卒中后3个月内抑郁的累计发生率及其相关危险因素研究

目的 观察卒中（包括脑梗死和脑实质内出血）后3个月内卒中后抑郁（post-stroke depression，PSD）的发生率，探讨与PSD发生相关的人口学和临床危险因素。方法 连续收集2008年4月至2009年12月住院的卒中患者（包括脑梗死和脑实质内出血）314例。收集患者的人口学资料及相关临床指标如美国国立卫生院神经功能缺损评分（National Institute of HealthStroke Scale，NIHSS）、改良Rankin量表评分（modified Rainkin Scale，mRS）和简易精神状态检查表（minimental status examination，MMSE）评分。在发病90±7 d，使用世界卫生组织复合性国际诊断交谈3.0中文版（The World Health Organization Composite International Diagnostic Interview，WHO-CIDI 3.0）对所有患者进行访谈，按照精神疾病诊断与统计手册-IV（Diagnostic and Statistical Manual of MentalDisorders-IV，DSM-IV）的诊断标准作出抑郁的诊断。结果 PSD在卒中后3个月的累计发生率为29%（91/314），其中重性抑郁76例（24.2%），轻性抑郁15例（4.8%）。PSD组和non-PSD组之间性别、既往抑郁病史差异有统计学意义（P <0.01）；PSD组发病后14 d的NIHSS、mRS和发病后90 d的mRS大于non-PSD组（P <0.01）。多因素分析结果显示：性别比值比（Odds ratio，OR）：2.178，95%可信区间（confidence interval，CI）：1.219～3.892，P <0.01]、既往抑郁病史（OR：5.762，95%CI：2.958～11.223，P <0.01）、发病后14 d的残障水平（OR：1.520，95%CI：1.212～1.907，P <0.01）是与PSD发生相关的独立危险因素。结论 卒中后3个月内，PSD的累积发生率为29%，说明PSD是卒中后的常见并发症，应该予以高度重视。女性、既往抑郁病史和发病后14 d的残障水平是卒中后3个月内发生抑郁的3个独立危险因素。

Study of Accumulative Incidence and Risk Factors of Post-Stroke Depression within Three Months after Stroke

Objective To examine the incidence, demographic factors and clinical determinants of post-stroke depression （PSD） within 3 months after stroke （including cerebral infarction and intracerebral hemorrhage）.
Methods Those patients who were hospitalized for acute cerebrovascular diseases （including cerebral infarction and intracerebral hemorrhage） within 14 days after the index stroke onset from April 2008 to December 2009 were screened. The following patient information was collected： demographics; clinical data including the National Institute Of Health Stroke Scale （NIHSS） modified Rainkin Scale （mRS） and mini mental status examination （MMSE）]. At 90-day follow up after stroke, the diagnosis of depression was considered by World Health Organization Composite International Diagnostic Interview 3.0 （WHO-CIDI 3.0） based on Diagnostic and Statistical Manual of Mental Disorders-IV （DSM-IV）.
Results The 3-month cumulative incidence of PSD was 29% （n=91） in this patient population, with 24.2% patients （n=76） diagnosed with major depression and 4.8% （n-15） diagnosed with minor depression. In univariate analysis, the percentage of female patients and patients with past history of depression were significantly higher in PSD group than in non-PSD group （all P〈0.01, respectively）. The severity of stroke （NIHSS） at 14 days and the level of disability （mRS） at 14 days as well as at 90 days after stroke were significantly higher in PSD group than in non-PSD group （all P〈0.01）. Multivariate analysis showed that female gender Odds ratio （OR）：2.178, 95% confidence interval （CI）：1.219-3.892, P〈0.01], history of depression（OR：5.762, 95%CI： 2.958-11.223, P〈0.01） and level of handicap at 14 days after stroke （OR：1.520, 95%CI： 1.212-1.907, P〈0.01） are three independent clinical risk factors of PSD.
Conclusion The 3-month cumulative incidence of PSD was 29% which suggested PSD is a common complication of stroke and should be attached great importance. Female gender, history of depression and level of handicap at 14 days after stroke are three independent risk factors of PSD during the first 3 months after stroke.