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轻型卒中患者扩大的血管周围间隙与卒中后抑郁的相关性
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Abstract:
目的：探讨急性轻型缺血性卒中患者扩大的血管周围间隙(Enlarged perivascular spaces, EPVS)与卒中后抑郁(post-stroke depression, PSD)的关系。方法：收集2019年10月到2021年6月期间就诊于本院神经内科首次发生急性轻型缺血性卒中患者187例(美国国立卫生研究院卒中量表评分 ≤ 3分)。入院后完成颅脑MRI检查并进行EPVS分级。在发病3个月时根据汉密尔顿抑郁量表(Hamilton depression scale, HAMD)和《卒中后抑郁临床实践的中国专家共识》进行PSD评定。将所有入组患者分为PSD组61例和非PSD组126例。通过统计学分析，探讨轻型卒中患者扩大的血管周围间隙与卒中后抑郁的相关性，并分析影响轻型卒中患者抑郁的危险因素。结果：1) PSD组与非PSD组在年龄、受教育年限、糖尿病、额叶梗死、半卵圆中心EPVS (centrum semiovale, CSO-EPVS)、脑白质病变(White matter hyperintensities，WMH)差异有统计学意义(P < 0.05)。受教育年限、糖尿病、WMH、CSO-EPVS是PSD的独立危险因素。2) PSD组抑郁严重程度与CSO-EPVS严重程度呈正相关，差异有统计学意义(P < 0.05)。结论：受教育年限、糖尿病、WMH、CSO-EPVS是急性轻型缺血性卒中患者发生抑郁的重要危险因素，且CSO-EPVS严重程度越高，抑郁程度越严重。
Objective: To investigate the relationship between enlarged perivascular spaces (EPVS) and post-stroke depression (PSD) in patients with acute minor ischemic stroke. Methods: A total of187 patients with acute minor stroke (National Institutes of Health Stroke Scale score ≤ 3 points) admitted to the Department of Neurology of our hospital from October 2019 to June 2021. The patients completed head MRI examination after admission and performed EPVS grading. At 3 months after symptom onset, they performed PSD assessment according to Hamilton Depression Scale (HAMD) and the Chinese Expert Consensus on Clinical Practice of Post-Stroke Depression. All enrolled patients were divided into PSD group 61 cases and non-PSD group 126 cases. Through statistical analysis, explore the correlation between the enlarged perivascular spaces in patients with minor ischemic stroke and post-stroke depression, analyze the risk factors that affect the depression of patients with minor stroke. Results: 1) Age, years of education, diabetes, frontal infarction, centrum semiovale EPVS and WMH were statistically significant different in PSD group and non-PSD group (all P < 0.05). Years of education, diabetes, centrum semiovale EPVS and WMH are independent risk factors for PSD. 2) The severity of depression in the PSD group was positively correlated with the severity of CSO-EPVS, and the difference was statistically significant (P < 0.05). Conclusion: Years of education, diabetes, CSO-EPVS and WMH are important risk factors for depression in patients with acute minor ischemic stroke, and the higher the severity of CSO-EPVS, the more severe the depression.
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