卒中前体力活动和西酞普兰治疗对卒中后抑郁症状的影响：来自丹麦 TALOS 随机对照试验数据的二次分析。

Impact of prestroke physical activity and citalopram treatment on poststroke depressive symptoms: a secondary analysis of data from the TALOS randomised controlled trial in Denmark.

机构信息

Department of Neurology, Aarhus University Hospital, Aarhus, Denmark

Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

出版信息

BMJ Open. 2023 Mar 30;13(3):e070822. doi: 10.1136/bmjopen-2022-070822.

DOI:10.1136/bmjopen-2022-070822

PMID:36997260

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10069592/

Abstract

OBJECTIVES

To investigate the association between prestroke physical activity and depressive symptoms up to 6 months after stroke and examine if citalopram treatment modified the association.

DESIGN

A secondary analysis of data from the multicentre randomised controlled trial The Efficacy of Citalopram Treatment in Acute Ischemic Stroke (TALOS).

SETTING AND PARTICIPANTS

TALOS was conducted at multiple stroke centres in Denmark from 2013 to 2016. It enrolled 642 non-depressed patients with first-ever acute ischaemic stroke. Patients were eligible for this study if a prestroke physical activity level was assessed by the Physical Activity Scale for the Elderly (PASE).

INTERVENTIONS

All patients were randomised to citalopram or placebo for 6 months.

OUTCOMES

Depressive symptoms 1 and 6 months after stroke measured on the Major Depression Inventory (MDI) ranging from 0 to 50.

RESULTS

A total of 625 patients were included. Median (IQR) age was 69 (60-77) years, 410 (65.6%) were men, 309 (49.4 %) received citalopram and median (IQR) prestroke PASE score was 132.5 (76-197). Higher prestroke PASE quartile, compared with the lowest PASE quartile, was associated with fewer depressive symptoms both after 1 month (mean difference third quartile -2.3 (-4.2, -0.5), p=0.013, mean difference fourth quartile -2.4 (-4.3, -0.5), p=0.015) and 6 months after stroke (mean difference third quartile -3.3 (-5.5, -1.2), p=0.002, mean difference fourth quartile -2.8 (-5.2, -0.3), p=0.027). There was no interaction between citalopram treatment and prestroke PASE score on poststroke MDI scores (p=0.86).

CONCLUSIONS

A higher prestroke physical activity level was associated with fewer depressive symptoms 1 and 6 months after stroke. Citalopram treatment did not seem to modify this association.

TRIAL REGISTRATION NUMBERS

NCT01937182 (ClinicalTrials.gov) and 2013-002253-30 (EUDRACT).

摘要

目的

调查卒中前体力活动与卒中后 6 个月内抑郁症状之间的关系，并探讨西酞普兰治疗是否改变了这种关系。

设计

多中心随机对照试验 The Efficacy of Citalopram Treatment in Acute Ischemic Stroke（TALOS）的二次分析。

地点和参与者

TALOS 于 2013 年至 2016 年在丹麦多个卒中中心进行。它招募了 642 名首次急性缺血性卒中且无抑郁的患者。如果在卒中前通过老年人体力活动量表（PASE）评估体力活动水平，则患者符合本研究的条件。

干预措施

所有患者随机分配至西酞普兰或安慰剂治疗 6 个月。

结局

卒中后 1 个月和 6 个月使用 Major Depression Inventory（MDI）评估抑郁症状，评分范围为 0 至 50。

结果

共纳入 625 例患者。中位（IQR）年龄为 69（60-77）岁，410 例（65.6%）为男性，309 例（49.4%）接受了西酞普兰治疗，中位（IQR）卒中前 PASE 评分为 132.5（76-197）。与最低 PASE 四分位组相比，较高的卒中前 PASE 四分位组在卒中后 1 个月（第三四分位组的平均差异-2.3（-4.2，-0.5），p=0.013，第四四分位组的平均差异-2.4（-4.3，-0.5），p=0.015）和 6 个月时（第三四分位组的平均差异-3.3（-5.5，-1.2），p=0.002，第四四分位组的平均差异-2.8（-5.2，-0.3），p=0.027）的抑郁症状较少。西酞普兰治疗与卒中后 MDI 评分之间无交互作用（p=0.86）。