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急性脑梗死患者卒中后抑郁的患病率及预测因素

Prevalence and Predictive factors of Post-Stroke Depression in Patients with Acute Cerebral Infarction.

作者信息

Yang Fang, Zhang Peilan

机构信息

Neurosurgery and Neurorehabilitation, Clinical College of Neurology, Tianjin Medical University, Tianjin, China.

Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.

出版信息

Alpha Psychiatry. 2024 Sep 1;25(5):592-597. doi: 10.5152/alphapsychiatry.2024.231381. eCollection 2024 Sep.

Abstract

OBJECTIVE

Acute cerebral infarction (ACI) has a high mortality and disability, which brings a heavy burden to the medical and health system. This study aims to discover the clinical prevalence of post-stroke depression (PSD) in patients with ACI, explore the predictive factors leading to this complication, and provide more evidence for better identification of PSD in clinic.

METHODS

From April 2021 to April 2023, this retrospective study selected 166 ACI patients as the research subjects, collected clinical symptoms and laboratory indicators at baseline, and observed the prevalence of PSD using the Hamilton depression scale 17 and the diagnostic and statistical manual of mental disorders. Multiple logistic regression analysis was adopted to explore the predictive factors of PSD in patients with ACI.

RESULTS

The total incidence of PSD was 35.54% in 166 patients with ACI. The score of National Institute of Health Stroke Scale (NIHSS), the score of daily life ability scale (ADL), and homocysteine (Hcy) level in the PSD group were higher than non-PSD group ( < .001, < .001,  = .001). Multiple logistic regression analysis showed that high Hcy levels, NIHSS scores, and ADL scores were independent risk factors for PSD (  =.038,  =.002, <.001). The receiver operating characteristic (ROC) curve showed that areas under curve (AUC) = 0.894, standard error = 0.025, progressive significance <.001, 95% CI = 0.845-0.943, cut-off value = 0.520, sensitivity = 91.60%, specificity = 74.60%, and Hosmer-Lemeshow goodness-of-fit test  = .246, suggesting that ROC curve has a certain clinical predictive efficacy.

CONCLUSION

The prevalence of early PSD in patients with ACI is relatively high. Homocysteine levels, NIHSS scores and ADL scores may be independent risk factors for PSD, and targeted clinical intervention should be implemented for the above factors.

摘要

目的

急性脑梗死(ACI)具有较高的死亡率和致残率,给医疗卫生系统带来沉重负担。本研究旨在探讨ACI患者中卒中后抑郁(PSD)的临床患病率,探究导致该并发症的预测因素,并为临床更好地识别PSD提供更多依据。

方法

2021年4月至2023年4月,本回顾性研究选取166例ACI患者作为研究对象,收集基线时的临床症状和实验室指标,采用汉密尔顿抑郁量表17项及《精神障碍诊断与统计手册》观察PSD的患病率。采用多因素logistic回归分析探究ACI患者发生PSD的预测因素。

结果

166例ACI患者中PSD的总发生率为35.54%。PSD组的美国国立卫生研究院卒中量表(NIHSS)评分、日常生活能力量表(ADL)评分及同型半胱氨酸(Hcy)水平均高于非PSD组(<0.001,<0.001,=0.001)。多因素logistic回归分析显示,高Hcy水平、NIHSS评分及ADL评分是PSD的独立危险因素(=0.038,=0.002,<0.001)。受试者工作特征(ROC)曲线显示,曲线下面积(AUC)=0.894,标准误=0.025,渐进显著性<0.001,95%可信区间=0.845 - 0.943,截断值=0.520,灵敏度=91.60%,特异度=74.60%,Hosmer-Lemeshow拟合优度检验=0.246,提示ROC曲线具有一定的临床预测效能。

结论

ACI患者早期PSD的患病率较高。同型半胱氨酸水平、NIHSS评分及ADL评分可能是PSD的独立危险因素,应对上述因素实施针对性的临床干预。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/218b/11562640/862e67d297fd/ap-25-5-592_f001.jpg

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