Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Department of Neurology, The Wenzhou Hospital of traditional Chinese medicine, Wenzhou, Zhejiang, China.
Int J Geriatr Psychiatry. 2018 Jul;33(7):956-963. doi: 10.1002/gps.4878. Epub 2018 Mar 30.
It is unknown whether prediabetes is a predictor of poststroke depression (PSD). We aimed to explore the relationship between prediabetes and PSD in Chinese patients with acute ischemic stroke.
This is a prospective cohort study, and a total of 358 patients with acute ischemic stroke were recruited and enrolled. Patients were divided into 3 groups: normal glucose group (NGT, n = 96), prediabetes group (preDM, n = 134, impaired fasting glucose (IFG), and/or impaired glucose tolerance (IGT) and/or HbA1c (A1c) 5.7%-6.4%), and the diabetes mellitus group (DM, n = 128). At 1 month after stroke, patients with a Hamilton Depression Scale score of ≥8 were diagnosed as PSD.
In post hoc comparisons, the risk of PSD in patients with diabetes and prediabetes was higher than patients with NGT (37.5% vs 31.3% vs 14.6%, P = .001). Compared with NGT, the incidence rate of PSD in patients with prediabetes with HbA1c 5.7% to 6.4% and patients with prediabetes with IFG/IGT + HbA1c 5.7% to 6.4% was higher (35.3% vs 14.6%, 38.0% vs 14.6%; P = .006; P = .003, respectively). In logistic regression, prediabetes with HbA1c 5.7% to 6.4% and prediabetes with IFG/IGT + HbA1c 5.7% to 6.4% were a significant independent predictor of PSD after adjusting for potential confounding factors, with odd ratios of 1.731 and 1.978, respectively.
Our study showed that prediabetes was associated with PSD and may predict its development at 1 month poststroke. In prediabetes subgroups, patients with HbA1c 5.7% to 6.4% were more likely to develop PSD compared to NGT and IFG/IGT groups.
目前尚不清楚糖尿病前期是否是卒中后抑郁（PSD）的预测因素。本研究旨在探讨中国急性缺血性脑卒中患者中糖尿病前期与 PSD 的关系。
这是一项前瞻性队列研究，共纳入 358 例急性缺血性脑卒中患者。患者被分为 3 组：正常血糖组（NGT，n=96）、糖尿病前期组（preDM，n=134，包括空腹血糖受损（IFG）和/或糖耐量受损（IGT）和/或糖化血红蛋白（HbA1c）5.7%~6.4%）和糖尿病组（DM，n=128）。卒中后 1 个月，采用汉密尔顿抑郁量表（HAMD）评分≥8 分诊断 PSD。
事后比较发现，糖尿病和糖尿病前期患者 PSD 的风险高于 NGT 患者（37.5%比 31.3%比 14.6%，P=0.001）。与 NGT 相比，HbA1c 5.7%6.4%的糖尿病前期患者和 IFG/IGT+HbA1c 5.7%6.4%的糖尿病前期患者 PSD 的发生率更高（35.3%比 14.6%，38.0%比 14.6%；P=0.006；P=0.003）。在 logistic 回归分析中，HbA1c 5.7%6.4%的糖尿病前期和 IFG/IGT+HbA1c 5.7%6.4%的糖尿病前期是 PSD 的独立危险因素，OR 值分别为 1.731 和 1.978。
本研究表明，糖尿病前期与 PSD 相关，可能预测卒中后 1 个月 PSD 的发生。在糖尿病前期亚组中，HbA1c 5.7%~6.4%的患者较 NGT 和 IFG/IGT 患者更易发生 PSD。
