脑卒中后抑郁:125例多因素分析

背景目前躯体疾病伴发抑郁的比例都很高,脑卒中后抑郁的危害已受到人们的广泛关注.目的研究脑卒中后抑郁的发生率、相关因素及病理生理机制.设计以患者为研究对象,病例分析,观察性研究.单位一所大学医院的神经内科、一所武装警察部队总队医院的内三科和一所省级医院的神经内科.对象2003-01/2004-05哈尔滨医科大学第一临床医学院、武装警察部队黑龙江省总队医院及黑龙江省医院神经内科脑卒中患者312例.方法对312例脑卒中患者在入院后48 h内用汉密顿抑郁量表(HAMD)和欧洲脑卒中评分(ESS)进行评定,同时收集有关的临床资料及社会心理因素.主要观察指标不同性别、年龄、个性、文化程度、脑卒中类型、脑卒中部位、神经功能缺损程度患者的抑郁发生率.结果脑卒中后抑郁的发生率为40.1%,以轻、中度抑郁为主;脑卒中后抑郁女性明显高于男性(P＜0.01),老年患者高于中青年患者(P＜0.01);性格内向者脑卒中后抑郁发生率较高;中学以上学历较小学文化程度者显著增高(P＜0.01);左侧大脑半球病变发生脑卒中后抑郁的频率明显高于右侧大脑半球病变(P＜0.01),其中额叶病变脑卒中后抑郁的发生率最高;脑卒中后抑郁的发生率与欧洲脑卒中评分(ESS)呈明显负相关(r=-0.846,P＜0.05).结论脑卒中后抑郁的发生是多源性因素作用的结果,符合生物-精神-社会模式.

Post stroke depression:multiple-factor analysis of 125 cases

BACKGROUND: The frequency of body ailments combined with depression is relatively higher, and hence post stoke depression(PSD) has gained more and more concentration.OBJECTIVE: To investigate the morbidity, related factors and pathophysiological mechanism of PSD.DESIGN: Case analysis and observation study.SETTING: Department of eurology in a hospital of a university; Third department of internal medicine in a hospital of Chinese People' s Armed Police Force; Department of neurology in a province hospital.PARTICIPANTS: This study was carried out at the Neurological Department of First Clinical Hospital Affiliated to Harbin Medical University and the General Hospital of Armed Police Army in Heilongjiang Province from January 2001 to May 2004. A cohort of 312 stroke patients was followed up in this study.METHODS: All 312 patients scored for Hamilton rating scale for depression (HAMD) and European stroke scale(ESS) within 48 hours of hospitalization. Meanwhile their clinical presentations and social-psychological factors were also collected.MAIN OUTCOME MEASURES: The stroke morbidity in patients with different sex, age, personality, educational degree, as well as stroke type, lesion location and extent of neurological functional deficit.RESULTS: The morbidity of PSD was 40. 1%, predominated by mild and medium stroke; amongst which PSD was found more frequent in women than men( P ＜ 0.01), as well as in elders than youngers( P ＜ 0.01); Patients who has diffidence personality are liable to suffer from PSD; and it was found more common in patients with over middle school education than those received only elementary school education ( P ＜ 0.01 ); depression was more frequent in left-sided stroke than right-sided stroke( P ＜ 0.01 ), especially in frontal lobal stroke; PSD was found negatively correlated with the scores for ESS(r= -0.846, P ＜0.05).CONCLUSION: As the result of the interaction of multiple factors, the development of PSD is found accorded with biology-psychology-society mode.