Neurology:AFFINITY试验:卒中后神经功能缺损程度增加抑郁发生风险,社会关系、文化背景可有助于降低相关风险

2022-02-11 Naomi MedSci原创

神经和功能缺陷的严重程度增加卒中后临床上明显的早期和持续抑郁症状的风险。卒中前的抑郁史、个人关系和文化背景有助于调解抑郁风险。尽量减少神经和功能缺陷严重性的干预措施应该降低卒中后临床明显的抑郁症状风险

      在卒中后的第1年中,每3个人中就有1个人出现了临床上明显的抑郁症状。抑郁症与明显的疾病负担相关,可能会阻碍卒中幸存者的康复。一项涉及3273名卒中幸存者的6个前瞻性研究系统综述发现,卒中后抑郁使长期残疾的风险增加了1倍以上(OR = 2.16,95% CI = 1.702.77)。

      最近更新的与卒中后抑郁临床显著症状相关因素的系统综述显示,只有5项研究调查了≥10个以上的因素,而身体残疾是卒中后抑郁最一致的危险因素。新的前瞻性研究已经证实,卒中后抑郁症的风险随着卒中严重程度的增加而增加。然而,卒中严重程度是否是抑郁症的因或是果仍不清楚。

      本研究旨在探讨氟西汀治疗对1280例脑卒中幸存者功能恢复的影响。本研究采用二级探索性分析方法,对52周以上的抑郁症患病率和发生率,以及与脑卒中后抑郁相关的社会人口学和临床因素进行研究。研究使用卒中恢复和康复圆桌工作组的指导方针,将12周定义为卒中后的早期阶段,并试图生成新颖的和临床相关的数据,说明在卒中恢复的不同阶段,即早期(≤12周)、晚期(> 12周)和持续(早期和晚期) ,临床上重要的抑郁症状的演变。与以前的研究一样,预计神经缺陷和功能障碍的严重程度是卒中后抑郁症临床重要症状的最有力预测因素,并且预计这种联系对于那些持续抑郁症状的患者来说尤其强有力。近日,有研究人员试图确定社会人口学和临床因素相关的早期,晚期和持续的临床显着症状抑郁症在第一年中的卒中。

      队列研究1221名男性和女性招募在两周内卒中发病在澳大利亚,新西兰和越南。NiH卒中评分(NIHSS)用于评估卒中的严重程度。其他研究指标包括年龄、性别、婚姻状况、生活安排、卒中前的功能、卒中前的抑郁、改良的兰金量表(mRS),以及氟西汀或安慰剂治疗26周。基线后52周内抑郁症的临床显著症状是感兴趣的结果,其存在是由总 phq-9评分≥9在第4、12、26、52周,临床医生诊断抑郁症之间的评估,或药物或心理治疗的抑郁症在随访期间。参与者被分为不抑郁,早期(最初12周) ,晚期(12至52周)或持续抑郁(12星期前后)。使用多项式 Logit模型来评估抑郁风险,所有列出的措施同时输入模型。

  • 平均年龄为63.8岁(sd = 12.3) ,男性775岁(63.5%)。在基线水平上,48名(3.9%)参与者曾经治疗过抑郁症,228名(18.7%)有临床明显的抑郁症状(phq-9≥9)。
  • 734例(63.3%)卒中后1年无抑郁症状,208例(17.9%)有早期抑郁症状,86例(7.4%)晚期抑郁症状,131例(11.3%)持续抑郁症状。
  • 卒中严重程度的增加,用NIHSS评分翻倍来衡量,与早期风险增加(风险比[ rr ] = 2.08,95% ci = 1.65-2.62) ,晚期风险增加(rr = 1.53,95% ci = 1.14-2.06)和持续的抑郁症临床显著症状(rr = 2.50,95% ci = 1.89-3.32)相关。
  • 类似的发现在女士身上也很明显,这是一种功能障碍的衡量标准。过去的抑郁与持续的临床显著抑郁症状的风险增加有关(rr = 6.28,95% ci = 2.88-13.71) ,与已婚或有伴侣有关(rr = 3.94,95% ci = 2.42-6.41)。
  •  在澳大利亚和新西兰,患抑郁症的风险比越南高。

      神经和功能缺陷的严重程度增加了卒中后临床上明显的早期和持续抑郁症状的风险。卒中前的抑郁,个人关系和文化背景有助于调解抑郁风险。尽量减少神经和功能缺陷严重性的干预措施应该降低卒中后临床上明显的抑郁症状的风险。

文献来源:Almeida OP, Hankey GJ, Ford AH, et al. Measures Associated With Early, Late, and Persistent Clinically Significant Symptoms of Depression 1 Year After Stroke in the AFFINITY Trial [published online ahead of print, 2022 Jan 18]. Neurology. 2022;10.1212/WNL.0000000000200058. doi:10.1212/WNL.0000000000200058

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    2022-10-01 yinhl1978
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    2022-02-26 杨海东

    坚持学习

    0

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    2022-02-25 yfykk

    卒中后抑郁值得关注

    0

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    2022-02-17 杨海东

    经常学习

    0

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