Stuckart Isabella, Siepmann Timo, Hartmann Christian, Pallesen Lars-Peder, Sedghi Annahita, Barlinn Jessica, Reichmann Heinz, Puetz Volker, Barlinn Kristian
Department of Neurology, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany.
Front Neurol. 2021 Oct 5;12:734170. doi: 10.3389/fneur.2021.734170. eCollection 2021.
Neuroprotective and neurorestorative effects have been postulated for selective serotonin-reuptake inhibitors (SSRI). We hypothesized that sertraline, which is characterized by less severe adverse effects and more stable pharmacokinetics than classic SSRI, is associated with improved functional recovery in acute ischemic stroke patients with motor deficits. Prospective observational study of consecutive acute ischemic stroke patients who received sertraline for clinically suspected post-stroke depression (PSD) or at high risk for PSD. Eligibility comprised acute motor deficit caused by ischemic stroke (≥2 points on NIHSS motor items) and functional independence pre-stroke (mRS ≤1). Decision to initiate treatment with SSRI during hospital stay was at the discretion of the treating stroke physician. Patients not receiving sertraline served as control group. Favorable functional recovery defined as mRS ≤2 was prospectively assessed at 3 months. Multivariable logistic regression analysis was used to explore the effects of sertraline on 3-months functional recovery. Secondary outcomes were frequency of any and incident PSD (defined by BDI ≥10) at 3 months. During the study period (03/2017-12/2018), 114 patients were assigned to sertraline ( = 72, 62.6%) or control group ( = 42, 37.4%). At study entry, patients in sertraline group were more severely neurologically affected than patients in the control group (NIHSS: 8 [IQR, 5-11] vs. 5 [IQR, 4-7]; = 0.002). Also, motor NIHSS scores were more pronounced in sertraline than in control group (4 [IQR 2-7] vs. 2 [IQR 2-4], = 0.001). After adjusting for age and baseline NIHSS, multivariable regression analysis revealed a significant association between sertraline intake and favorable functional outcome at 3 months (OR 3.10, 95% CI 1.02-9.41; = 0.045). There was no difference between both groups regarding the frequency of any depression at 3 months (26/53 [49.1%] vs. 14/28 [50.0%] patients, = 0.643, BDI ≥10). However, fewer incident depressions were observed in sertraline group patients compared to patients in control group (0/53 [0%] vs. 5/28 [17.9%] patients, = 0.004). In this non-randomized comparison, early treatment with sertraline tended to favor functional recovery in patients with acute ischemic stroke. While exploratory in nature, this hypothesis needs further investigation in a clinical trial.
已有研究推测选择性5-羟色胺再摄取抑制剂（SSRI）具有神经保护和神经修复作用。我们假设，与传统SSRI相比，舍曲林具有不良反应较轻、药代动力学更稳定的特点，它与急性缺血性卒中伴运动功能缺损患者功能恢复的改善相关。对连续的急性缺血性卒中患者进行前瞻性观察研究，这些患者因临床怀疑有卒中后抑郁（PSD）或有PSD高风险而接受舍曲林治疗。纳入标准包括由缺血性卒中导致的急性运动功能缺损（NIHSS运动项目评分≥2分）以及卒中前功能独立（改良Rankin量表评分≤1分）。住院期间开始使用SSRI治疗的决定由治疗卒中的医生自行决定。未接受舍曲林治疗的患者作为对照组。前瞻性评估3个月时功能恢复良好（定义为改良Rankin量表评分≤2分）的情况。采用多变量逻辑回归分析来探讨舍曲林对3个月时功能恢复的影响。次要结局指标是3个月时任何抑郁及新发PSD（定义为贝克抑郁量表评分≥10分）的发生率。在研究期间（2017年3月至2018年12月），114例患者被分配至舍曲林组（n = 72，62.6%）或对照组（n = 42，37.4%）。在研究开始时，舍曲林组患者的神经功能损害比对照组患者更严重（NIHSS评分：8分[四分位间距，5 - 11分] vs. 5分[四分位间距，4 - 7分]；P = 0.002）。此外，舍曲林组的运动NIHSS评分比对照组更明显（4分[四分位间距2 - 7分] vs. 2分[四分位间距2 - 4分]，P = 0.001）。在对年龄和基线NIHSS进行校正后，多变量回归分析显示舍曲林的使用与3个月时良好的功能结局之间存在显著关联（比值比3.10，9５%置信区间1.02 - 9.41；P = 0.045）。两组在3个月时任何抑郁的发生率方面没有差异（26/53例患者[49.1%] vs. 14/28例患者[50.0%]，P = 0.643，贝克抑郁量表评分≥10分）。然而，与对照组患者相比，舍曲林组患者中观察到的新发抑郁较少（0/53例患者[0%] vs. 5/28例患者[17.9%]，P = 0.004）。在这项非随机对照研究中，舍曲林早期治疗倾向于有利于急性缺血性卒中患者的功能恢复。虽然本研究本质上是探索性的，但这一假设需要在临床试验中进一步研究。
