脑卒中后抑郁发生的相关因素分析

摘要

目的:研究脑卒中发病1个月后卒中后抑郁(PSD)的发生率及其相关因素.方法:共纳入160例脑卒中住院康复患者,根据汉密尔顿抑郁量表(HAMD)分为PSD组和非PSD组.收集一般资料、临床变量和血液生化检查(总胆固醇、低密度脂蛋白、高密度脂蛋白、空腹血糖、超敏C反应蛋白、血同型半胱氨酸等),入院时评估美国国立卫生研究院卒中量表(NIHSS),发病1个月时评估NIHSS、Barthel指数(BI)、Fugl-Meyer运动功能评分(FMA).分析对比2组间差异,多因素回归分析PSD发生的独立危险因素.结果:恢复期PSD的发生率为38.1％,轻度、中度和重度抑郁的发生率分别为12.5％、16.9％、8.7％.与非PSD组比较,PSD组患者病灶数目多(P＜0.05),血同型半胱氨酸、超敏C反应蛋白较高(P＜0.05),入院时及发病1个月后的NIHSS评分高(P＜0.05),发病1个月后ADL及FMA评分低(P＜0.05),手功能及步行能力差(P＜0.05),发生肩手并发症多(P＜0.05).Logistic回归分析显示血同型半胱氨酸、超敏C反应蛋白、发病时的NIHSS程度、缺血性卒中病灶数目、肩手并发症、步行能力为恢复期发生PSD的相关因素.结论:血同型半胱氨酸、超敏C反应蛋白、发病时NIHSS评分、缺血性卒中病灶数目、肩手并发症、步行能力为脑卒中恢复期PSD发生的独立危险因素.%Objective:To investigate the incidence of post stroke depression (PSD) and its risk factors one month after stroke.Methods:160 stroke inpatients were enrolled and divided into the PSD group and the non PSD group according to the scores of HAMD.Demographics,clinical features and blood biochemistry tests (e.g.total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,fasting glucose,C-reactive protein,homocysteine,etc.) were collected in each patient.The National Institute of Health stroke scale (NIHSS) was assessed at admission and one month after stroke.The Barthel index of ADL (BI) and Fugl-Meyer Motor Function Assessment (FMA) were assessed at 1st month after stroke.All parameters were compared and analyzed,and the difference between PSD group and non-PSD group was calculated.Further,multivariable logistic regression was used to assess the independent risk factors.Results:The incidence of PSD during the recovery period was 38.1 ％.The incidence of mild,moderate and severe PSD was 12.5％,16.9％ and 8.7％ respectively.The scores of NIHSS both at admission and one month after stroke were higher (P＜0.05),and the scores of BI and FMA were lower one month after stroke (P＜0.05) in the PSD group than in the non-PSD group.The PSD group had worse hand function and walking ability one month after stroke,and had more complex regional pain syndrome one month after stroke (P＜0.05).Logistic regression analysis revealed that the levels of homocysteine and C-reactive protein,NIHSS scores at admission,the number of isehemic lesions,complex regional pain syndrome and walking ability were the relevant factors of PSD during the recovery period.Conclusions:The levels of homocysteine and C-reactive protein,NIHSS scores at admission,the number of ischemic lesions,complex regional pain syndrome and walking ability were the risk factors of PSD during the recovery period.