Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China; Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.
BrainNow Research Institute, Shenzhen, Guangdong Province, China.
J Stroke Cerebrovasc Dis. 2019 Dec;28(12):104413. doi: 10.1016/j.jstrokecerebrovasdis.2019.104413. Epub 2019 Sep 30.
Poststroke depression (PSD) is one of the most common complications after ischemic stroke, and periodontitis is associated with depression. However, whether severe periodontitis is associated with early-onset PSD status remains unknown. In this study, we aimed to investigate whether there is an association between severe periodontitis and PSD status in acute ischemic stroke patients.
We recruited 202 acute ischemic stroke patients within 7 days after stroke onset. Pocket depth and clinical attachment loss were assessed by oral examination to define the severe periodontitis. On the basis of diagnosis of PSD status according to DSM-5 criteria and a 24-item Hamilton Depression Rating Scale score greater than or equal to 8 within 2 weeks after stroke onset, we stratified patients into PSD status or non-PSD status groups and identified the independent predictors for the development of PSD status in multivariate logistic analysis.
77 (38.1%) patients were diagnosed as early-onset PSD status. PSD status group showed more severe periodontitis, lower income, lower Barthel Index (BI) score and Montreal Cognitive Assessment score, higher National Institutes of Health Stroke Scale score and modified Rankin scale (mRS) score compared with non-PSD status group. Multivariate logistic regression showed that severe periodontitis (odds ratio 2.401) and NIHSS score (>4, odds ratio 2.130) were independent predictors for early-onset PSD status.
Severe periodontitis is found to be an important independent predictor of early-onset PSD status in patients with acute ischemic stroke, in addition to the well-known prognostic factors such as nonminor stroke assessed by NIHSS greater than 4.
卒中后抑郁（PSD）是缺血性卒中后最常见的并发症之一，而牙周炎与抑郁有关。然而，严重牙周炎是否与 PSD 的早期发病有关尚不清楚。在本研究中，我们旨在探讨急性缺血性卒中患者中严重牙周炎与 PSD 状态之间是否存在关联。
我们招募了 202 名发病后 7 天内的急性缺血性卒中患者。通过口腔检查评估牙周袋深度和临床附着丧失，以确定严重牙周炎。根据 DSM-5 标准和卒中发病后 2 周内汉密尔顿抑郁量表评分大于或等于 8 的 PSD 诊断标准，将患者分为 PSD 状态或非 PSD 状态组，并在多变量逻辑回归中确定 PSD 状态发生的独立预测因素。
77 例（38.1%）患者被诊断为早期 PSD 状态。与非 PSD 状态组相比，PSD 状态组的牙周炎更严重，收入更低，Barthel 指数（BI）和蒙特利尔认知评估评分更低，NIHSS 评分和改良 Rankin 量表（mRS）评分更高。多变量逻辑回归显示，严重牙周炎（比值比 2.401）和 NIHSS 评分（>4，比值比 2.130）是早期 PSD 状态的独立预测因素。
除了 NIHSS 评分大于 4 等已知的预后因素外，严重牙周炎被发现是急性缺血性卒中患者早期 PSD 状态的重要独立预测因素。
