| Objectives To explore the relationship between early-onset post-stroke depression and the characteristics of infarct focus and homocysteine level by observing the changes of focus characteristics and homocysteine level in patients with first-episode acute cerebral infarction.Methods 1 The first acute cerebral infarction patients in neurology department of Affiliated Hospital of North China University of technology from October 2018 to September 2019 were studied.Hamilton Depression Scale was used to evaluate each patient at 14±2 days of the course of disease.According to the scores,the patients were divided into case group(PSD group)and control group(NPSD group).2 According to the results of brain imaging(MRI+DWI/CT)at the time of admission,the lesions were divided into left,right and bilateral according to the location of the infarction,and according to the brain anatomy,they were temporal lobe,frontal lobe,basal ganglia,parietal lobe,occipital lobe,brain stem and cerebellum.3 The degree of neurological impairment was assessed by NIHSS scale 24 hours after admission,and the cognitive function was assessed by MMSE scale.4 All the participants were fasted for 12 hours,and 5m L of venous blood was taken to detect total cholesterol,high-density lipoprotein,very low-density lipoprotein,triglyceride,low-density lipoprotein,uric acid,serum homocysteine and other indicators in the morning of the second day without diet.5 Statistical methods: SPSS 22.0 statistical software was used to analyze the data.The measurement data was expressed in the form of "mean ± standard deviation".The mean comparison between the two groups was performed by independent samplet-test,and the comparison between multiple groups was performed by one-way ANOVA.The percentage of counting data was calculated,and chi square test was used for group comparison.Multivariate logistic regression model was used in multivariate analysis.P<0.05 was statistically significant.Results 1 Among the 205 patients with acute cerebral infarction,85 were diagnosed with PSD,120 were not diagnosed with PSD,and the incidence of PSD was 41.5%.According to the Hamilton depression rating scale,85 patients in the case group were divided into mild depression group,moderate depression group and severe depression group.2 There was no significant difference between the two groups in age,gender,education level,BMI,smoking,drinking,history of hypertension,history of diabetes,and history of coronary heart disease(P>0.05),indicating that these factors were comparable between the groups.The difference between NIHSS and MMSE was statistically significant(P<0.05).3 Blood test indexes mainly analyzed triglycerides,total cholesterol,low-density lipoprotein,very low-density lipoprotein,high-density lipoprotein and uric acid.There was significant difference in the level of uric acid between groups(P<0.05),but there was no significant difference in other indexes(P>0.05),it shows that all the indexes except uric acid are comparable.4 The difference was statistically significant(P<0.05).The risk of depression in patients with multiple lesions was 1.806 times higher than that in patients with single lesions.5 The proportion of focus in the left hemisphere in the 5 cases group was higher than that in the control group,and the difference between the groups was statistically significant(P<0.05).The risk of depression in the patients with focus on the left side was 2.577 times higher than that in the patients with focus on the right side.There was no significant difference in the risk of depression.6 The difference between the two groups was statistically significant(P<0.05).The proportion of patients with lesions in frontal lobe,temporal lobe and basal ganglia was higher than that in the control group,and the proportion of patients with lesions in parietooccipital lobe,brain stem and cerebellum was lower than that in the control group.7 The ratio of lesion diameter>3.0cm in the case group was higher than that in the control group,and the difference between the two groups was statistically significant(P<0.05).The risk of depression was 1.902 times higher in the group with focus diameter>3.0cm than in the group with focus diameter 1.5?3cm.There was no significant difference in the risk of depression in the group with lesion diameter<1.5cm.8 The plasma homocysteine level of the case group was 21.95 ± 6.41umol/l,and that of the control group was 13.76±7.53umol/l.The plasma homocysteine level of the case group was significantly higher than that of the control group,and the difference between the two groups was statistically significant(P< 0.05).The mean value of homocysteine in plasma of the two groups was taken as the boundary value of exposure and non exposure.The exposure ratio of the case group was higher than that of the control group,the difference was statistically significant,the level of homocysteine increased,and the risk of depression after early-onset stroke increased.There was significant difference in Hcy level among patients with different depression(P<0.05).There was no significant difference between the moderate and severe depression group(P>0.05).The Hcy level of the patients in the moderate and severe depression group was significantly higher than that in the mild depression group(P<0.05).9 In order to eliminate the interference of confounding factors,multivariate logistic regression analysis was carried out.The results showed that the lesions were located in frontal lobe,temporal lobe and basal ganglia,the number of multiple lesions,homocysteine level,serum uric acid level,NIHSS score,MMSE score and other factors were still statistically significant(P<0.05),while the left cerebral hemisphere,lesion diameter>3.0cm were not statistically significant(P>0.05).Conclusions 1 The early-onset post-stroke depression is related to the location of cerebral infarction focus,and the risk of post-stroke depression is high in frontal lobe,temporal lobe and basal ganglia.2 Early post-stroke depression is related to the number of cerebral infarction lesions,and the number of lesions is the risk of multiple post-stroke depression.3.The higher the level of homocysteine,the higher the risk of post-stroke depression.Figure 0;Table 12;Reference 119... |
PDF Full Text Request