急性缺血性卒中后抑郁的相关危险因素分析

目的探讨急性缺血性卒中后抑郁(PSD)的发生率及其相关危险因素。方法 185例经CT或MRI证实的急性缺血性卒中患者根据精神障碍诊断和统计手册第5版(DSM-V)标准和24项Hamilton抑郁量表(HAMD)评分分为PSD组和non-PSD组;分析PSD社会人口学资料、血管危险因素、相关生化指标、NIHSS、Barthel指数(BI)、MMSE等相关因素对PSD的影响。结果本组PSD发生率为40.54%(75例),主要以轻、中度抑郁为主;与non-PSD组比较,PSD组患者糖尿病发生率高(P=0.044),神经功能缺损程度重、日常生活活动能力差(P=0.000,P=0.001),MMSE评分降低(P=0.000),而超敏C-反应蛋白(hs-CRP)和同型半胱氨酸(Hcy)水平升高(P=0.000,P=0.006);其中BI、MMSE评分与HAMD评分呈负相关(均P0.05),而NIHSS评分、hs-CRP和Hcy与HAMD评分呈正相关(均P0.05);Logistic回归分析提示,低MMSE评分、高NIHSS评分及高hs-CRP和Hcy水平可能是急性缺血性PSD的独立危险因素。结论 PSD主要以轻、中度抑郁为主;PSD与糖尿病病史、认知功能障碍、神经功能缺损程度、hs-CRP和Hcy水平密切相关。

Analysis of relevant risk factors of acute ischemic post-stroke depression

Objective To study the incidence rate of acute ischemic post-stroke depression ( PSD ) and its relevant risk factors .Methods One hundred and eighty-five acute ischemic stroke patients confirmed with CT or MRI were divided into PSD group and non-PSD group by the Diagnostic and Statistical Manual of Mental Disorder-V ( DSM-V) criteria and 24-item Hamilton Depression Rating Scale ( HAMD) .The influence factors on PSD including social demographic data , vascular risk factors , relevant biochemical indicators , NIHSS, Barthel Index ( BI ) and MMSE were analyzed.Results In this group , the incidence of PSD was 40.54%(75 cases), was mainly composed of mild and moderate depression .Compared with non-PSD group, PSD group had a higher diabetes incidence rate (P=0.044), more severe neural function deficiency and worse activities of daily living (P=0.000, P=0.001), and lower MMSE scores(P=0.000), while high-sensitivity C-reaction protein (hs-CRP) and homocysteine (Hcy) levels increased (P=0.000, P=0.006).BI and MMSE scores were negatively correlated with HAMD scores (all P<0.05), while NIHSS scores, hs-CRP and Hcy levels were positively correlated with HAMD scores ( all P<0.05).The Logistic regression analysis indicated that , low MMSE scores, high NIHSS scores, high hs-CRP and Hcy levels might be independent risk factors of acute ischemic PSD .Conclusions PSD is mainly composed of mild and moderate depression .PSD is closely related with diabetes history , cognition impairment , neural function deficiency degree, hs-CRP and Hcy levels.