CAJ | 학술논문

目的：通过对急性缺血性脑卒中患者进行磁共振弥散加权成像（DWI）检查和随访，结合急性缺血性脑卒中的相关危险因素及卒中的严重程度，探究磁共振DWI上新发生的卒中病灶位置与卒中后抑郁（ PSD）之间的关系，对急性缺血性脑卒中患者在预防PSD方面提供帮助，从根本上改善卒中患者的预后和生存质量。方法选择2013年5至11月于哈尔滨医科大学附属第一医院神经内科三病房就诊且符合本试验入组标准的急性缺血性脑卒中患者70例。所有患者入院后对其性别、年龄、高血压病史、糖尿病病史、冠心病病史、吸烟史、饮酒史、文化水平等进行登记，给予适当的改善循环、营养神经及控制相关危险因素的治疗，并完善磁共振DWI及其他相关的实验室检查，院外要求继续相应的二级预防并对其进行相关临床资料的分析和随访（自入院起2周、1个月、3个月），观察并比较各时间点PSD的发病率及其与磁共振DWI上新病灶的关系。结果 DWI上具有新病灶的急性缺血性卒中患者发病3个月内PSD发病率比较：多发脑梗死（75.00％）＞额叶梗死（50.00％）＞边缘系统梗死（21.43％）＞基底节区梗死（12.50％），且各组患者间PSD发病率的比较差异具有统计学意义（ P＜0.05）；2周时PSD发病率比较：多发脑梗死（50.00％）＞额叶梗死（18.75％）＞边缘系统梗死（7.14％）＞基底节区梗死（0），且各组患者间PSD发病率的比较差异具有统计学意义（P＜0.05）。DWI上显示多发脑梗死的患者不同随访时间PSD发病率的比较差异具有统计学意义（ P＜0.05）。结论2周时及3个月内PSD的发病率与DWI上新病灶之间有关，且DWI上显示多发脑梗死者PSD的发病率高于单个脑区梗死者；DWI上显示多发脑梗死者PSD的发病率与随访时间有关；DWI上显示单个脑区（额叶、边缘系统、基底节区）梗死者PSD的发病率与随访时间无关；DWI检查对PSD具有提示性。目的：通過對急性缺血性腦卒中患者進行磁共振瀰散加權成像（DWI）檢查和隨訪，結閤急性缺血性腦卒中的相關危險因素及卒中的嚴重程度，探究磁共振DWI上新髮生的卒中病竈位置與卒中後抑鬱（ PSD）之間的關繫，對急性缺血性腦卒中患者在預防PSD方麵提供幫助，從根本上改善卒中患者的預後和生存質量。方法選擇2013年5至11月于哈爾濱醫科大學附屬第一醫院神經內科三病房就診且符閤本試驗入組標準的急性缺血性腦卒中患者70例。所有患者入院後對其性彆、年齡、高血壓病史、糖尿病病史、冠心病病史、吸煙史、飲酒史、文化水平等進行登記，給予適噹的改善循環、營養神經及控製相關危險因素的治療，併完善磁共振DWI及其他相關的實驗室檢查，院外要求繼續相應的二級預防併對其進行相關臨床資料的分析和隨訪（自入院起2週、1箇月、3箇月），觀察併比較各時間點PSD的髮病率及其與磁共振DWI上新病竈的關繫。結果 DWI上具有新病竈的急性缺血性卒中患者髮病3箇月內PSD髮病率比較：多髮腦梗死（75.00％）＞額葉梗死（50.00％）＞邊緣繫統梗死（21.43％）＞基底節區梗死（12.50％），且各組患者間PSD髮病率的比較差異具有統計學意義（ P＜0.05）；2週時PSD髮病率比較：多髮腦梗死（50.00％）＞額葉梗死（18.75％）＞邊緣繫統梗死（7.14％）＞基底節區梗死（0），且各組患者間PSD髮病率的比較差異具有統計學意義（P＜0.05）。DWI上顯示多髮腦梗死的患者不同隨訪時間PSD髮病率的比較差異具有統計學意義（ P＜0.05）。結論2週時及3箇月內PSD的髮病率與DWI上新病竈之間有關，且DWI上顯示多髮腦梗死者PSD的髮病率高于單箇腦區梗死者；DWI上顯示多髮腦梗死者PSD的髮病率與隨訪時間有關；DWI上顯示單箇腦區（額葉、邊緣繫統、基底節區）梗死者PSD的髮病率與隨訪時間無關；DWI檢查對PSD具有提示性。
목적：통과대급성결혈성뇌졸중환자진행자공진미산가권성상（DWI）검사화수방，결합급성결혈성뇌졸중적상관위험인소급졸중적엄중정도，탐구자공진DWI상신발생적졸중병조위치여졸중후억욱（ PSD）지간적관계，대급성결혈성뇌졸중환자재예방PSD방면제공방조，종근본상개선졸중환자적예후화생존질량。방법선택2013년5지11월우합이빈의과대학부속제일의원신경내과삼병방취진차부합본시험입조표준적급성결혈성뇌졸중환자70례。소유환자입원후대기성별、년령、고혈압병사、당뇨병병사、관심병병사、흡연사、음주사、문화수평등진행등기，급여괄당적개선순배、영양신경급공제상관위험인소적치료，병완선자공진DWI급기타상관적실험실검사，원외요구계속상응적이급예방병대기진행상관림상자료적분석화수방（자입원기2주、1개월、3개월），관찰병비교각시간점PSD적발병솔급기여자공진DWI상신병조적관계。결과 DWI상구유신병조적급성결혈성졸중환자발병3개월내PSD발병솔비교：다발뇌경사（75.00％）＞액협경사（50.00％）＞변연계통경사（21.43％）＞기저절구경사（12.50％），차각조환자간PSD발병솔적비교차이구유통계학의의（ P＜0.05）；2주시PSD발병솔비교：다발뇌경사（50.00％）＞액협경사（18.75％）＞변연계통경사（7.14％）＞기저절구경사（0），차각조환자간PSD발병솔적비교차이구유통계학의의（P＜0.05）。DWI상현시다발뇌경사적환자불동수방시간PSD발병솔적비교차이구유통계학의의（ P＜0.05）。결론2주시급3개월내PSD적발병솔여DWI상신병조지간유관，차DWI상현시다발뇌경사자PSD적발병솔고우단개뇌구경사자；DWI상현시다발뇌경사자PSD적발병솔여수방시간유관；DWI상현시단개뇌구（액협、변연계통、기저절구）경사자PSD적발병솔여수방시간무관；DWI검사대PSD구유제시성。
Objective To analyze the diffusion weighted imaging ( DWI) and the data of follow-up of acute ischemic stroke patients ,according to related risk factors and the severity of stroke to try to explore the relationship of the stroke lesion on the diffusion weighted imaging and post-stroke depression (PSD),which could provide help in the prevention of PSD and improve the quality of life of stroke patients . Methods Seventy patients who recepted treatment from the Third Department of Neurology in the First Affiliated Hospital of Harbin Medical University during July 2013 to October 2013 who were accord with our enter criterion were chosen in our study ,and information such as gender ,age,history of hypertension ,diabetes mellitus,history of coronary heart disease,smoking history,drinking history,level of education,social support and other information were collected .All these patients were given proper treatment , such as improving circulation,trophic nerve and controling risk factors .The patients finished DWI as soon as possible .They would be asked to continue their treatment for secondary prevention and cooperate to complete the collection of clinical data and follow-up ( from 2 weeks of admission , 1 month, 3 months ) , the relationships of the incidence of post-stroke depression and the new location of the lesion on weighted magnetic resonance imaging were observed and compared .Results The comparison of the incidence of PSD of acute ischemic stroke patients whose responsibility lesions was showed on DWI lesions in 3 months:multiple cerebral infarction( 75.00%) >frontal lobe infarction ( 50.00%) >limbic system infarction ( 21.43%) >basal ganglia infarction(12.50%),and the incidence of PSD had significant difference (P<0.05);On 2 weeks:multiple cerebral infarction ( 50.00%) >frontal lobe infarction ( 18.75%) >limbic system infarction (7.14%)>basal ganglia infarction(0),and the incidence of PSD had significant difference (P<0.05). Patients who were showed multiple cerebral infarction on DWI , the comparison of PSD had significant difference(P<0.05).Conclusion The incidence of PSD on 2 weeks and 3 months and is relevant to new lesions on DWI , and the incidence of PSD in multiple cerebral infarction is higher than the other system infarction and relevant with the follow-up time.There is no relevance between the incidence of PSD and deferent follow-up times on these who are showed single infarction (frontal lobe,limbic system,basal ganglia) on DWI.DWI can prompt PSD in someways .