Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Institut für Medizinische Biometrie und Epidemiologie, Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Eur J Neurol. 2021 Jun;28(6):2017-2025. doi: 10.1111/ene.14797. Epub 2021 Mar 22.
The aim was to study the effect of intravenous alteplase on the development of post-stroke depression (PSD) in acute stroke patients, and to identify predictors of PSD.
This post hoc analysis included patients with unknown onset stroke randomized to treatment with alteplase or placebo in the WAKE-UP trial (ClinicalTrials.gov number, NCT01525290), in whom a composite end-point of PSD was defined as a Beck Depression Inventory ≥10, medication with an antidepressant, or depression recorded as an adverse event. Multiple logistic regression was used to identify predictors of PSD at 90 days. Structural equation modelling was applied to assess the indirect effect of thrombolysis on PSD mediated by the modified Rankin Scale.
Information on the composite end-point was available for 438 of 503 randomized patients. PSD was present in 96 of 224 (42.9%) patients in the alteplase group and 115 of 214 (53.7%) in the placebo group (odds ratio 0.63; 95% confidence interval 0.43-0.94; p = 0.022; adjusted for age and National Institutes of Health Stroke Scale at baseline). Prognostic factors associated with PSD included baseline medication with antidepressants, higher lesion volume, history of depression and assignment to placebo. While 65% of the effect of thrombolysis on PSD were caused directly, 35% were mediated by an improvement of the mRS.
Treatment with alteplase in patients with acute stroke resulted in lower rates of depression at 90 days, which were only partially explained by reduced functional disability. Predictors of PSD including history and clinical characteristics may help in identifying patients at risk of PSD.
本研究旨在探讨急性脑卒中患者静脉注射阿替普酶对卒中后抑郁（PSD）发展的影响，并确定 PSD 的预测因素。
本研究对 WAKE-UP 试验（ClinicalTrials.gov 注册号：NCT01525290）中接受阿替普酶或安慰剂治疗的未知发病时间的脑卒中患者进行了一项事后分析，将 PSD 的复合终点定义为贝克抑郁量表（BDI）评分≥10 分、使用抗抑郁药或抑郁被记录为不良事件。采用多因素逻辑回归分析确定 90 天时 PSD 的预测因素。采用结构方程模型评估改良 Rankin 量表（mRS）对溶栓治疗与 PSD 之间的间接影响。
共纳入 503 例随机患者，其中 438 例患者的复合终点数据可用。阿替普酶组 224 例患者中有 96 例（42.9%）发生 PSD，安慰剂组 214 例患者中有 115 例（53.7%）发生 PSD（比值比 0.63；95%置信区间 0.43-0.94；p=0.022；校正基线时的年龄和 NIHSS 评分）。与 PSD 相关的预后因素包括基线时使用抗抑郁药、病灶体积较大、有抑郁史和分配至安慰剂组。溶栓治疗对 PSD 的影响有 65%是直接造成的，35%是通过改善 mRS 间接造成的。
急性脑卒中患者接受阿替普酶治疗可降低 90 天时的抑郁发生率，但这一效果仅部分归因于功能残疾的减轻。包括既往史和临床特征在内的 PSD 预测因素有助于识别 PSD 风险患者。
