不同性别急性缺血性卒中后抑郁患者的临床异质性

Clinical heterogeneity of depression after acute ischemic stroke between genders

【摘要】目的 探讨不同性别卒中后抑郁(PSD)患者临床症状的异质性。方法 选取2020年12月至2022年2月于华北理工大学附属医院501例急性缺血性脑卒中患者为研究对象,收集其一般临床资料,入院24 h内进行美国国立卫生研究院脑卒中评分(NIHSS)、日常生活活动能力(ADL)评分,入院1周后采用24项汉密尔顿抑郁量表(HAMD-24)评估患者抑郁情绪。采用SPSS 26.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、非参数检验及χ²检验。结果 501例脑卒中患者中,PSD患者173例,其中男性96例,女性77例。男性PSD患者NIHSS评分显著高于女性[(5.44±4.25)和(3.97±5.63)分;P<0.01],男性PSD患者ADL评分显著低于女性[(68.07±20.10)和(79.35±21.69)分;P<0.01]。HAMD-24单项症状比较,男性PSD患者抑郁情绪得分低于女性PSD患者[1.00(0.00,2.00)和1.00(1.00,2.00)分;P<0.05],男性PSD患者的工作和兴趣[0.00(0.00,1.00)和0.00(0.00,0.00)分]、迟缓[0.00(0.00,1.00)和0.00(0.00,0.00)分]、激越[0.50(0.00,2.00)和0.00(0.00,1.00)分]、全身症状[2.00(1.00,3.00)和1.00(0.00,2.00)分]、体质量减轻[1.00(0.00,2.00)和0.00(0.00,1.00)分]、自知力[0.00(0.00,1.00)和0.00(0.00,0.00)分]得分均高于女性PSD患者(均P<0.05)。HAMD-24各因子比较,男性PSD患者体质量减轻[1.00(0.00,2.00)和0.00(0.00,1.00)分]、绝望感因子[1.00(0.00,2.00)和0.00(0.00,2.00)分]均高于女性PSD患者(均P<0.05)。不同性别PSD患者症状严重系数较高的因子均为焦虑/躯体化和睡眠障碍。结论 不同性别PSD患者临床症状存在异质性,临床工作中应针对不同性别脑卒中患者的临床症状予以鉴别。

基金项目:河北省2020年度医学科学研究课题(20201216)

【Abstract】Objective To explore the heterogeneity of clinical symptoms between genders in patients with post-stroke depression (PSD). Methods A total of 501 patients with acute ischemic stroke in Affiliated Hospital of North China University of Science and Technology from December 2020 to February 2022 were selected as the subjects. Their general clinical data were collected, and they were evaluated with National Institutes of Health Stroke Scale (NIHSS) and the activities of Daily Living (ADL) scale within 24 hours after admission. One week after admission, the depressive mood of patients was evaluated using the 24-item Hamilton Depression Scale (HAMD-24). SPSS 26.0 was used for statistical analysis. Depending on data type, comparison between groups was performed using t test, non-parametric test or χ² test. Results Among 501 patients with stroke, 173 (96 men and 77 women) had PSD. PSD men scored significantly higher than women [(5.44±4.25)vs (3.97±5.63) points; P<0.01] on NIHSS and significantly lower [(68.07±20.10) vs (79.35±21.69) points; P<0.01] on ADL scale. With the single symptom of HAMD-24, PSD men scored significantly lower than PSD women in depression [1.00(0.00,2.00) vs 1.00(1.00,2.00) points；P<0.05], but significantly higher in work and interest [0.00(0.00,1.00) vs 0.00(0.00,0.00) points], tardiness [0.00(0.00,1.00) vs 0.00(0.00,0.00) points], agitation [0.50(0.00,2.00) vs 0.00(0.00,1.00) points], systemic symptoms [2.00(1.00,3.00) vs 1.00(0.00,2.00) points], weight loss [1.00(0.00,2.00) vs 0.00(0.00,1.00) points] and self-awareness [0.00(0.00,1.00) vs 0.00(0.00,0.00) points] ( P<0.05 for all). Among HAMD-24 symptoms, the scores for weight loss [1.00(0.00,2.00) vs 0.00(0.00,1.00) points] and for despair [1.00(0.00,2.00) vs 0.00(0.00,2.00) points] were higher in PSD men than in PSD women (P<0.05 for both). Anxiety, somatization, and sleep disorders were the factors with higher symptom severity coefficients in PSD patients of both genders. Conclusion The clinical symptoms of PSD patients are heterogeneous between genders. Attention should be paid to the gender differences in symptoms among stroke patients of in clinical practice.

This work was supported by the Research Projects in Medical Sciences of Hebei Province 2020 (20201216).