老年脑卒中后抑郁与卒中缺损程度及血清脑源性神经营养因子的相关性研究

摘要

目的 探讨老年脑卒中后抑郁与卒中缺损程度及血清脑源性神经营养因子(BDNF)的关系. 方法 选取2010年8月至2013年9月我院神经内科收治150例老年脑卒中患者,采用汉密尔顿抑郁量表(HAMD)、神经功能缺损量表(NIHSS)、日常生活能力量表(ADL)、Barthel指数对其进行评估和分析,同时测定血清BDNF水平. 结果 老年脑卒中后抑郁的发生率为42.0％ (63/150),抑郁组和非抑郁组神经功能缺损程度分别为(14.72±4.06)分和(5.51±1.93)分,差异具有统计学意义(t=18.49,P＜0.0001);日常生活依赖性分别为(40.63±17.06)分和(79.66±29.31)分,差异具有统计学意义(t=9.47,P＜0.0001).患者HAMD、HIHSS评分随着抑郁程度加重而升高,与抑郁程度呈正相关(r=0.998,P=0.0012;r=0.962,P=0.0375);ADL评分及血清BDNF含量随抑郁程度升高而降低,与抑郁程度呈负相关(r=0.985,P=0.0149;r=-0.995,P=0.0049).结论 老年卒中后抑郁与卒中神经功能缺损程度正相关,与日常生活能力、血清BDNF水平呈负相关.临床应该积极治疗原发病,改善脑组织代谢和微循环,减轻神经功能损害,早期进行康复治疗,提高患者肢体活动和生活自理能力,降低病残程度,以减轻抑郁程度.%Objective To explore the association of post stroke depression (PSD) with the scale of stroke deficit and serum brain-derived neurotrophic factor levels in the elderly.Methods A total of 150 elderly stroke patients from the department of neurology of our hospital were recruited from August 2010 to September 2013.Patients were assessed by the Hamilton depression rating scale (HAMD),the National Institutes of Health Stroke Scale (NIHSS),and the Activitics of Daily Living Scale (ADL).In addition,serum BDNF levels were determined by ELISA.Results 42.0％ of the 150 elderly patients suffered depression after stroke (63/150).There were significant differences in neurological function impairment and ADL scores between the PSD group and the non-PSD group [(14.72±4.06) vs.(5.51±1.93) and (40.63±17.06) vs.(79.66±29.31),t=18.49 and 9.47,respectively,P＜0.0001 for both].HAMD and NIHSS scores showed positive correlations with the degreeof depression (r=0.998 and 0.962,P=0.0012 and 0.0375,respectively).ADL scores and serum BDNF levels decreased as the degree of depression increased,and were negatively correlated with the degree of depression (r=-0.985 and-0.995,P=0.0149 and 0.0049,respectively).Conclusions The degree of post-stoke depression is positively correlated with the scale of neurological dysfunction and negatively correlated with the activities of daily living scale and serum BDNF levels in the elderly.The primary disease should be properly treated,and improvement in brain metabolism and micro circulation should be attempted to alleviate neurological dysfunction.In addition,rehabilitation therapy should be performed early in elderly stroke patients in order to improve physical activity and self-care ability,thus reducing the degree of disability and depression.