卒中后抑郁与患者神经功能及再发卒中风险的关系

目的探讨卒中后抑郁与卒中患者神经功能以及卒中复发的关系。方法回顾性分析2017年3月至2018年3月于我科就诊并完成1年随访的脑卒中患者,以卒中后抑郁(PSD)患者108例为PSD组,并选取112例同期治疗的不伴有PSD患者作为无PSD组,分析PSD与患者远期功能恢复和1年内再发风险的关系。结果中、重度PSD患者的NIHSS评分、1年内卒中复发率、mRS评分均高于无PSD和轻度PSD患者(P0.05),Pearson相关模型显示SDS评分与NIHSS评分呈正相关(r=0.628,P0.001);多因素Logistic回归分析显示,收缩压、PSD、卒中后2周NIHSS评分、卒中后2周mRS评分均为1年内卒中再发的危险因素。结论 PSD与患者远期功能恢复以及1年内再发卒中风险呈显著相关性,PSD患者远期功能恢复较差,加强早期对PSD的发现与干预。     

288例脑卒中后抑郁的临床分析

目的探讨脑卒中后抑郁（PSD）的发生率及其主要相关因素。方法选择在本院住院确诊为脑卒中患者769例,采用汉密尔顿抑郁量表（HAMD）17项评分≥18分及卒中患者神经功能缺损程度进行评估。结果 PSD288例,发生率为37.45%,且与卒中性质、部位、程度、生化指标异常等密切相关。动态观察卒中患者CRP水平有助于早期发现PSP。结论预防性抗抑郁剂应用和抗抑郁剂治疗PSD,不仅减低PSD发生率,且有助于PSD和卒中患者神经功能的恢复。     

首发脑梗死患者卒中后抑郁与卒中部位的关系

目的 研究首次发病的脑梗死患者卒中后抑郁(PSD)与卒中部位之间的关系.方法 选取340例经CT/MR确诊的脑梗死患者,其中169例抑郁自评量表指数大于或等于0.5者为PSD组,采用χ2检验和Logistic回归分析PSD与卒中部位之间的相关性.结果 脑梗死患者PSD的患病率为49.7%(169/340),其中额叶卒中患者PSD的患病率为66.7%,其他部位卒中患者PSD患病率为47.3%,两者差异有统计学意义(χ2=5.51,P=0.02).分层及回归分析显示额叶卒中是卒中6个月内PSD患病的独立危险因素,调整年龄、文化程度、梗死类型、患高血压、患心脏病、日常生活活动能力评分、认知功能后,额叶卒中患者PSD的患病风险是其他部位卒中患者的2.42倍(P=0.02,RR=2.42,95%CI:1.17-5.03).结论 脑梗死患者PSD的患病率较高,额叶卒中患者在卒中后6个月内有更高的PSD患病风险.     

卒中后抑郁与脑卒中患者载脂蛋白E水平对照研究

目的:探讨卒中后抑郁(PSD)患者载脂蛋白E(ApoE)水平特点,为PSD的诊断提供新的客观依据。方法:采用实时荧光定量PCR技术和酶联免疫吸附法(ELISA)检测PSD患者及卒中后非抑郁患者ApoE水平。结果:PSD组ApoE基因mRNA表达量低于卒中组,差异具有统计学意义(P<0.01);PSD组血清ApoE水平高于卒中组,差异具有统计学意义(P<0.05)。结论:PSD患者外周血ApoE基因mRNA表达和血清ApoE水平与卒中非抑郁患者不同。     

脑卒中早期康复与卒中后抑郁的相关性

脑卒中后抑郁(PSD)是急性脑卒中后产生的一种情绪低落反应。机制可能与大脑神经环路受损有关,PSD可增加卒中并发症及死亡率,并阻碍卒中患者神经功能的恢复。医学研究发现,卒中后有效的康复、护理、家庭支持,能降低PSD发病率。本文就PSD的病因、发生率、相关因素、筛查PSD的工具,早期康复与PSD的关系作一综述。     

卒中后抑郁的发生与识别

抑郁是卒中后最常见的精神障碍,而卒中后是并发抑郁障碍的高危期.卒中后抑郁(Post-stroke Depression,PSD)不仅影响患者神经功能的恢复和生活质量,还增加卒中的病死率.一项随访10年的研究发现,在控制了人口学因素、共患躯体疾病、用药、躯体及认知损害、病灶部位等因素后,PSD患者的死亡率是卒中后非抑郁者的3.5倍.然而,PSD症状常常被临床医生及家属忽视,约75%的患者因种种原因被漏诊.因此,神经科医生有必要对PSD的发生、危险因素、诊断标准等深入了解,在临床工作中早期筛选与识别PSD患者.……     

P300评定卒中后抑郁患者认知功能对照研究的Meta分析

目的系统评价事件相关电位P300评定卒中后抑郁(post-stroke depression,PSD)患者认知功能的价值。方法采用STATA11.0软件对国内有关卒中后抑郁(PSD)患者事件相关电位P300的临床研究进行Meta分析。结果共纳入7项符合条件的病例对照研究,共907例研究对象,均包括卒中后抑郁组(PSD组,n=422),另对照组包括卒中无抑郁组(N-PSD组,n=265)和/或正常对照组(NC组,n=220),评价各组之间比较存在异质性,采用随机效应模型进行综合检验,结果为:①P300波幅:4项研究比较了PSD组与NC组P300波幅变化,结果显示PSD组较NC组P300波幅降低明显,差异具有显著统计学意义[OR=-3.56,95%CI(-5.71,-1.40),P=0.001]。6项研究比较了PSD组与N-PSD组P300波幅变化,结果显示PSD组较N-PSD组P300波幅降低明显,差异具有显著统计学意义[OR=-2.17,95%CI(-3.25,-1.09),P=0.000]。3项研究比较了N-PSD组与NC组P300波幅变化,结果显示N-PSD组较NC组P300波幅降低,差异具有统计学意义[OR=1.92,95%CI(0.34,3.49),P=0.017];②P300潜伏期:4项研究同时报道了PSD组与NC组P300潜伏期变化,结果显示PSD组较NC组P300潜伏期明显延长,差异具有显著统计学意义[OR=42.90,95%CI(26.58,59.21),P=0.000]。6项研究同时报道了PSD组与N-PSD组P300潜伏期变化,结果显示PSD较N-PSD组P300潜伏期明显延长,差异具有显著统计学意义[OR=27.02,95%CI(15.89,38.15),P=0.000]。3项研究同时报道了N-PSD组与NC组P300潜伏期变化,结果显示N-PSD组较NC组P300潜伏期延长,差异具有显著统计学意义[OR=-17.67,95%CI(-23.64,-11.70),P=0.000]。结论目前研究表明,与卒中后无抑郁患者及正常人相比,卒中后抑郁患者P300波幅显著降低、潜伏期明显延长;P300检测可为筛查卒中后抑郁患者早期认知功能损害的辅助指标。     

卒中后抑郁的影响因素

脑卒中是当今危害人类健康的最主要疾病之一,卒中后抑郁(poststrokedepression,PSD)是脑卒中后常见的并发症,卒中后一年内PSD的累积发病率在30%左右[1]。PSD临床表现为情绪低落、焦虑、自责内疚、精力明显减退、睡眠障碍等。它不仅影响患者生活质量,导致患者出现不良的心境体验和躯体功能障碍,同时还影响患者神经功能和肢体活动功能的康复,而且PSD患者的死亡率要比未患者高[2]。因此研究PSD发病的相关因素,阐明其发生发展规律,对于PSD的早期发现和治疗有实际意义。与PSD相关的因素可以归纳为下列几方面。1生物学因素1.1脑卒中的部…     

专题综述：卒中后抑郁

正编者按卒中是导致死亡的第三大病因,也是导致成年人长期残疾的主要原因,并有年轻化的趋势。抑郁是卒中患者较常见的神经精神症状之一,约有1/3以上的卒中患者在不同阶段罹患卒中后抑郁(post-stroke depression,PSD)。然而到目前为止,PSD的发病机制、诊断分类和诊断标准、卒中患者是否需要预防性使用抗抑郁药均没有明确的定论,因此本刊编辑部邀请张志教授等对上述问题作一评述,希望对大家有所启发。关于PSD的发病机制,早期提出的"卒中部位决定论"与"心理应激决定论"现在     

卒中后抑郁的临床特点及相关因素

目的探讨卒中后抑郁（PSD）的发生率、临床表现、相关因素和治疗情况。方法对114例脑卒中患者采用汉密尔顿抑郁量表（HAMD）等进行评定,分析符合PSD诊断的54例患者的临床特点。结果PSD的发生率为47.37%,以轻-中度抑郁为主,PSD的常见症状有全身症状、能力减退感、睡眠障碍、忧郁情绪、工作和兴趣减退等。结论卒中后抑郁的发生率高,神经功能缺损程度与卒中后抑郁的发生有密切关系。     

脑卒中后早期抑郁障碍患者磁共振波谱分析研究

目的应用磁共振波谱分析(MRS)技术探讨卒中后早期抑郁障碍的神经生化改变。方法选择住院连续病例223例,入院72h内均经头颅CT或磁共振成像(MRI)检查确诊为急性脑卒中,于卒中后72h给予汉密顿抑郁量表(HAMD 24项版)评分,44例评分≥8分,界定为卒中后早期抑郁。根据病例编号,采用随机数字表法,分为对照组(23例)、抗抑郁药物治疗组(21例)。对照组中男性14例,年龄47～75岁,平均年龄62.40±3.17岁;女性9例,年龄54～75岁,平均年龄63.00±4.12岁。有1例于1-2M间失访。对照组分别于发病72h、1M、2M及3M进行HAMD量表评分,得出1M时HAMD评分≥8分组(1组)、<8分组(2组);2M时评分≥8分组(3组)、<8分组(4组);3M时评分≥8分组(5组)、<8分组(6组)。对以上各组患者发病72h的MRS检测结果进行分析。结果在NAA/CR中,第1组各VOI的比值均低于第2组,差异有统计学意义;第3组左侧颞叶、双侧丘脑各比值明显低于第4组(P<0.01);第5组与第6组相比,差异均无统计学意义。在Cho/Cr中,第1组各VOI的比值高于第2组,差异有统计学意义;第3组各VOI的比值明显高于第4组(P<0.01);第5组与第6组相比,差异均无统计学意义。结论 MRS可在一定程度上反映卒中后脑的细微结构及功能的改变,卒中后早期抑郁障碍患者MRS显著异常对病程1M、2M时PSD的真正发生有一定的预示意义,并推测针对这一人群早期药物干预治疗在改善脑代谢方面具有积极意义。     

Does amygdalar perfusion correlate with antidepressant response to partial sleep deprivation in major depression?

This study used functional MRI (fMRI) to clarify the sites of brain activity associated with the antidepressant effects of sleep deprivation (SD). We hypothesized: (1) baseline perfusion in right and left amygdalae will be greater in responders than in nonresponders; (2) following partial sleep deprivation (PSD), perfusion in responders' right and left amygdalae would decrease. Seventeen unmedicated outpatients with current major depression and eight controls received perfusion-weighted fMRI and structural MRI at baseline and following 1 night of late-night PSD. Baseline bilateral amygdalar perfusion was greater in responders than nonresponders. Clusters involving both amygdalae decreased from baseline to PSD specifically in responders. Right amygdalar perfusion diverged with PSD, increasing in nonresponders and decreasing in responders. These novel amygdalar findings are consistent with the overarousal hypothesis of SD as well as other functional imaging studies showing increased baseline amygdalar activity in depression and decreased amygdalar activity with remission or antidepressant medications.     

Association of frontal subcortical circuits infarcts in poststroke depression: a magnetic resonance imaging study of 591 Chinese patients with ischemic stroke

Despite extensive research into poststroke depression (PSD), the role played by lesion location in the pathogenesis of PSD remains uncertain. The aim of this study was to estimate the magnetic resonance imaging (MRI) correlates of PSD in Chinese patients with first or recurrent stroke. A total of 591 patients with acute ischemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong were recruited. A psychiatrist assessed all the patients 3 months after the stroke. The psychiatrist used the Structured Clinical Interview for Diagnostic and Statistical Manual, fourth edition (DSM-IV) to confirm whether the patients met the criteria of a depressive disorder. In addition, a host of demographic, clinical, and radiological variables were examined. A tota; of 475 and 116 patients had first and recurrent strokes, respectively. In all, 75 (12.7%) patients received a diagnosis of PSD. In univariate analysis of the MRI findings, the presence of infarcts in the frontal subcortical circuits ([FSC], 66.7% vs 53.3%) was significantly associated with PSD (P = .03) compared to the patients without PSD. The FSC infarct-PSD association remained significant (odds ratio = 2.6) in subsequent logistic regression analysis after adjusting for gender, history of depression, neurological impairment, level of social support, and major life events. In conclusion, FSC infarcts are independent predictors of PSD. Further work is needed to clarify whether these infarcts have an impact on the clinical presentation, treatment responses, and prognosis of PSD.     

卒中后抑郁的磁共振影像学研究进展

卒中后抑郁（post-stroke depression,PSD）是卒中的常见并发症。加强对PSD的识别,提高对PSD机制和诊断手段的理解,有助于提高对PSD的诊断和治疗水平。现就PSD磁共振影像学,包括磁共振波谱成像、磁共振扩散张量成像及静息态脑功能磁共振成像的研究进展予以综述。     

脑卒中后抑郁与部位的相关性研究

目的：探讨急性期脑卒中患者影像学改变在脑卒中后抑郁（PSD）患者中的相关性和临床意义,期望早期发现PSD患者并为及时干预提供帮助。方法：对329例急性脑卒中后1个月内患者采用系统的神经心理评估和MRI检查。所有患者均常规行汉密尔顿抑郁量表（HAMD）评分,根据头颅MRJ结果分析病变部位。结果：PSD的发病率以左侧半球脑卒中患者明显高于双侧和右侧半球脑卒中患者,且左侧额叶和基底节尤为突出。不同病灶数目组间比较,PSD的发生率以多灶患者明显高于单灶患者（P〈0．01）。结论：急性脑卒中后PSD与病变部位在左侧半球尤其是左侧额叶、颞叶和基底节区具有显著相关性。完全前循环梗死也是易患PSD的危险因素。     

Improved anatomic delineation of the antidepressant response to partial sleep deprivation in medial frontal cortex using perfusion-weighted functional MRI

This study used functional magnetic resonance imaging (fMRI) to clarify the sites of brain activity associated with the antidepressant effects of sleep deprivation (SD). We hypothesized: 1) depressed responders' baseline ventral anterior cingulate (AC) perfusion will be greater than that of nonresponders and controls; 2) following partial sleep deprivation (PSD), ventral AC perfusion will significantly decrease in responders only. Seventeen unmedicated outpatients with current major depression and eight controls received perfusion-weighted fMRI and structural MRI at baseline and following 1 night of late-night PSD. Talairach-transformed gray matter masks were merged with Talairach Daemon-based region of interest (ROI) templates. Baseline left ventral AC (LVAC) perfusion was greater in responders than nonresponders. There was no difference involving the medial frontal cortex. Responders' LVAC perfusion dropped from baseline to PSD scans compared with nonresponders and controls, as did perfusion in the right dorsal AC. In the patient group as a whole, decrease in LVAC perfusion from baseline to PSD scans correlated directly with the decrease in the modified 17-item Hamilton Depression Rating Scale (HDRS17) between baseline and PSD conditions. These data--the first using fMRI--show greater anatomic specificity than previous findings of SD and depression in linking decreased brain activity in this area with clinical improvement.     

卒中后抑郁与脑损伤部位相关性的临床研究

目的探讨不同的脑损伤部位与脑卒中后抑郁病变的关系,探讨PSD的现况以及对结局的影响。方法收集2010年09月～2011年09月期间河北联合大学附属医院神经内科脑卒中患者300例,通过颅脑CT或MRI进行卒中病灶定位,采用Hamilton抑郁量表对卒中患者在发病14±2d及90±7d进行抑郁及程度的评价。对收集患者的相关临床指标如美国国立卫生院神经功能缺损评分(NIHSS)、改良Rankin量表评分(MRS)、简易精神状态检查表(MMSE)评分等相关因素进行统计分析。结果 140例脑卒中患者合并PSD,总发生率为46.67%,其中轻中度抑郁占46.00%,重度抑郁占0.67%;多发性、左侧半球、额颞叶、基底节区脑卒中患者PSD发生率高。结论脑卒中患者神经功能缺损程度评分越高,其患抑郁的程度也就越高。PSD发生与卒中类型无关,而与卒中部位、卒中残疾程度等因素有关。     

Magnetic resonance imaging markers for early diagnosis of Parkinson’s disease

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by selective and progressive degeneration, as well as loss of dopaminergic neurons in the substantia nigra. In PD, approximately 60-70% of nigrostriatal neurons are degenerated and 80% of content of the striatal dopamine is reduced before the diagnosis can be established according to widely accepted clinical diagnostic criteria. This condition describes a stage of disease called "prodromal", where non-motor symptoms, such as olfactory dysfunction, constipation, rapid eye movement behaviour disorder, depression, precede motor sign of PD. Detection of prodromal phase of PD is becoming an important goal for determining the prognosis and choosing a suitable treatment strategy. In this review, we present some non-invasive instrumental approaches that could be useful to identify patients in the prodromal phase of PD or in an early clinical phase, when the first motor symptoms begin to be apparent. Conventional magnetic resonance imaging (MRI) and advanced MRI techniques, such as magnetic resonance spectroscopy imaging, diffusion-weighted and diffusion tensor imaging and functional MRI, are useful to differentiate early PD with initial motor symptoms from atypical parkinsonian disorders, thus, making easier early diagnosis. Functional MRI and diffusion tensor imaging techniques can show abnormalities in the olfactory system in prodromal PD.     

Post-stroke depression

Post-stroke depression (PSD) is the most frequent psychiatric complication of stroke. Its prevalence has been estimated to be around 30-35%, ranging from 20 to 60%. Despite the extensive literature on this topic, there is no agreement on causal mechanisms, risk factors and consequences of PSD. Stroke patients with PSD suffer higher mortality rates and show a minor improvement in rehabilitation programs in comparison to non depressed stroke patients. Consequently, they have worse functional outcomes and quality of life. The available evidence supports PSD as being multifactorial in origin, and consistent with the biopsychosocial model of mental illness. Nonetheless, the stroke itself poses the risk of depression. Stroke survivors are more predisposed to PSD compared to physically ill patients with similar levels of disability, even quite a long time after the stroke, regardless of other risk factors. Early effective treatment of depression may have a positive effect not only on depressive symptoms but also on the rehabilitation outcome of stroke patients. On the other hand, there is no definitive evidence that antidepressants or psychotherapy are useful to prevent depression. Implementing preventive and therapeutic strategies to reduce the risk of mood alteration and thus improve rehabilitation outcomes would appear important in the organization of stroke services.     

脑卒中后不同时段发生抑郁患者的头颅磁共振波谱分析

目的：应用磁共振波谱（MRS）技术探讨脑卒中后不同时段发生脑卒中后抑郁（PSD）脑N-天冬氨酸盐/肌苷（NAA/Cr）和胆碱/肌酐（Cho/Cr）的代谢改变。方法：急性脑卒中住院病例223例,脑卒中后72h予汉密顿抑郁量表（24项版）评分,≥8分者（PSD患者）根据病例编号,采用随机数字表法分为干预组（第1组）和对照组（第2组）;〈8分者1个月时再次评分,≥8分者再分为干预组（第3组）和对照组（第4组）;〈8分者2个月时再评分,≥8分者再分为干预组（第5组）和对照组（第6组）;〈8分者3个月再评分,≥8分组（第7组）、〈8分组（第8组）。干预组（1、3、5、7组）给予帕罗西汀20mg·d-1治疗。分别在72h、3个月对PSD患者行MRS（双侧颞叶海马、丘脑）检测。结果：①在NAA/Cr比值中：72h和3个月时,第4、6组颞叶海马、丘脑ROINAA/Cr比值低于第2组（P〈0.05）;而与第7组相比,P〈0.01;第4组与第6组比较和第7组与第2组比较,均差异无统计学意义;各组患者各ROINAA/Cr比值72h与3个月比较,均差异无统计学意义。Cho/Cr比值中：第4、6组海马和丘脑ROICho/Cr比值高于第2、7组,且以海马更为显著（P〈0.01）;而第4组与第6组比较和第7组与第2组比较,均差异无统计学意义;第4、6组右侧丘脑ROICho/Cr比值3个月较72h时增高。②3个月时第4、6组右颞叶ROICho/Cr高于第5组（P〈0.05）。③第7组72h、3个月时右海马ROICho/Cr比值高于第8组（P〈0.05）。结论：MRS在PSD早期诊断中价值有限,但对病程1和2个月时PSD的发生有较为肯定的预示意义;针对该人群进行早期干预对改善脑代谢具有积极意义。