Omura Tomoko, Kimura Mahito, Kim Kyongsong, Mishina Masahiro, Mizunari Takayuki, Kobayashi Shiro, Morita Akio
Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai-city, Chiba, Japan.
Department of Neuropsychiatry, Nippon Medical School Chiba Hokusoh Hospital, Inzai-city, Chiba, Japan.
J Stroke Cerebrovasc Dis. 2018 Feb;27(2):499-505. doi: 10.1016/j.jstrokecerebrovasdis.2017.09.028. Epub 2017 Nov 1.
We investigated the role of acute-phase stroke lesions and patient characteristics in poststroke depression (PSD) and its effect on the clinical outcome.
Five and 30 days after admission, 175 patients self-reported their depressive symptoms on the Patient Health Questionnaire-9. We compared the clinical characteristics and outcomes in patients with (n = 41) and without PSD (n = 134). Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS); the modified Rankin Scale (mRS) was used to determine the functional outcome.
There was no significant difference between patients with and without PSD in the age, gender ratio, lesion side, and the history of hypertension, diabetes mellitus, alcohol and tobacco use, and previous stroke. Thalamic lesions were significantly associated with PSD (P = .03), although there was no significant difference in both the NIHSS score and the final mRS score of patients with thalamic lesions. Backward stepwise logistic regression analysis showed that a higher NIHSS score and thalamic lesions were independent predictors of PSD. Total hospitalization was significantly longer in patients with PSD. At the time of admission, the NIHSS score was significantly higher in patients who developed moderate to severe PSD than in those with mild PSD or without PSD.
PSD in the acute phase was associated with thalamic lesions and severe stroke. Hospitalization was significantly longer in patients with PSD and their functional disability was more severe, suggesting that PSD played a role in the unsatisfactory results of poststroke rehabilitation.
我们研究了急性期卒中病灶及患者特征在卒中后抑郁（PSD）中的作用及其对临床结局的影响。
入院后5天和30天，175例患者通过患者健康问卷-9自我报告其抑郁症状。我们比较了有PSD（n = 41）和无PSD（n = 134）患者的临床特征及结局。采用美国国立卫生研究院卒中量表（NIHSS）评估卒中严重程度；改良Rankin量表（mRS）用于确定功能结局。
有PSD和无PSD的患者在年龄、性别比例、病灶侧以及高血压、糖尿病、烟酒使用史和既往卒中史方面无显著差异。丘脑病灶与PSD显著相关（P = 0.03），尽管丘脑病灶患者的NIHSS评分和最终mRS评分均无显著差异。向后逐步逻辑回归分析显示，较高的NIHSS评分和丘脑病灶是PSD的独立预测因素。PSD患者的总住院时间显著更长。入院时，发生中度至重度PSD的患者的NIHSS评分显著高于轻度PSD或无PSD的患者。
急性期PSD与丘脑病灶和严重卒中相关。PSD患者的住院时间显著更长，且其功能残疾更严重，这表明PSD在卒中后康复效果不佳中起作用。
