健身活动与社会交往和用脑习惯对老年首发缺血性脑卒中患者抑郁症状的影响研究
|
摘要
目的分析健身活动、社会交往和用脑习惯对老年首发缺血性脑卒中患者抑郁症状的影响。方法 2016年6月—2017年7月,选取济宁医学院附属医院神经内科就诊的符合纳入标准的首次发病的老年缺血性脑卒中患者916例为调查对象。患者发病后3个月,由经过培训的神经内科医护人员进行问卷调查。调查问卷包括一般状况调查表[性别、年龄、民族、婚姻状况、文化程度、健身活动参与情况(剧烈健身活动、中等强度健身活动、轻度休闲健身活动)、社会交往情况(与子女、朋友交流次数)和用脑习惯(阅读、下棋)]、简版老年抑郁量表(GDS-15)、病变部位[脑卒中位置(左/右、前/后)、脑卒中部位]、美国国立卫生院脑卒中量表(NIHSS)评分。采用单因素、多因素Logistic回归分析分析老年首发缺血性脑卒中患者发生抑郁症状的影响因素。结果共发放调查问卷916份,回收有效问卷764份,有效回收率为83.4%。764例脑卒中患者中有抑郁症状70例(9.2%),无抑郁症状694例(90.8%)。单因素Logistic回归分析显示,轻度休闲健身活动[OR=0.451,95%CI(0.253,0.805)]、与朋友交流次数[OR=0.176,95%CI(0.103,0.301)]、脑卒中位置(前/后)[OR=2.359,95%CI(1.510,3.562)]、NIHSS评分[OR=1.817,95%CI(1.166,3.358)]是老年首发缺血性脑卒中患者发生抑郁症状的影响因素(P<0.05)。多因素Logistic回归分析显示,轻度休闲健身活动[OR=0.503,95%CI(0.277,0.915)]、与朋友交流次数[OR=0.189,95%CI(0.110,0.326)]、脑卒中位置(前/后)[OR=2.487,95%CI(1.497,4.134)]、NIHSS评分[OR=1.901,95%CI(1.154,3.130)]是老年首发缺血性脑卒中患者发生抑郁症状的影响因素(P<0.05)。结论参加轻度休闲健身活动、多与朋友交流是老年首发缺血性脑卒中患者发生抑郁症状的保护因素,而脑卒中位置位于前部及NIHSS评分≥5分是老年首发缺血性脑卒中患者发生抑郁症状的危险因素;用脑习惯与老年首发缺血性脑卒中患者发生抑郁症状的关系不显著。
Objective To analyze the influence of fitness activities,social interactions and brain habits on the depressive symptoms of elderly patients with newly diagnosed ischemic stroke.Methods A total of 916 elderly patients with first-onset ischemic stroke who were treated in the Department of Neurology of the Affiliated Hospital of Jining Medical University between June 2016 and July 2017 and met the inclusion criteria were selected as study subjects.Three months after the onset of the disease,a questionnaire survey was conducted by trained neurosurgical staff.The items in the questionnaire comprised general information including sex,age,ethnicity,marital status,education level,participation in fitness activities(intensive,moderate and leisure fitness activities),social activities(communication frequency with families and friends) and brain habits(reading and playing chess),geriatric depression scale(GDS-15) score,lesion locations(stroke lesion in the left/right or anterior/posterior,as well as specific stroke sites),and NIH stroke scale(NIHSS) score.Univariate and multivariate Logistic regression were used to analyze factors influencing the depression symptoms in elderly patients with newly diagnosed ischemic stroke.Results A total of 916 questionnaires were distributed,and 764 valid questionnaires were collected.The effective recovery rate was 83.4%.Of the 764 stroke patients,70(9.2%) had depressive symptoms,and 694(90.8%) had no depressive symptoms.Univariate Logistic regression analysis showed that mild leisure fitness activities[OR=0.451,95%CI(0.253,0.805)],the frequency of interaction with families or friends[OR=0.176,95%CI(0.103,0.301)],the stroke position(anterior/posterior)[OR=2.359,95%CI(1.510,3.562)],and the NIHSS score[OR=1.817,95%CI(1.166,3.358)] were the factors associated with depressive symptoms in elderly patients with ischemic stroke(P<0.05).Multivariate Logistic regression analysis showed that mild leisure fitness activities[OR=0.503,95%CI(0.277,0.915)],the frequency of interaction with families or friends[OR=0.189,95%CI(0.110,0.326)],the stroke position(anterior/posterior)[OR=2.487,95%CI(1.497,4.134)],and the NIHSS score[OR=1.901,95%CI(1.154,3.130)] were the factors associated with depressive symptoms in elderly patients with ischemic stroke(P<0.05).Conclusion Participating in mild leisure fitness activities and communicating with friends are protective factors against depressive symptoms in elderly patients with newly diagnosed ischemic stroke.Stroke in the anterior brain and an NIHSS score ≥ 5 are the risk factors for depression in elderly patients with newly diagnosed ischemic stroke.The relationship between brain habits and depressive symptoms was not significant in the population.
Objective To analyze the influence of fitness activities,social interactions and brain habits on the depressive symptoms of elderly patients with newly diagnosed ischemic stroke.Methods A total of 916 elderly patients with first-onset ischemic stroke who were treated in the Department of Neurology of the Affiliated Hospital of Jining Medical University between June 2016 and July 2017 and met the inclusion criteria were selected as study subjects.Three months after the onset of the disease,a questionnaire survey was conducted by trained neurosurgical staff.The items in the questionnaire comprised general information including sex,age,ethnicity,marital status,education level,participation in fitness activities(intensive,moderate and leisure fitness activities),social activities(communication frequency with families and friends) and brain habits(reading and playing chess),geriatric depression scale(GDS-15) score,lesion locations(stroke lesion in the left/right or anterior/posterior,as well as specific stroke sites),and NIH stroke scale(NIHSS) score.Univariate and multivariate Logistic regression were used to analyze factors influencing the depression symptoms in elderly patients with newly diagnosed ischemic stroke.Results A total of 916 questionnaires were distributed,and 764 valid questionnaires were collected.The effective recovery rate was 83.4%.Of the 764 stroke patients,70(9.2%) had depressive symptoms,and 694(90.8%) had no depressive symptoms.Univariate Logistic regression analysis showed that mild leisure fitness activities[OR=0.451,95%CI(0.253,0.805)],the frequency of interaction with families or friends[OR=0.176,95%CI(0.103,0.301)],the stroke position(anterior/posterior)[OR=2.359,95%CI(1.510,3.562)],and the NIHSS score[OR=1.817,95%CI(1.166,3.358)] were the factors associated with depressive symptoms in elderly patients with ischemic stroke(P<0.05).Multivariate Logistic regression analysis showed that mild leisure fitness activities[OR=0.503,95%CI(0.277,0.915)],the frequency of interaction with families or friends[OR=0.189,95%CI(0.110,0.326)],the stroke position(anterior/posterior)[OR=2.487,95%CI(1.497,4.134)],and the NIHSS score[OR=1.901,95%CI(1.154,3.130)] were the factors associated with depressive symptoms in elderly patients with ischemic stroke(P<0.05).Conclusion Participating in mild leisure fitness activities and communicating with friends are protective factors against depressive symptoms in elderly patients with newly diagnosed ischemic stroke.Stroke in the anterior brain and an NIHSS score ≥ 5 are the risk factors for depression in elderly patients with newly diagnosed ischemic stroke.The relationship between brain habits and depressive symptoms was not significant in the population.
引文
[1]ROTH G A,FOROUZANFAR M H,MORAN A E,et al.Demographic and epidemiologic drivers of global cardiovascular mortality[J].N Engl J Med,2015,372(14):1333-1341.DOI:10.1056/NEJMoa1406656.
[2]FEIGIN V L,KRISHNAMURTHI R V,PARMAR P,et al.Update on the Global Burden of Ischemic and Hemorrhagic Stroke in1990-2013:the GBD 2013 study[J].Neuroepidemiology,2015,45(3):161-176.DOI:10.1159/000441085.
[3]DOU D M,HUANG L L,DOU J,et al.Post-stroke depression as a predictor of caregivers burden of acute ischemic stroke patients in China[J].Psychol Health Med,2018,23(5):541-547.DOI:10.1080/13548506.2017.1371778.
[4]唐本玲,王强,唐琦.老年脑卒中后抑郁患者的影响因素研究[J].神经损伤与功能重建,2017,12(4):307-309.DOI:10.16780/j.cnki.sjssgncj.2017.04.008.TANG B L,WANG Q,TANG Q.Influencing factors of post-stroke depression in Chinese elderly population[J].Neural Injury and Functional Reconstruction,2017,12(4):307-309.DOI:10.16780/j.cnki.sjssgncj.2017.04.008.
[5]王思博,王慧彬,曲慧玲,等.卒中后抑郁的影响因素及其对生活质量的影响[J].中国医科大学学报,2017,46(9):844-847.DOI:10.12007/j.issn.0258-4646.2017.09.017.WANG S B,WANG H B,QU H L,et al.Influencing factors of post-stroke depression and the impact on the quality of life[J].Journal of China Medical University,2017,46(9):844-847.DOI:10.12007/j.issn.0258-4646.2017.09.017.
[6]陈艳黎,郑艳玲,余立平,等.社区中老年脑卒中后抑郁发生的相关危险因素研究[J].中国社会医学杂志,2017,34(5):491-493.DOI:10.3969/j.issn.1673-5625.2017.05.022.CHEN Y L,ZHENG Y L,YU L P,et al.Research of the risk factors of post-stroke depression for middle-aged and elderly patients in the community[J].Chinese Journal of Social Medicine,2017,34(5):491-493.DOI:10.3969/j.issn.1673-5625.2017.05.022.
[7]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,43(2):146-153.DOI:10.3760/cma.j.issn.1006-7876.2010.02.022.
[8]CRUICE M,WORRALL L,HICKSON L.Reporting on psychological well-being of older adults with chronic aphasia in the context of unaffected peers[J].Disabil Rehabil,2011,33(3):219-228.DOI:10.3109/09638288.2010.503835.
[9]唐丹.简版老年抑郁量表(GDS-15)在中国老年人中的使用[J].中国临床心理学杂志,2013,21(3):402-405.TANG D.Application of Short Form Geriatric Depression Scale(GDS-15)in Chinese elderly[J].Chinese Journal of Clinical Psychology,2013,21(3):402-405.
[10]BROTT T,ADAMS H P,OLINGER C P,et al.Measurements of acute cerebral infarction:a clinical examination scale[J].Stroke,1989,20(7):864-870.
[11]黄海蓉,陈晓峰,孙仕强,等.360名深圳市退休老年人的抑郁状况及其影响因素分析[J].中国疗养医学,2016,25(7):684-686.DOI:10.13517/j.cnki.ccm.2016.07.005.HUANG H R,CHEN X F,SUN S Q,et al.Analysis of depression and its influencing factors among 360 retired elderly people in Shenzhen[J].Chinese Journal of Convalescent Medicine,2016,25(7):684-686.DOI:10.13517/j.cnki.ccm.2016.07.005.
[12]何婷,沈珊珊,褚娇娇,等.老年人抑郁症状与功能状态和衰弱的相关性研究[J].中华老年医学杂志,2017,36(6):613-617.DOI:10.3760/cma.j.issn.0254-9026.2017.06.003.HE T,SHEN S S,CHU J J,et al.The associations of depressive symptoms with cognitive and physical functions and frailty in elderly outpatients[J].Chinese Journal of Geriatrics,2017,36(6):613-617.DOI:10.3760/cma.j.issn.0254-9026.2017.06.003.
[13]龙洁,蔡焯基,刘永珍,等.卒中后抑郁状态及其影响因素的相关研究[J].中国神经精神疾病杂志,2001,27(6):430-432.DOI:10.3969/j.issn.1002-0152.2001.06.010.LONG J,CAI Z J,LIU Y Z,et al.A study of prevalence and related factors of post-stroke depression[J].Chinese Journal of Nervous and Mental Diseases,2001,27(6):430-432.DOI:10.3969/j.issn.1002-0152.2001.06.010.
[14]ZHANG T,WANG C,LIU L,et al.A prospective cohort study of the incidence and determinants of post-stroke depression among the mainland Chinese patients[J].Neurol Res,2010,32(4):347-352.DOI:10.1179/016164110X12656393665125.
[15]ZHANG N,WANG C X,WANG A X,et al.Time course of depression and one-year prognosis of patients with stroke in mainland China[J].CNS Neurosci Ther,2012,18(6):475-481.DOI:10.1111/j.1755-5949.2012.00312.x.
[16]BOUR A,RASQUIN S,ABEN I,et al.A one-year follow-up study into the course of depression after stroke[J].J Nutr Health Aging,2010,14(6):488-493.
[17]张志珺,袁勇贵.卒中后抑郁障碍:机制、诊断与治疗[J].中国卒中杂志,2014,9(1):5-8.DOI:10.3969/j.issn.1673-5765.2014.01.002.ZHANG Z J,YUAN Y G.Post-stroke depression:mechanism,diagnosis and treatment[J].Chinese Journal of Stroke,2014,9(1):5-8.DOI:10.3969/j.issn.1673-5765.2014.01.002.
[18]AARON S E,GREGORY C M,SIMPSON A N.Lower Odds of Poststroke Symptoms of Depression When Physical Activity Guidelines Met:National Health and Nutrition Examination Survey2011-2012[J].J Phys Act Health,2016,13(8):903-909.DOI:10.1123/jpah.2015-0446.
[19]孙金菊,陈长香,张敏,等.言语听觉反馈训练对脑卒中患者认知功能障碍的康复效果[J].中华行为医学与脑科学杂志,2017,26(6):524-528.DOI:10.3760/cma.j.issn.1674-6554.2017.06.009.SUN J J,CHEN C X,ZHANG M,et al.Effect of speech auditory feedback training on cognitive function in patients with post stroke[J].Chinese Journal of Behavioral Medicine and Brain Science,2017,26(6):524-528.DOI:10.3760/cma.j.issn.1674-6554.2017.06.009.
[20]毛荣华,陈长香,李丹,等.Brain HQ视觉训练对脑卒中后抑郁患者抑郁症状的干预效果[J].中华行为医学与脑科学杂志,2015,24(12):1097-1099.DOI:10.3760/cma.j.issn.1674-6554.2015.12.011.MAO R H,CHEN C X,LI D,et al.Intervention effect of Brain HQ visual training on depressive symptom in patients with post stroke depression[J].Chinese Journal of Behavioral Medicine and Brain Science,2015,24(12):1097-1099.DOI:10.3760/cma.j.issn.1674-6554.2015.12.011.
[21]DERYCKA,BROUNS R,FRANSENE,et al.Aprospective study on the prevalence and risk factors of poststroke depression[J].Cerebrovasc Dis Extra,2013,3(1):1-13.DOI:10.1159/000345557.
[22]BERG A,L?NNQVIST J,PALOM?KI H,et al.Assessment of depression after stroke:a comparison of different screening instruments[J].Stroke,2009,40(2):523-529.DOI:10.1161/STROKEAHA.108.527705.
[23]李欣,宋鲁平,邢春晓,等.生物反馈对脑卒中后抑郁患者的情绪及压力测试参数的影响[J].疑难病杂志,2016,15(10):1010-1015,1019.DOI:10.3969/j.issn.1671-6450.2016.10.006.LI X,SONG L P,XING C X,et al.The effects of biofeedback therapy on mood and stress test parameters in patients with poststroke depression[J].Chinese Journal of Difficult and Complicated Cases,2016,15(10):1010-1015,1019.DOI:10.3969/j.issn.1671-6450.2016.10.006.
[24]GóMEZ-GONZáLEZ J V,GIL-EXTREMERA B.Ischemic stroke:complication of hypertension in hospital west of Almeria in Spain[J].Family Medicine and Community Health,2013,1(1):8-13.(收稿日期:2018-04-16;修回日期:2018-05-10)
[2]FEIGIN V L,KRISHNAMURTHI R V,PARMAR P,et al.Update on the Global Burden of Ischemic and Hemorrhagic Stroke in1990-2013:the GBD 2013 study[J].Neuroepidemiology,2015,45(3):161-176.DOI:10.1159/000441085.
[3]DOU D M,HUANG L L,DOU J,et al.Post-stroke depression as a predictor of caregivers burden of acute ischemic stroke patients in China[J].Psychol Health Med,2018,23(5):541-547.DOI:10.1080/13548506.2017.1371778.
[4]唐本玲,王强,唐琦.老年脑卒中后抑郁患者的影响因素研究[J].神经损伤与功能重建,2017,12(4):307-309.DOI:10.16780/j.cnki.sjssgncj.2017.04.008.TANG B L,WANG Q,TANG Q.Influencing factors of post-stroke depression in Chinese elderly population[J].Neural Injury and Functional Reconstruction,2017,12(4):307-309.DOI:10.16780/j.cnki.sjssgncj.2017.04.008.
[5]王思博,王慧彬,曲慧玲,等.卒中后抑郁的影响因素及其对生活质量的影响[J].中国医科大学学报,2017,46(9):844-847.DOI:10.12007/j.issn.0258-4646.2017.09.017.WANG S B,WANG H B,QU H L,et al.Influencing factors of post-stroke depression and the impact on the quality of life[J].Journal of China Medical University,2017,46(9):844-847.DOI:10.12007/j.issn.0258-4646.2017.09.017.
[6]陈艳黎,郑艳玲,余立平,等.社区中老年脑卒中后抑郁发生的相关危险因素研究[J].中国社会医学杂志,2017,34(5):491-493.DOI:10.3969/j.issn.1673-5625.2017.05.022.CHEN Y L,ZHENG Y L,YU L P,et al.Research of the risk factors of post-stroke depression for middle-aged and elderly patients in the community[J].Chinese Journal of Social Medicine,2017,34(5):491-493.DOI:10.3969/j.issn.1673-5625.2017.05.022.
[7]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,43(2):146-153.DOI:10.3760/cma.j.issn.1006-7876.2010.02.022.
[8]CRUICE M,WORRALL L,HICKSON L.Reporting on psychological well-being of older adults with chronic aphasia in the context of unaffected peers[J].Disabil Rehabil,2011,33(3):219-228.DOI:10.3109/09638288.2010.503835.
[9]唐丹.简版老年抑郁量表(GDS-15)在中国老年人中的使用[J].中国临床心理学杂志,2013,21(3):402-405.TANG D.Application of Short Form Geriatric Depression Scale(GDS-15)in Chinese elderly[J].Chinese Journal of Clinical Psychology,2013,21(3):402-405.
[10]BROTT T,ADAMS H P,OLINGER C P,et al.Measurements of acute cerebral infarction:a clinical examination scale[J].Stroke,1989,20(7):864-870.
[11]黄海蓉,陈晓峰,孙仕强,等.360名深圳市退休老年人的抑郁状况及其影响因素分析[J].中国疗养医学,2016,25(7):684-686.DOI:10.13517/j.cnki.ccm.2016.07.005.HUANG H R,CHEN X F,SUN S Q,et al.Analysis of depression and its influencing factors among 360 retired elderly people in Shenzhen[J].Chinese Journal of Convalescent Medicine,2016,25(7):684-686.DOI:10.13517/j.cnki.ccm.2016.07.005.
[12]何婷,沈珊珊,褚娇娇,等.老年人抑郁症状与功能状态和衰弱的相关性研究[J].中华老年医学杂志,2017,36(6):613-617.DOI:10.3760/cma.j.issn.0254-9026.2017.06.003.HE T,SHEN S S,CHU J J,et al.The associations of depressive symptoms with cognitive and physical functions and frailty in elderly outpatients[J].Chinese Journal of Geriatrics,2017,36(6):613-617.DOI:10.3760/cma.j.issn.0254-9026.2017.06.003.
[13]龙洁,蔡焯基,刘永珍,等.卒中后抑郁状态及其影响因素的相关研究[J].中国神经精神疾病杂志,2001,27(6):430-432.DOI:10.3969/j.issn.1002-0152.2001.06.010.LONG J,CAI Z J,LIU Y Z,et al.A study of prevalence and related factors of post-stroke depression[J].Chinese Journal of Nervous and Mental Diseases,2001,27(6):430-432.DOI:10.3969/j.issn.1002-0152.2001.06.010.
[14]ZHANG T,WANG C,LIU L,et al.A prospective cohort study of the incidence and determinants of post-stroke depression among the mainland Chinese patients[J].Neurol Res,2010,32(4):347-352.DOI:10.1179/016164110X12656393665125.
[15]ZHANG N,WANG C X,WANG A X,et al.Time course of depression and one-year prognosis of patients with stroke in mainland China[J].CNS Neurosci Ther,2012,18(6):475-481.DOI:10.1111/j.1755-5949.2012.00312.x.
[16]BOUR A,RASQUIN S,ABEN I,et al.A one-year follow-up study into the course of depression after stroke[J].J Nutr Health Aging,2010,14(6):488-493.
[17]张志珺,袁勇贵.卒中后抑郁障碍:机制、诊断与治疗[J].中国卒中杂志,2014,9(1):5-8.DOI:10.3969/j.issn.1673-5765.2014.01.002.ZHANG Z J,YUAN Y G.Post-stroke depression:mechanism,diagnosis and treatment[J].Chinese Journal of Stroke,2014,9(1):5-8.DOI:10.3969/j.issn.1673-5765.2014.01.002.
[18]AARON S E,GREGORY C M,SIMPSON A N.Lower Odds of Poststroke Symptoms of Depression When Physical Activity Guidelines Met:National Health and Nutrition Examination Survey2011-2012[J].J Phys Act Health,2016,13(8):903-909.DOI:10.1123/jpah.2015-0446.
[19]孙金菊,陈长香,张敏,等.言语听觉反馈训练对脑卒中患者认知功能障碍的康复效果[J].中华行为医学与脑科学杂志,2017,26(6):524-528.DOI:10.3760/cma.j.issn.1674-6554.2017.06.009.SUN J J,CHEN C X,ZHANG M,et al.Effect of speech auditory feedback training on cognitive function in patients with post stroke[J].Chinese Journal of Behavioral Medicine and Brain Science,2017,26(6):524-528.DOI:10.3760/cma.j.issn.1674-6554.2017.06.009.
[20]毛荣华,陈长香,李丹,等.Brain HQ视觉训练对脑卒中后抑郁患者抑郁症状的干预效果[J].中华行为医学与脑科学杂志,2015,24(12):1097-1099.DOI:10.3760/cma.j.issn.1674-6554.2015.12.011.MAO R H,CHEN C X,LI D,et al.Intervention effect of Brain HQ visual training on depressive symptom in patients with post stroke depression[J].Chinese Journal of Behavioral Medicine and Brain Science,2015,24(12):1097-1099.DOI:10.3760/cma.j.issn.1674-6554.2015.12.011.
[21]DERYCKA,BROUNS R,FRANSENE,et al.Aprospective study on the prevalence and risk factors of poststroke depression[J].Cerebrovasc Dis Extra,2013,3(1):1-13.DOI:10.1159/000345557.
[22]BERG A,L?NNQVIST J,PALOM?KI H,et al.Assessment of depression after stroke:a comparison of different screening instruments[J].Stroke,2009,40(2):523-529.DOI:10.1161/STROKEAHA.108.527705.
[23]李欣,宋鲁平,邢春晓,等.生物反馈对脑卒中后抑郁患者的情绪及压力测试参数的影响[J].疑难病杂志,2016,15(10):1010-1015,1019.DOI:10.3969/j.issn.1671-6450.2016.10.006.LI X,SONG L P,XING C X,et al.The effects of biofeedback therapy on mood and stress test parameters in patients with poststroke depression[J].Chinese Journal of Difficult and Complicated Cases,2016,15(10):1010-1015,1019.DOI:10.3969/j.issn.1671-6450.2016.10.006.
[24]GóMEZ-GONZáLEZ J V,GIL-EXTREMERA B.Ischemic stroke:complication of hypertension in hospital west of Almeria in Spain[J].Family Medicine and Community Health,2013,1(1):8-13.(收稿日期:2018-04-16;修回日期:2018-05-10)