杨弘文 汤春琼 区嘉欢 尹剑 李趣红 聂亚雄

[摘要]目的 探讨急性缺血性脑卒中后抑郁（PSD）的发病率及相关因素，为缺血性脑卒中的心理治疗提供依据。方法 选择2014年1月～2016年12月在南华大学附属第一医院和广东省佛山市南方医科大学南海医院神经内科序贯住院的符合入选标准的急性脑卒中患者首次发作并72 h内住院的缺血性脑卒中患者384例进行汉密尔顿抑郁量表评分，依据评估结果分为PSD组（116例）及非PSD组（268例）。对潜在的抑郁危险因素进行统计分析，将差异有统计学意义的因素进行多因素Logistic回归分析。结果 PSD患者的低教育程度、性格内向、经济状况不良、独居、婚姻状态、入院时NIHSS评分≥9分、并发症及关键部位梗死（额叶、基底节）的比例明显高于非抑郁组，差异有统计学意义（P<0.05）。PSD组患者入院时的血清淀粉样蛋白A（SAA）水平为（18.69±5.18）mg/L，显著高于非PSD患者的（15.37±4.75）mg/L，差异有统计学意义（t=6.325，P<0.001）。Logistic回归分析显示，性格内向、经济状况、独居、NIHSS评分、关键部位梗死、血清SAA水平是PSD独立的影响因素（P<0.05）。结论 缺血性PSD受多種因素的影响，血清SAA在缺血性PSD的预测中具有一定的临床应用价值。

[关键词]血清淀粉样蛋白A；脑卒中；卒中后抑郁；Logistic模型

[中图分类号] R743.3 [文献标识码] A [文章编号] 1674-4721（2018）4（a）-0059-04

Analysis on the related influencing factors of post-stroke depression

YANG Hong-wen1 TANG Chun-qiong1 OU Jia-huan1 YIN Jian2 LI Qu-hong1 NIE Ya-xiong2

1.Department of Neurology，Nanhai Hospital of Southern Medical University，Guangdong Province，Foshan 528244，China；2.Department of Neurology，the First Affiliated Hospital of University of South China，Hunan Province，Hengyang 421000，China

[Abstract]Objective To investigate the incidence rate and related factors of post-stroke depression （PSD），so as to provide evidence for psychological treatment of ischemic stroke.Methods From January 2014 to December 2016，patients with acute stroke who met the inclusion criteria and were hospitalized in succession in the Department of Neurology of the First Affiliated Hospital of University of South China and Nanhai Hospital of Southern Medical University in Guangdong Province，Foshan were selected.384 patients with first attack of ischemic stroke who were hospitalized within 72 hours were scored by Hamilton depression rating scale and divided into the PSD group （n=116） and non PSD group （n=268） according to the assessment results.Statistical analysis of potential risk factors for depression was performed，and multiple Logistic regression analysis was carried out for statistically significant factors.Results In the PSD group，the proportion of the low education level，introverted personality，poor economic status，living alone and marital status，NIHSS score ≥9 on admission，complications and infarction at key parts （frontal lobe，basal ganglia） were significantly higher than those in the non PSD group，and the differences were statistically significant （P<0.05）.Serum SSA level in patients of the PSD group （[18.69±5.18] mg/L） was significantly higher than those in non PSD group （[15.37±4.75] mg/L），and the differences were statistically significant （t=6.325，P<0.001）.Logistic regression analysis showed that introverted personality，economic status，living alone，NIHSS score，infarction at key parts and serum SAA level were the independent factors of PSD （P<0.05）.Conclusion Ischemic PSD is affected by many factors.Serum SAA in the prediction of ischemic PSD has a certain clinical application value.

[Key words]Serum amyloid protein A；Cerebral stroke；Post-stroke depression；Logistic model

缺血性脑卒中与心肌梗死、恶性肿瘤并列为致死率最高的三大疾病之一，并且存活者中有50%～70%患者遗留严重残疾，给社会和家庭带来沉重负担。脑梗死所引发的不仅是肢体活动障碍及认知障碍等，部分患者还引发精神类并发症。脑卒中后抑郁症（post-stroke depression，PSD）是脑卒中后发病率最高的精神类并发症，性格改变、偏执及自杀倾向是患者自身伤害和困惑家庭的主要障碍[1]。但是，关于PSD的发病率及其影响因素各研究报道差异较大[2-4]，因而对治疗造成一定影响。本研究通过多因素分析急性缺血性脑卒中患者与PSD的相关性，以期为PSD的早期诊断和干预提供理论依据。……