本文選題：腦卒中后抑郁 + 皮膚交感反應(yīng)　； 參考：《延邊大學(xué)》2017年碩士論文

【摘要】：目的:深入研究腦卒中后抑郁(Post-stroke depression,PSD)患者經(jīng)檢測交感神經(jīng)皮膚反應(yīng)(skin sympathetic response,SSR)結(jié)合測定血漿中 5-羥色胺(5-hydroxy tryptamine,5-HT)、多巴胺(dopamine,DA)等單胺類神經(jīng)遞質(zhì)含量及漢密爾頓量表評分,評價(jià)PSD患者的抑郁程度,為臨床供科學(xué)診斷依據(jù)。方法:采用美國Medtronic公司Keypoint肌電圖機(jī)對經(jīng)漢密爾頓抑郁量表分組后的正常對照組(健康人),單純腦卒中組(stroke,S),腦卒中后抑郁組(post-stroke depression,PSD),各20例進(jìn)行皮膚交感反應(yīng)(SSR)檢查,測定上肢及下肢潛伏期和波幅,用于對比各組之間潛伏期及波幅有無差異,從而推斷大腦神經(jīng)功能損害后的自主神經(jīng)功能有無變化。同時(shí)檢測受試者血漿中5-HT及DA的含量,對比各組之間有無差異,并進(jìn)一步研究腦卒中后抑郁程度、SSr測定結(jié)果及血漿中單胺類神經(jīng)質(zhì)之間有無相關(guān)性。結(jié)果:1.腦卒中后抑郁組與正常對照組對比上肢、下肢SSR的潛伏期及波幅均有顯著差異(P0.01);腦卒中后抑郁組與單純腦卒中組對比上肢、下肢SSR的潛伏期有顯著差異(P0.01),其波幅差異不顯著,沒有統(tǒng)計(jì)學(xué)意義(P0.05);單純腦卒中組與正常對照組對比上肢SSR的伏期及波幅、下肢SSR的波幅均有顯著差異(P0.05),與下肢SSR的潛伏期差異不顯著沒有統(tǒng)計(jì)學(xué)意義(P0.05)。2.腦卒中后抑郁組患者血漿當(dāng)中5-HT、DA含量較正常對照組和單純腦卒中組下降明顯(P0.01);單純腦卒中組和正常對照組血漿中5-HT、DA含量進(jìn)行比較,無明顯差異,不具有統(tǒng)計(jì)學(xué)意義(P0.05)。3.腦卒中后抑郁組漢密爾頓抑郁量表評分與上肢、下肢潛伏期正相關(guān),與波幅無相關(guān);單純腦卒中組的漢密爾頓抑郁量表評分與下肢SSR的潛伏期正相關(guān),正常對照組的漢密爾頓抑郁量表評分與各項(xiàng)SSR結(jié)果無相關(guān)。4.腦卒中后抑郁組血漿中5-HT、DA含量與HAMD評分、SSR上、下肢的潛伏潛呈負(fù)相關(guān)。結(jié)論:1.腦卒中后抑郁患者SSR檢查結(jié)果與正常組及單純腦卒中患者比較,潛伏期明顯延長,且與抑郁程度正相關(guān),故檢測SSR異常變化可以作為一種客觀指標(biāo)判斷腦損傷后自主神經(jīng)功能有無異常。2.正常對照組或單純腦卒中患者血漿中5-羥色胺、多巴胺含量明顯高于腦卒中后抑郁組,故檢測血漿中單胺類神經(jīng)遞質(zhì)含量可有助于支持PSD診斷。3.在檢測患者SSR基礎(chǔ)上,結(jié)合血漿中單胺類神經(jīng)遞質(zhì)含量測定及HAMD評分,可以對腦卒中后抑郁做出更加準(zhǔn)確、嚴(yán)謹(jǐn)?shù)脑\斷,為將來臨床工作提供可靠的診斷依據(jù)。
[Abstract]:Objective: to study the contents of monoamine neurotransmitters such as 5-hydroxytryptamine 5-HT (5-hydroxytryptamine 5-HT), dopamine dopamine (DA) and Hamilton scale (Hamilton scale) in patients with post-stroke depression after stroke (Post-stroke depression) by detecting sympathetic skin skin sympathetic response (SSRs) and plasma serotonin 5-hydrotryptamine 5-HT (5-HT). To evaluate the degree of depression in patients with PSD and to provide scientific basis for clinical diagnosis. Methods: the normal control group (healthy controls, simple stroke group, post-stroke depression group) and post-stroke depression group (20 patients with post-stroke depression) were examined by Keypoint electromyography machine of Medtronic Company, USA. The latencies and amplitudes of upper and lower limbs were measured to compare whether there were differences in latency and amplitudes among the groups, so as to infer the changes of autonomic nerve function after cerebral nerve function damage. At the same time, the plasma 5-HT and DA levels in the subjects were measured, and the differences among the groups were compared, and the correlation between the level of depression after stroke and the monoamine neuroticism was further studied. The result is 1: 1. There were significant differences in the latency and amplitude of lower limb SSR between the depression group and the normal control group (P 0.01), the latency of lower extremity SSR was significantly different between the depression group and the simple stroke group (P 0.01), and the amplitude of SSR was not significantly different between the depression group and the simple stroke group. There was no significant difference in the amplitude and latency of SSR in upper limb and lower extremity between simple stroke group and normal control group (P 0.05), but there was no significant difference in latency of SSR between stroke group and normal control group (P 0.05). There was no significant difference in incubation period between stroke group and lower extremity SSR (P 0.05 路2), but there was no significant difference in the amplitude of lower extremity SSR between simple stroke group and normal control group. The levels of 5-HTDA in the patients with post-stroke depression were significantly lower than those in the normal control group and the simple stroke group, but there was no significant difference in the plasma 5-HTDA level between the stroke group and the normal control group. The scores of Hamilton Depression scale (Hamd) in post-stroke depression group were positively correlated with the latency of upper limb and lower extremity, but not with the amplitude of wave, and the scores of Hamilton Depression scale in simple stroke group were positively correlated with the latency of lower extremity SSR. There was no correlation between the scores of Hamilton Depression scale and the results of SSR in normal control group. 4. 4. There was a negative correlation between the level of 5 HT DA in plasma and the latent potential of lower extremity in HAMD score. Conclusion 1. The results of SSR examination in patients with post-stroke depression were significantly longer than those in the normal group and the patients with simple stroke, and were positively correlated with the degree of depression. Therefore, the detection of abnormal changes of SSR can be used as an objective index to determine the autonomic nervous function after brain injury. The levels of 5-hydroxytryptamine and dopamine in normal control group or simple stroke group were significantly higher than those in post-stroke depression group, so the detection of monoamine neurotransmitters in plasma could be helpful to support the diagnosis of PSD. 3. On the basis of the detection of SSR, combined with the determination of monoamine neurotransmitters in plasma and HAMD score, we can make a more accurate and rigorous diagnosis of post-stroke depression, and provide a reliable diagnostic basis for future clinical work.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R749.13

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