中华神经医学杂志
中華神經醫學雜誌
중화신경의학잡지
CHINESE JOURNAL OF NEUROMEDICINE
2013年
10期
1043-1049
,共7页
钱俊枫%张志珺%钱方媛%杨玲俐%栾军祥
錢俊楓%張誌珺%錢方媛%楊玲俐%欒軍祥
전준풍%장지군%전방원%양령리%란군상
脑卒中后抑郁%脑白质疏松%年龄相关的白质改变%深部脑白质高信号
腦卒中後抑鬱%腦白質疏鬆%年齡相關的白質改變%深部腦白質高信號
뇌졸중후억욱%뇌백질소송%년령상관적백질개변%심부뇌백질고신호
Post-stroke depression%Leukoaraiosis%Age-related white matter change%Deep white matter hyperintensity
目的 初步探讨缺血性脑卒中急性期抑郁发生与脑白质疏松的关系.方法 对东南大学附属中大医院神经内科自2007年6月至2011年3月收治的168例缺血性脑卒中急性期患者入院后均行头颅磁共振检查.在脑卒中发病14d参照美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准进行脑卒中后抑郁的诊断,其中60例(35.7％)患者发生脑卒中后抑郁(脑卒中后抑郁组),剩余患者中随机选取年龄与性别相匹配的60例脑卒中后非抑郁患者纳入脑卒中后非抑郁组.对2组患者采用Fazekas评分方法和年龄相关的白质改变(ARWMC)量表评估脑白质疏松的部位及严重程度,并且依据各变量在单因素分析中的检验水平(P＜0.05)及临床意义筛选进入多因素Logistic回归分析中以探讨脑卒中后抑郁的危险因素.结果 脑卒中后抑郁组深部脑白质高信号(DWMHs)评分和额叶区ARWMC评分明显高于脑卒中后非抑郁组,差异有统计学意义(P＜0.05).2组间脑室旁白质高信号(PVw MHs)及顶枕区、颞区、幕下区、基底节区ARWMC评分比较差异均无统计学意义(P＞0.05).多因素Logistic回归分析显示,DWMHs是缺血性脑卒中急性期抑郁发生的独立危险因素(OR:1.740,95％CI:1.194～2.536,P=0.004).结论 严重的深部脑白质疏松可能增加缺血性脑卒中急性期抑郁发生的易患性.
目的 初步探討缺血性腦卒中急性期抑鬱髮生與腦白質疏鬆的關繫.方法 對東南大學附屬中大醫院神經內科自2007年6月至2011年3月收治的168例缺血性腦卒中急性期患者入院後均行頭顱磁共振檢查.在腦卒中髮病14d參照美國精神障礙診斷與統計手冊第4版(DSM-Ⅳ)診斷標準進行腦卒中後抑鬱的診斷,其中60例(35.7％)患者髮生腦卒中後抑鬱(腦卒中後抑鬱組),剩餘患者中隨機選取年齡與性彆相匹配的60例腦卒中後非抑鬱患者納入腦卒中後非抑鬱組.對2組患者採用Fazekas評分方法和年齡相關的白質改變(ARWMC)量錶評估腦白質疏鬆的部位及嚴重程度,併且依據各變量在單因素分析中的檢驗水平(P＜0.05)及臨床意義篩選進入多因素Logistic迴歸分析中以探討腦卒中後抑鬱的危險因素.結果 腦卒中後抑鬱組深部腦白質高信號(DWMHs)評分和額葉區ARWMC評分明顯高于腦卒中後非抑鬱組,差異有統計學意義(P＜0.05).2組間腦室徬白質高信號(PVw MHs)及頂枕區、顳區、幕下區、基底節區ARWMC評分比較差異均無統計學意義(P＞0.05).多因素Logistic迴歸分析顯示,DWMHs是缺血性腦卒中急性期抑鬱髮生的獨立危險因素(OR:1.740,95％CI:1.194～2.536,P=0.004).結論 嚴重的深部腦白質疏鬆可能增加缺血性腦卒中急性期抑鬱髮生的易患性.
목적 초보탐토결혈성뇌졸중급성기억욱발생여뇌백질소송적관계.방법 대동남대학부속중대의원신경내과자2007년6월지2011년3월수치적168례결혈성뇌졸중급성기환자입원후균행두로자공진검사.재뇌졸중발병14d삼조미국정신장애진단여통계수책제4판(DSM-Ⅳ)진단표준진행뇌졸중후억욱적진단,기중60례(35.7％)환자발생뇌졸중후억욱(뇌졸중후억욱조),잉여환자중수궤선취년령여성별상필배적60례뇌졸중후비억욱환자납입뇌졸중후비억욱조.대2조환자채용Fazekas평분방법화년령상관적백질개변(ARWMC)량표평고뇌백질소송적부위급엄중정도,병차의거각변량재단인소분석중적검험수평(P＜0.05)급림상의의사선진입다인소Logistic회귀분석중이탐토뇌졸중후억욱적위험인소.결과 뇌졸중후억욱조심부뇌백질고신호(DWMHs)평분화액협구ARWMC평분명현고우뇌졸중후비억욱조,차이유통계학의의(P＜0.05).2조간뇌실방백질고신호(PVw MHs)급정침구、섭구、막하구、기저절구ARWMC평분비교차이균무통계학의의(P＞0.05).다인소Logistic회귀분석현시,DWMHs시결혈성뇌졸중급성기억욱발생적독립위험인소(OR:1.740,95％CI:1.194～2.536,P=0.004).결론 엄중적심부뇌백질소송가능증가결혈성뇌졸중급성기억욱발생적역환성.
Objective To evaluate the relationship between post-stroke depression (PSD) and leukoaraiosis in a well-defined acute ischemic stroke cohort.Methods One hundred and sixty-eight patients with acute ischemic stroke,admitted to our hospital from June 2007 to March 2011,were examined by magnetic resonance imaging.The patients were made a diagnosis of post-stroke depression by the Diagnostic and Statistical Manual for Mental Disorders,Fourth Edition (DSM-IV) criteria 2 weeks after the index stroke; 60 (35.7％) patients had PSD in the acute period and 60 stroke patients without depression matched according to age and gender served as a control group were chosen.The distribution and severity of leukoaraiosis were evaluated using scale developed by Fazekas and age-related white matter changes (ARWMC) scale.The risk factors of PSD were chosen after univariate analysis and multivariate logistic regression analysis.Results In comparison with the non-PSD group,patients in the PSD group were more likely to have high deep white matter hyperintensities (DWMHs) scores and ARWMC scale scores in the frontal area with significant difference (P＜0.05).There were no significant differences in periventricular white matter hypertensities (PVWMHs) scores and ARWMC scale scores in the parieto-occipital area,temporal area,infratentorial area and basal ganglia area between the PSD and control groups (P＞0.05).In the multivariate logistic regression analysis,DWMHs remained an independent risk factor of PSD (OR:1.740,95％CI:1.194-2.536,P=0.004).Conclusion There may be an association between PSD and leukoaraiosis; severe leukoaraiosis in the deep area may increase vulnerability to develop depression in the acute period after ischemic stroke.
