脑卒中患者的数量也逐年增加，卒中后抑郁（PSD）作为脑卒中的常见并发症之一，目前尚缺乏有意义的预测指标。目的 分析老年急性缺血性脑卒中患者衰弱与PSD的相关性，为早期临床评估及干预提供参考依据。方法 选取2017年6-12月在商丘市第一人民医院全科医学科、神经内科住院的符合研究标准的急性缺血性脑卒中患者118例。收集患者的一般资料〔性别，年龄，体质指数（BMI），吸烟、饮酒情况，高血压、糖尿病、高脂血症、心房颤动发生情况〕、临床资料〔疾病共存（共存疾病≥5种）情况、入院时美国国立卫生研究院卒中量表（NIHSS）评分及改良Rankin量表（mRS）评分、TOAST分型〕。依据患者入院后24 h内衰弱筛查量表（FRAIL）评分分为无衰弱组（n=85，FRAIL评分<3分）和衰弱组（n=33，FRAIL评分≥3分）；依据患者发病后随访6~12个月时的美国精神病学会《精神障碍诊断与统计手册》第四版（DSM-Ⅳ）及汉密尔顿抑郁量表（HAMD）将患者分为无PSD组（n=73，HAMD评分<7分）和PSD组（n=45，HAMD评分≥7分）。采用多因素Logistic回归分析进行老年急性缺血性脑卒中患者发生衰弱、PSD的影响因素分析。结果 多因素Logistic回归分析结果显示，年龄〔OR=1.131，95%CI（1.055，1.211），P<0.001〕和入院时mRS评分〔OR=4.626，95%CI（2.027，10.561），P<0.001〕是老年急性缺血性脑卒中患者发生衰弱的影响因素；年龄〔OR=1.060，95%CI（1.005，1.118），P=0.031〕、衰弱〔OR=2.855，95%CI（1.144，7.126），P=0.025〕是老年急性缺血性脑卒中患者发生PSD的影响因素。无衰弱组患者 25例（29.4%）发生PSD，衰弱组患者 20例（60.6%）发生PSD，衰弱组患者PSD发生率高于无衰弱组（P=0.002）。随着PSD程度的增加，老年急性缺血性脑卒中患者衰弱发生率无明显趋势变化，差异无统计学意义（P>0.05）。结论 老年急性缺血性脑卒中患者的年龄、衰弱情况与其发生PSD密切相关，及时对其进行衰弱评估可预测PSD发生风险。 |
| 关 键 词： | 卒中 脑缺血 衰弱 老年人 抑郁 影响因素分析 |
Frailty and Post-stroke Depression in Elderly Patients with Acute Ischemic Stroke |
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| SHANG Xiaofeng,ZHANG Ying,LI Hong,WANG Su,RAN Xiurong,WANG Tan. Frailty and Post-stroke Depression in Elderly Patients with Acute Ischemic Stroke[J]. Chinese General Practice, 2020, 23(30): 3834-3838. DOI: 10.12114/j.issn.1007-9572.2020.00.462 | |
| Authors: | SHANG Xiaofeng ZHANG Ying LI Hong WANG Su RAN Xiurong WANG Tan |
| Affiliation: | 1.Department of General Medicine，the First People's Hospital of Shangqiu，Shangqiu 476100，China 2.Department of Neurology，the First People's Hospital of Shangqiu，Shangqiu 476100，China 3.Department of Geriatric Neurology，Qilu Hospital of Shandong University，Jinan 250012，China *Corresponding author：SHANG Xiaofeng，Attending physician；E-mail：xiaofeng8435@163.com |
| Abstract: | Background The prevalence of stoke is increasing yearly with the aggravation of population aging in China.Post-stroke depression（PSD） is one of the common complications of stroke，but there is still lacks meaningful predictive indicators for it.Objective To evaluate the correlation between frailty and PSD in elderly patients with acute ischemic stroke，to provide evidence for evaluating PSD and delivering intervention timely.Methods 118 patients with acute ischemic stroke were selected from Department of General Medicine and Department of Neurology，the First People's Hospital of Shangqiu from June to December 2017.General information 〔gender，age，body mass index（BMI），smoking and drinking atatus，prevalence of hypertension，diabetes，hyperlipidemia and atrial fibrillation〕，and clinical data 〔prevalence of multicormodity（having ≥ 5 coexisting diseases），admission NIHSS score，modified Rankin scale（mRS ）score and TOAST typing 〕were collected.The frailty prevalence assessed within 24 hours of admission by the FRAIL〔33 with frailty（with FRAIL score equal to or greater than 3），and 85 without（with FRAIL score less than 3）〕，and PSD prevalence assessed within 6-12 months of follow-up by both the DSM-Ⅳand Hamilton Depression Rating Scale（HAMD）〔45 with PSD（with HAMD score equal to or greater than 7） and 73 without（with HAMD score less than 7）〕 were also collected.Multivariate Logistic regression analysis was used to identify the factors associated with frailty or PSD in elderly patients with acute ischemic stroke.Results Multivariate Logistic regression analysis showed that age 〔OR=1.131，95%CI（1.055，1.211），P<0.001〕 and admission mRS score〔OR=4.626，95%CI（2.027，10.561），P<0.001〕were influencing factors of frailty，meanwhile age〔OR=1.060，95%CI（1.005，1.118），P=0.031〕and frailty〔OR=2.855，95%CI（1.144，7.126），P=0.025〕were influencing factors of PSD in elderly patients with acute ischemic stroke.Those with frailty had higher PSD prevalence than those without〔60.6%（20/33） vs 29.4%（25/85）〕（P=0.002）.The frailty prevalence showed no significant growth with the increase of the severity of PSD（P>0.05）.Conclusion Age and frailty are closely related to PSD in elderly patients with acute ischemic stroke.The assessment of frailty can be evaluated in time to predict the risk of PSD. |
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