缺血性脑卒中患者远期抑郁症状的发生率及相关因素分析

目的探讨首发缺血性脑卒中(IS)偏侧肢体功能障碍患者远期抑郁症状(DS)的发生率及影响因素。方法前瞻性研究连续入选商丘市第一人民医院神经内科2012-11—2013-07收治的首发IS偏侧肢体功能障碍患者126例,入组后收集患者一般资料并采用美国国立卫生研究院卒中量表(NIHSS)、改良Rankin Scale(MRS)评分进行评估,发病后2~3a采用NIHSS、MRS评分、Barthel指数(BI)、脑卒中专用生活质量量表(SS-QOL)、汉密尔顿抑郁评分量表(HDRS)再次随访。通过单因素分析筛选出与远期抑郁症状(DS)具有显著性联系的因素后,使用非条件Logistic回归分析DS的影响因素。结果首发IS偏侧肢体功能障碍患者中远期抑郁症状发生率38.6%(44/114),其中轻、中、重度分别占19.3%(22/114)、11.4%(13/114)、7.9%(9/114)。多因素非条件Logistic回归分析结果显示,首发IS偏侧肢体功能障碍患者远期DS的影响因素包括文化程度(OR=2.847,95%CI=1.241~6.532)、BI(OR=0.763,95%CI=0.648~0.916)、SS-QOL评分(OR=0.970,95%CI=0.937~0.989)。且轻、中、重度抑郁症状患者的远期BI评分(F=29.426,P0.01)和SS-QOL评分(F=21.379,P0.01)的总体均数不同。结论 IS偏侧肢体功能障碍患者远期DS的危险因素为文化程度高,保护因素为远期BI评分高、生活质量高。其中远期BI评分、SS-QOL评分越低,IS偏侧肢体功能障碍患者的远期抑郁症状越重。日常生活能力的恢复及生活质量的提高等可能是改善IS偏侧肢体功能障碍患者远期抑郁症状的重要措施。

Analysis of the morbidity and related factors of long-term depressive symptoms in patients with ischemic stroke

Objective To estimate the prevalence rate and related risk factors of long-term depressive symptoms (DS) in first-episode ischemic stroke (IS) patients with unilateral limb disorder.Methods After our prospective research having consecutively collected 126 patients who suffered from first-episode IS and unilateral limb disorder from November 2012 to July 2013,we gathered all patients'' general information and used NIHSS and modified Rankin Scale (MRS) to assess patients'' disease states.2~3 years after stroke,a follow-up research continued to use NIHSS,MRS,Barthel Index (BI),stroke specific quality of life (SS-QOL) and the Hamilton Depression Rating Scale (HDRS) to evaluate body and function impairment.The related factors for affecting long-term DS were identified by univariate analysis and were further researched by unconditioned Logistic regression analysis.Results Of the selected 126 patients,the occurrence rate of long-term DS was 38.60%(44/114).Mild,moderate and severe DS patients accounted for 19.30%(22/114),11.40%(13/114) and 7.90%(9/114),respectively.Multivariate unconditioned Logistic regression showed that education level (OR=2.847,95% CI:1.241 to 6.532),BI scores (OR=0.763,95% CI:0.648 to 0.916) and SS-QOL scores (OR=0.970,95% CI:0.937 to 0.989) were the influencing factors of long-term DS.As for population mean,the long-term BI scores of mild,moderate and severe DS patients (F=29.426,P<0.01) differed from SS-QOL scores (F=21.379,P<0.01).Conclusion The risk factor of long-term DS in first-episode ischemic stroke patients is high education level and the protective factors are high long-term BI scores and high quality of life.The less scores the long-term BI and SS-QOL present,the severer depressive symptoms patients suffer.Our study suggests that the important measures of improving long-term DS in IS patients may recover daily living ability and improve the quality of life.