脑微出血与急性缺血性卒中后抑郁的相关性

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摘要

目的: 探讨脑微出血与急性缺血性卒中患者卒中后抑郁(poststroke depression, PSD)的相关性。方法: 回顾性纳入初发或复发急性缺血性脑卒中患者，记录患者入院时的人口学及临床基线资料，纳入患者均入院3 d内完成头颅MRI检查，根据脑微出血位置将患者分为脑叶、深部和后颅窝(脑干和小脑)组，并记录每个部位的脑微出血总数。随访3个月时根据抑郁诊断标准分为PSD组和非PSD组，采用多元Logistic回归分析脑微出血与PSD的相关性。结果：最终入组并完成随访者203例，其中PSD组67例，非PSD 组136例。单因素分析显示，受教育年限、基线NIHSS评分、3个月MMSE评分、3个月LSNS评分、额叶、深部以及脑干脑微出血、前额叶急性脑梗死与PSD发生显著相关(P均<0.05)。多因素回归分析显示，对相关因素调整后，深部(OR=2.091, 95%CI 1.061~4.138，P=0.036)以及脑干脑微出血(OR=2.235，95%CI 1.179~4.587，P=0.031)与PSD发生具有独立相关性；基线NHISS评分(OR=1.174, 95%CI=1.008~1.346，P=0.041)，前额叶急性脑梗死(OR 4.326, 95%CI=1.074~14.371，P=0.045)也与PSD发生独立相关。结论：在轻中度急性缺血性卒中患者中，脑干和深部脑微出血是缺血性脑卒中3个月发生PSD的独立危险因素。

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	胡佳1
	周志明1
	杨倩1
	韩剑2
	颜燕1

关键词 ：脑微出血, 卒中后抑郁, 脑梗死, 急性缺血性卒中, 血脑屏障

Abstract：

Objective: To investigate the correlation between cerebral microbleeds(CMBs) and poststroke depression(PSD) in acute ischemic stroke. Methods: The clinical data of hospitalized patients with first time or recurrence acute ischemic stroke were collected from department of neurology. Baseline demographic and clinical information on admission were recorded. Head MRI images were completed within 3 days on admission. The patients were divided into lobes, deep and posterior fossa (brainstem and cerebellum) groups according to ischemic location, and the total number of CMBs in each site was recorded. PSD was diagnosed according to depression criteria at the end of 3 month followingup. The patients enrolled were divided into the PSD and nonPSD group. Multivariate Logistic regression analysis was used to analyze the correlation between CMBs and poststroke depression. Results: A total of 203 cases were enrolled, and 67 cases in PSD group and 136 cases in nonPSD group. Univariate analysis showed that years of education, baseline NIHSS score, 3-month MMSE score, 3-month LSNS score, cerebral microbleed in frontal lobe, deep brain stem and frontal lobe acute cerebral infarction were significantly correlated with the occurrence of PSD (all P<0.05). Multivariate Logistic regression analysis showed, after adjusting for relevant factors, cerebral microbleeds in deep and brainstem (OR=2.091, 95%CI=1.061-4.138, P=0.036; OR=2.235, 95%CI=1.179-4.587, P=0.031) had independent correlation with the occurrence of PSD. Baseline NHISS score (OR=1.174, 95%CI=1.008-1.346, P=0.041) and acute prefrontal lobe cerebral infarction (OR=4.326, 95%CI=1.074-14.371, P=0.045) were also independently correlated with the occurrence of PSD. Conclusion: In patients with mild to moderate acute ischemic stroke, microbleeds in the brain stem and deep brain is an independent risk factor for poststroke depression after 3 months of ischemic stroke.

基金资助:

[基金项目] 2015年度皖南医学院中青年科研基金资助项目(WK2015F6)

作者简介: 胡佳(1985—)，女，安徽芜湖人，硕士，主治医师，主要从事脑血管病、神经心理疾病以及中枢神经系统感染等研究

引用本文:

胡佳1，周志明1，杨倩1，韩剑2，颜燕1. 脑微出血与急性缺血性卒中后抑郁的相关性[J]. 江苏大学学报:医学版, 2019, 29(05): 419-424. HU Jia1， ZHOU Zhi-ming1, YANG Qian1, HAN Jian2, YAN Yan1. The correlation between cerebral microbleeds and poststroke depression in acute ischemic stroke. Journal of Jiangsu University(Medicine Edition), 2019, 29(05): 419-424.

链接本文:

http://zzs.ujs.edu.cn/xbyxb/CN/ 或 http://zzs.ujs.edu.cn/xbyxb/CN/Y2019/V29/I05/419

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