Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

《国家中心数据管理与共享系统操作说明书 —— 研究者部分》

Predictors of Remission of Early-Onset Poststroke Depression and the Interaction Between Depression and Cognition During Follow-Up

First author：Jing Huang ,Fu-Chun Zhou

Corresponding author：Chunxue Wang,Chuan-Yue Wang

early-onset poststroke depression predictors of

essential_information

2019-01-08

Published articles

Journal：Frontiers in Psychiatry

Publication type: Original Contributions

IF(IF): 4.157

PMID: 30670990 Link To Pubmed Full text Download

Background And Purpose

卒中后抑郁（PSD）是卒中后最常见的精神科并发症，在卒中后5年内，其发生率可达33%左右。越来越多的证据表明，抑郁等情感障碍会对卒中患者的病死率、功能恢复以及生活质量造成负面影响。PSD的发病机制是复杂的，可能涉及多因素相互作用[8]，生理因素如卒中的严重程度及病变的部位（脑区）, 另外对躯体功能丧失的心理反应和其他很多心理社会因素和人口学变量，均可能促使PSD发生。既往研究表明，卒中后早期发生的PSD与那些数月之后较晚发生的PSD有很多不同。早期PSD与卒中造成的生物学变化更加直接相关，而晚期PSD与心理社会因素关系更为密切。 截至目前，很少有研究关注卒中后抑郁的自然病程，有限的资料表明仅有部分PSD患者的抑郁能在1年随访时缓解，另外的患者的抑郁症状则呈现慢性化。所以，从治疗角度考虑，很有必要确定与抑郁状态临床缓解（或不缓解）的预测因素，以便对这些因素进行相应的干预，从而改善患者的临床结局。截至目前，尚无针对早期PSD患者临床缓解预测因素的研究报告发表。 本研究的目的是描述PSD患者在卒中发生后1年内抑郁症状的转归和结局（缓解或未缓解），并探索其与各种人口学变量、卒中类型（脑梗死或脑出血）和其他临床变量的关系，确定抑郁临床缓解独立预测变量。

Method

A total of 820 patients with PSD from a massive multicenter prospective cohort project in China (PRIOD) were included in the present study. Depressive symptoms were measured with the Hamilton Depression Rating Scale (17 Items, HDRS-17) at 2 weeks and the endpoint of the 3-month follow-up. The cut-off score of HDRS-17 (<8) was used to define remission of depression at the endpoint. The Mini-Mental State Exam (MMSE) was used to evaluate the cognitive impairment of the patients (at the 2-week follow-up and 3-month endpoint). The National Institutes of Health Stroke Scale (NIHSS) was used to measure the severity of stroke.

Conclusion

（1) Six hundred and forty-two patients completed the 3-month follow-up, and 332 (51.7%) patients remitted by the end of the study. Univariate analyses indicated that there was a higher proportion of patients who had hypertension, frontal lobe lesion, basal ganglia lesion, poor outcome at 2 weeks, high scores on the NIHSS at 2 weeks, major life events within 3 months, and major medical diseases within 3 months in the nonremission group. In stepwise multiple logistic regression analyses, remission was significantly predicted by lower NIHSS scores at 2 weeks (p = 0.001, OR = 1.086, 95% CI 1.035–1.139), fewer major life events (p = 0.036, OR = 5.195, 95% CI 1.111–27.283), fewer major medical comorbidities (p = 0.015, OR = 2.434, 95% CI 1.190–4.979), and fewer frontal lobe lesions (p = 0.042, OR = 1.717, 95% CI 1.019–2.891). (2) After controlling for confounding variables, repeated measures analysis of variance revealed a significant interaction between time (2 weeks vs. 3 months) and group (remitters vs. nonremitters) on MMSE scores [F (1, 532) =20.2, p < 0.001].

Main results

Early-onset PSD patients with milder neurological impairment, fewer major life events, fewer major medical comorbidities and no frontal lobe lesion at baseline were more likely to achieve remission 3 months after stroke. Only remitters of PSD improved significantly in cognitive impairment after stroke.