Christensen Michael C, Mayer Stephan A, Ferran Jean-Marc, Kissela Brett
Global Development, Novo Nordisk A/S, Bagsvaerd, Denmark.
Cerebrovasc Dis. 2009;27(4):353-60. doi: 10.1159/000202012. Epub 2009 Feb 14.
Depression is a frequent and important complication of stroke. Few data exist on the prevalence of depression/depressed mood after intracerebral hemorrhage (ICH) and the relationship between depression/depressed mood and the quality of life (QoL) more generally experienced by survivors of ICH.
Factor Seven for Acute Hemorrhagic Stroke (FAST) was a randomized, multicenter, double-blind, placebo-controlled trial conducted between May 2005 and February 2007 at 122 sites in 22 countries. All patients were evaluated at day 90 after ICH onset for depressed mood and QoL with the Hamilton Depression Rating Scale (HDRS) and the EuroQoL, respectively. Multivariate stepwise logistic regression was used to develop a predictive model for depressed mood at day 90. Relationships between HDRS and EuroQoL scores at day 90 were evaluated with Spearman correlation coefficients.
657 patients were alive at 3 months after ICH onset; 596 (91%) completed the HDRS. Twenty percent reported an HDRS score >10, indicating at least a minor degree of depressed mood; 6% endorsed symptoms of severely depressed mood. Significant predictors of depressed mood included comorbidities (p = 0.0022), moderate to severe neurological impairment according to the National Institutes of Health Stroke Scale (NIHSS) at day 15 (p = 0.0097), physical disability as measured by the Barthel Index (BI) at day 15 (p = 0.0486), and female gender (p = 0.04), but not hemorrhage severity or a history of depression. Irrespective of the presence of post-ICH disability and impairment, the severity of depressed mood at day 90 was significantly correlated with poor QoL.
Depressed mood affects approximately 20% of ICH survivors and adversely affects QoL. Physicians should be vigilant to ensure that chronically ill and severely impaired survivors of ICH are adequately monitored and treated for depression after ICH.
抑郁症是卒中常见且重要的并发症。关于脑出血（ICH）后抑郁/情绪低落的患病率以及抑郁/情绪低落与ICH幸存者总体生活质量（QoL）之间的关系，现有数据较少。
急性出血性卒中的因子七（FAST）是一项随机、多中心、双盲、安慰剂对照试验，于2005年5月至2007年2月在22个国家的122个地点进行。所有患者在ICH发病后90天分别使用汉密尔顿抑郁量表（HDRS）和欧洲生活质量量表（EuroQoL）评估情绪低落和生活质量。采用多变量逐步逻辑回归建立90天时情绪低落的预测模型。用Spearman相关系数评估90天时HDRS和EuroQoL评分之间的关系。
657例患者在ICH发病后3个月时存活；596例（91%）完成了HDRS评估。20%的患者报告HDRS评分>10，表明至少有轻度情绪低落；6%的患者认可重度情绪低落症状。情绪低落的显著预测因素包括合并症（p = 0.0022）、第15天时根据美国国立卫生研究院卒中量表（NIHSS）评定的中度至重度神经功能缺损（p = 0.0097）、第15天时用巴氏指数（BI）测量的身体残疾（p = 0.0486）以及女性性别（p = 0.04），但不包括出血严重程度或抑郁病史。无论ICH后是否存在残疾和功能缺损，90天时情绪低落的严重程度与生活质量差显著相关。
情绪低落影响约20%的ICH幸存者，并对生活质量产生不利影响。医生应保持警惕，确保对患有慢性病和严重功能缺损的ICH幸存者在ICH后进行充分的抑郁监测和治疗。
