缺血性卒中患者病变部位与卒中后抑郁的相关性

摘要

目的 探讨急性缺血性卒中患者病变部位与卒中后抑郁(post-stroke depression,PSD)的关系.方法 前瞻性纳入2015年1月至2016年6月期间芜湖弋矶山医院神经内科收治的首发急性缺血性卒中患者,记录患者人口统计学及基线临床资料,在患者入院24 h内通过影像学及临床症状进行卒中病灶定位,1个月随访时根据汉密尔顿抑郁评定量表评分将患者分为PSD组(≥8分)和非PSD组(＜8分).采用多变量logistic回归分析探讨PSD与病变部位的独立相关性.结果 共纳入376例急性缺血性卒中患者,其中男性199例(52.93％),女性177例(47.07％);PSD组164例(43.62％),非PSD组212例(56.38％).单变量分析显示,PSD组性别、受教育年限、高血压、卒中病因学分型(小血管闭塞、心源性栓塞)、基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、基线简易精神状态检查量表(Mini-Mental State Examination,MMSE)评分以及左侧额叶、左侧颞叶、左侧基底节区病灶与非PSD组差异有统计学意义(P均＜0.05).多变量logistic回归分析显示,校正年龄、性别、受教育年限、高血压、卒中病因分型以及基线NIHSS评分和MMSE评分后,病变位于左侧额叶[优势比(odds ratio,OR)1.838,95％可信区间(confidence interval,CI)1.028 ～ 3.947;P=0.034]和左侧基底节区(OR 1.672,95％ CI 1.103 ～2.883;P=0.023)以及高血压(OR 1.764,95％ CI1.179 ～3.365;P=0.016)与PSD之间存在独立相关性.结论 缺血性卒中发病1个月后出现的PSD与病灶部位具有显著相关性,其中左侧额叶病灶和左侧基底节区病灶是其独立预测因素.%Objeetive To investigate the relationship between the lesion sites and post-stroke depression (PSD) in patients with acute ischemic stroke.Methods From January 2015 to June 2016,patients with first-ever acute ischemic stroke admitted to the Department of Neurology,Wuhu Yijishan Hospital were enrolled prospectively.The demographic and baseline clinical data were recorded.The stroke lesions were localized by imaging and clinical symptoms within 24 h after admission.The patients were divided into PSD group (≥8) and non-PSD group (＜8) according to the Hamilton Depression Rating Scale score at l-month follow-up.Multivariate logistic regression analysis was used to investigate the independent correlation between PSD and lesion sites.Results A total of 376 patients with acute ischemie stroke were enrolled,including 177 females (47.07％) and 199 males (52.93％).Univariate analysis showed that there were significant differences in sex,years of education,hypertension,etiological classification of stroke (small vessel occlusion,cardiogenic embolism),baseline National Institutes of Health Stroke Scale (NIHSS) score,baseline Mini-Mental State Examination (MMSE) and left frontal lobe,left temporal lobe,and left basal ganglia lesions between the PSD group and the non-PSD group (all P ＜0.05).Multivariate logistic regression analysis showed that after adjusting for age,sex,years of education,hypertension,etiological classification of stroke,NIHSS score,and MMSE score,there was an independent correlation between the lesions in the left frontal lobe (odds ratio [OR] 1.838,95％ confidence interval [CI] 1.028-3.947;P =0.034),the left basal ganglia (OR 1.672,95％ CI 1.103-2.883;P=0.023),hypertension (OR 1.764,95％ CI 1.179-3.365;P =0.016) and PSD.Conclusions One month after the onset of ischemic stroke,there was a significant correlation between PSD and the lesion sites.Left frontal lobe lesion and left basal ganglia lesion were the independent predictors.