Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, China; Henan Key Lab of Biological Psychiatry, Henan International Joint Laboratory of Psychiatry and Neuroscience, Xinxiang Medical University, China.
General Hospital of Pingmei Shenma Group, Pingdingshan, China.
J Affect Disord. 2023 Jan 1;320:370-380. doi: 10.1016/j.jad.2022.09.166. Epub 2022 Oct 6.
Post-stroke depression (PSD) is the most common emotional problem following a stroke. White matter hyperintensities (WMHs) are often reported in patients with a stroke, and are often divided into deep WMHs (DWMHs) and periventricular WMHs (PVWMHs). The relationship between WMHs and PSD remains controversial. This review aims to resolve this controversy.
A systematic search of electronic databases was conducted for studies. We extracted the relevant data and evaluated the study quality by using the Newcastle-Ottawa Scale. We pooled odds ratios (OR) for the same type of WMHs that were present in the relevant PSD period.
15 studies (n = 4133 patients) met our inclusion criteria. In the acute phase, WMHs, DWMHs, severe WMHs, and severe DWMHs were not significant risk factors for incident depression, but PVWMHs (pooled OR, 1.21; 95 % CI, 1.01-1.44) and severe PVWMHs (pooled OR, 1.72; 95 % CI, 1.12-2.65) had a significant association with PSD. In the subacute phase, DWMHs, DWMHs, and severe WMHs were not significantly associated with PSD, but PVWMHs (pooled OR, 2.44; 95 % CI, 1.25-4.76) showed a significant association with PSD. In the chronic phase, severe PVWMHs had no significant association with PSD, while WMHs (pooled OR, 1.063; 95 % CI, 1.03-1.09), DWMHs (pooled OR, 1.40; 95 % CI, 1.11-1.76), PVWMHs (pooled OR, 1.28; 95 % CI, 1.11-1.48), and severe DWMHs (pooled OR, 1.52; 95 % CI, 1.12-2.05) showed a significant association with PSD.
We found a significant association between WMHs/DWMHs/PVWMHs and PSD in the chronic post-stroke phase. PVWMHs had a stronger correlation with PSD in each period after stroke than WMHs and DWMHs. High-quality prospective studies are still needed to fully resolve this relationship.
中风后抑郁（PSD）是中风后最常见的情绪问题。脑白质高信号（WMHs）在中风患者中经常被报道，通常分为深部脑白质高信号（DWMHs）和脑室周围脑白质高信号（PVWMHs）。WMHs 与 PSD 之间的关系仍存在争议。本综述旨在解决这一争议。
对电子数据库进行了系统搜索，以寻找相关研究。我们提取了相关数据，并使用纽卡斯尔-渥太华量表评估了研究质量。我们对同一类型的 WMHs 进行了荟萃分析，这些 WMHs 出现在 PSD 相关时期。
15 项研究（n=4133 例患者）符合纳入标准。在急性期，WMHs、DWMHs、重度 WMHs 和重度 DWMHs 不是抑郁发作的显著危险因素，但 PVWMHs（汇总 OR，1.21；95%CI，1.01-1.44）和重度 PVWMHs（汇总 OR，1.72；95%CI，1.12-2.65）与 PSD 有显著相关性。在亚急性期，DWMHs、DWMHs 和重度 WMHs 与 PSD 无显著相关性，但 PVWMHs（汇总 OR，2.44；95%CI，1.25-4.76）与 PSD 有显著相关性。在慢性期，重度 PVWMHs 与 PSD 无显著相关性，而 WMHs（汇总 OR，1.063；95%CI，1.03-1.09）、DWMHs（汇总 OR，1.40；95%CI，1.11-1.76）、PVWMHs（汇总 OR，1.28；95%CI，1.11-1.48）和重度 DWMHs（汇总 OR，1.52；95%CI，1.12-2.05）与 PSD 有显著相关性。
我们发现，在中风后慢性期，WMHs/DWMHs/PVWMHs 与 PSD 之间存在显著相关性。在中风后每个时期，PVWMHs 与 PSD 的相关性均强于 WMHs 和 DWMHs。仍需要高质量的前瞻性研究来充分解决这一关系。
