脑卒中后抑郁发病的相关因素分析及其发病机制探讨

发布时间：2018-05-04 04:16

本文选题：卒中后抑郁 + 相关因素　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]应用神经影像技术判断卒中患者的卒中性质和病程时间,结合量表评定患者的神经功能功能缺损程度、社会支持度和卒中后抑郁程度,分析脑卒中后抑郁发生的相关因素,并进一步检测脑卒中患者的神经递质和免疫因子,探索脑卒中后抑郁发病的机制。[方法]随机收集脑卒中患者45例,根据患者的影像学数据判断其卒中性质(缺血性脑卒中或者出血性脑卒中),明确脑卒中的病程时间,并分别应用美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评定患者的神经功能缺损程度、社会支持评定量表(social support rating scale,SSRS)评价其获得的社会支持度以及卒中后抑郁量表(post-stroke depression scale,PSDS)评估其抑郁程度,分析PSD发生的相关因素。采集脑卒中患者的外周血,应用安捷伦液相色谱质谱联用仪检测血清中的神经递质水平,包括5-HT、多巴胺、去甲肾上腺素和肾上腺素;同时应用ELISA法检测白细胞介素(IL-1β、IL-2、IL-6)和肿瘤坏死因子(TNF-α);并同时分析患者的5-HTTLPR;探索PSD的发病机制。[结果]1、PSDS与患者的卒中类型无显著相关性(P0.05)。2、PSDS与患者的卒中病程无显著相关性(P0.05);但卒中病程显著影响患者的神经功能缺损程度,病程大于3个月的患者的神经功能缺损程度最严重。3、PSDS与患者的神经功能缺损程度呈显著正相关(P0.05)。4、PSDS与患者的社会支持度无显著相关性(P0.05),但表现为随着社会支持度的增加,患者卒中后抑郁的发生有下降趋势。5、PSDS与患者的5-HTTLPR无显著相关性(P0.05);但5-HTTLPR对患者的神经功能缺损程度有显著性影响,SS基因型的患者神经功能缺损程度最严重。6、PSDS与患者的细胞因子无显著相关性。7、PSDS与患者的神经递质无显著相关性(P0.05),但随着DA与5-HT水平的下降,患者的PSDS评分有上升的趋势分数的增加,E、NE有上升趋势,DA与5-HT有下降趋势,且5-HT下降趋势尤为明显。[结论]1、卒中后抑郁症的发生与患者的卒中类型、病程和社会支持度没有显著相关性,而是与其神经功能缺损程度呈显著正相关。2、卒中后抑郁症的发生可能是由于患者的神经递质水平下降所致。
[Abstract]:[objective] to judge the nature and duration of stroke by using neuroimaging technique, and to evaluate the degree of neurological function deficit, social support and post-stroke depression with the scale. The related factors of post-stroke depression were analyzed and the neurotransmitters and immune factors of stroke patients were detected to explore the mechanism of post-stroke depression. [methods] Forty-five patients with stroke were randomly collected to determine the nature of stroke (ischemic stroke or hemorrhagic stroke) according to the imaging data of the patients, and to determine the duration of stroke. The national institute of health stroke scale NIHSS was used to assess the degree of neurological impairment in the patients. Social support rating scale (SSRS) was used to evaluate the degree of social support and post-stroke depression scale (PSDSs) to evaluate the degree of depression, and to analyze the factors related to the occurrence of PSD. The peripheral blood samples of stroke patients were collected and the levels of neurotransmitters, including 5-HT, dopamine, norepinephrine and epinephrine, were detected by Agilent liquid chromatography-mass spectrometry. At the same time, ELISA method was used to detect interleukin-1 尾 interleukin-2 (IL-6) and tumor necrosis factor TNF- 伪 (TNF- 伪), and to analyze 5-HTTLPRs in order to explore the pathogenesis of PSD. [results] 1 there was no significant correlation between PSDS and stroke type. There was no significant correlation between P0.05 PSDS and the course of stroke, but the severity of neurological impairment was significantly affected by the course of stroke. There was a significant positive correlation between the degree of nerve function defect and the degree of nerve function defect in patients whose course of disease was longer than 3 months. There was no significant correlation between P0.05 PSDS and social support degree of patients, but it showed that with the increase of social support degree, there was no significant correlation between P0.05 and P0.05, but with the increase of social support, there was no significant correlation between the degree of PSDS and the degree of social support. There was no significant correlation between PSDs and 5-HTTLPR in patients with post-stroke depression, but 5-HTTLPR had a significant effect on the degree of neurological function defect in patients with SS genotype. There was no significant correlation between PSDs and neurotransmitters, but with the decrease of DA and 5-HT levels, there was no significant correlation between PSDs and neurotransmitters. The PSDS scores of the patients increased with the increasing trend of scores. There was an increasing trend of DA and 5-HT in the patients, especially in the 5-HT. [conclusion] 1. There was no significant correlation between the occurrence of post-stroke depression and the type of stroke, course of disease and degree of social support. However, there was a significant positive correlation between the degree of neurologic impairment and poststroke depression, which may be due to the decrease of neurotransmitter level in patients with stroke.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R749.4

【参考文献】