卒中后抑郁患者的临床异质性研究被引量：8

Clinical Heterogeneity in Patients with Post-stroke Depression

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摘要目的探讨卒中后抑郁(PSD)患者的临床异质性。方法选取2015年10月—2016年5月华北理工大学附属医院收治的脑卒中患者474例,收集其一般临床资料并采用汉密尔顿抑郁量表(HAMD)评估其抑郁状况。结果 474例患者中,PSD患者169例(35.6%)。轻中度PSD患者[133例(78.7%)]症状严重系数较高的2项因子为睡眠障碍(0.77)和绝望感(0.43),症状严重系数较低的2项因子为日夜变化(0.06)和体质量(0.20)。重度PSD患者[36例(21.3%)]症状严重系数较高的2项因子为睡眠障碍(0.81)和焦虑/躯体化(0.64),症状严重系数较低的2项因子为日夜变化(0.24)和认知障碍(0.37)。不同性别PSD患者焦虑/躯体化、绝望感因子均分比较,差异有统计学意义(P<0.05);不同性别PSD患者体质量、认知障碍、日夜变化、迟缓、睡眠障碍因子均分及HAMD总分比较,差异无统计学意义(P>0.05)。不同年龄PSD患者焦虑/躯体化、认知障碍、日夜变化、迟缓、睡眠障碍、绝望感因子均分及HAMD总分比较,差异有统计学意义(P<0.05);不同年龄PSD患者体质量因子均分比较,差异无统计学意义(P>0.05)。结论不同严重程度、性别及年龄的PSD患者抑郁可能存在临床异质性,应制定个性化治疗方案和选用合理的药物,提高治疗效果和改善患者预后。 Objective To investigate the clinical heterogeneity of post-stroke depression. Methods The enrolled participants were 474 cases of stroke who received treatment in the Affiliated Hospital of North China University of Science and Technology from October 2015 to May 2016. We collected their clinical data and assessed the depression status of them by Hamilton Depression Rating Scale（ HAMD）. Results Of the 474 patients,169（ 35. 6%） were found with PSD. Compared with other subscale factors,the average scores for sleep disturbance（ 0. 77） and hopelessness（ 0. 43） were higher while those of diurnal variation（ 0. 06） and weight loss（ 0. 20） were lower in patients with mild to moderate PSD [133（ 78. 7%） ]. For patients with severe PSD [36（ 21. 3%） ], compared with other subscale factors, the average scores for sleep disturbance（ 0. 81） and anxiety/somatization（ 0. 64） were higher but those of diurnal variation（ 0. 24） and insight（ 0. 37） were lower. The average scores for anxiety-somatic and hopelessness in PSD patients varied significantly by sex（ P 0. 05）,while those of weight loss,insight,diurnal variation,retardation,sleep disturbance and HAMD did not（ P 0. 05）. The average scores of anxiety-somatic,insight,diurnal variation,retardation,sleep disturbance,hopelessness and HAMD in PSD patients differed substantially by age（ P 0. 05）,while those of weight loss did not（ P 0. 05）. Conclusion There was probably clinical heterogeneity in patients with PSD,which is not associated with the level of PSD,sex and age. Therefore,in order to improve the therapeutic effect and prognosis of the patients,personalized treatment regimen should be developed and medicines should be rationally used.