腔隙性脑梗死轻度认知障碍患者伴抑郁的影响因素

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目的:观察腔隙性脑梗死轻度认知障碍患者伴抑郁的相关因素。方法:收集2016-2019年开滦总医院收治的114例腔隙性脑梗死轻度认知功能障碍患者为研究对象,于入院后72 h之内完成核磁共振颅脑扫描,并于1周内应用Zung氏抑郁自评量表(self-rating depression scale,SDS)对情绪测评。根据SDS评定结果,选择腔隙性脑梗死轻度认知功能障碍无抑郁患者69例为对照组;选择腔隙性脑梗死轻度认知功能障碍伴轻度抑郁患者45例为病例组。观察两组患者一般临床资料、不同脑区腔隙性脑梗死患者比例特点及认知功能,运用Logistic回归法分析腔隙性脑梗死轻度认知功能障碍发生抑郁的危险因素,并观察临床躯体化症状表现特点。结果:(1)对照组患者男53例(76.81%,53/69),女16例(23.19%,16/69);病例组男29例(64.44%,29/45),女16例(35.55%,16/45),两组性别比较差异有统计学意义(n P=0.049);对照组和病例组高同型半胱氨酸血症发生率分别为31.88%(22/69)、53.33%(24/45),两组比较差异有统计学意义(n P=0.003)。(2)病例组患者基底节区和半卵圆中心腔隙性脑梗死灶发病率分别为80.00%(36/45)、71.11%(32/45),对照组分别为59.42%(41/69)、18.84%(13/69),两组比较差异均有统计学意义(n P值分别为0.001、0.05)。(3)病例组注意力和计算力受损比例为88.89%(40/45),高于对照组的78.26%(54/69),两组比较差异有统计学意义(n P=0.036)。(4)多因素Logistic回归分析结果显示,高同型半胱氨酸血症(n OR=2.659,95%n CI 1.041~6.793,n P<0.05)、半卵圆中心梗死灶(n OR=10.332,95%n CI 4.069~26.235,n P<0.01)是腔隙性脑梗死轻度认知功能障碍伴抑郁的独立危险因素。(5)躯体化症状失眠和流泪的比例病例组分别为35.56%(16/45)、37.77%(17/45),均高于对照组8.70%(6/69)、2.90%(2/69),两组比较差异均有计学意义(n P值均为0.000)。n 结论:高同型半胱氨酸血症和半卵圆中心脑梗死病灶是腔隙性脑梗死轻度认知功能障碍患者发生抑郁的独立危险因素,且患者可伴有失眠和流泪的躯体化症状。“,”Objective:To observe the related factors of depression in patients with lacunar cerebral infarction with mild cognitive impairment.Methods:From 2016 to 2019, 114 patients with mild cognitive impairment of lacunar cerebral infarction in Kailuan General Hospital were selected as the research objects.MRI brain scan was completed within 72 hours after admission, and Zung′s self rating Depression Scale (SDS) was used to evaluate emotion within 1 week.According to the results of SDS, 69 patients with mild cognitive impairment and no depression of lacunar infarction were selected as the control group, and 45 patients with mild cognitive impairment and mild depression of lacunar infarction were selected as the case group.The general clinical data, the proportion of patients with lacunar infarction in different brain regions and cognitive function of the two groups were observed.Logistic regression method was used to analyze the risk factors of depression in patients with mild cognitive impairment of lacunar infarction, and the characteristics of clinical somatization symptoms were observed.Results:(1)There were 53 males (76.81%, 53/69) and 16 females (23.19%, 16/69) in the control group, 29 males (64.44%, 29/45) and 16 females (35.55%, 16/45) in the case group, and the difference between the two groups was statistically significant (n P=0.049). Hyperhomocysteinemia in the control group and the case group was 31.88% (22/69) and 53.33%(24/45), respectively, with statistically significant differences between the two groups (n P=0.003). (2) The incidence rates of lacunar infarction in basal ganglia and oval center was 80% (36/45) and 71.11% (32/45) in case group respectively, and 59.42% (41/69) and 18.84% (13/69) in control group respectively.The difference between two groups was statistically significant (n P values were 0.001 and 0.05). (3) The rate of impaired attention and computing power in the case group was 88.89%(40/45), which was higher than that in the control group 78.26%(54/69), and the difference was statistically significant (n P=0.036). (4) Multivariate Logistic regression analysis showed that hyperhomocysteemia (n OR=2.659, 95%n CI 1.041-6.793, n P<0.05) and central oval infarction (n OR=10.332, 95%n CI 4.069-26.235, n P<0.01) were independent risk factors for mild cognitive dysfunction and depression in lacunar cerebral infarction.(5) The proportion of insomnia and tears with somatization symptoms in the case group was 35.56%(16/45) and 37.77%(17/45), respectively, which were higher than that in the control group 8.70%(6/69) and 2.90%(2/69), respectively, with statistically significant differences (alln P<0.001).n Conclusion:Hyperhomocysteinemia and hemioval central cerebral infarction are independent risk factors for depression in patients with lacunar cerebral infarction with mild cognitive dysfunction, accompanied by somatization symptoms of insomnia and tearing.
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