本文選題：腦卒中后抑郁癥 + 單因素分析　； 參考：《鄭州大學(xué)》2013年碩士論文

【摘要】：第一部分腦卒中后抑郁癥的高危因素 目的： 分析腦卒中后抑郁癥的高危因素。 方法： 將238例腦卒中患者分為PSD組(110例)和非PSD組(128例),通過(guò)單因素分析、多因素Logistic回歸分析性別、年齡、性格特點(diǎn)、文化程度、固定職業(yè)、收入、居住地、社會(huì)支持、并發(fā)癥、腦卒中類型、病變側(cè)別、病變部位、神經(jīng)功能和日常生活活動(dòng)能力對(duì)PSD的影響。結(jié)果： 1單因素分析結(jié)果顯示,兩組的性別、性格、固定職業(yè)、社會(huì)支持、并發(fā)癥、病變側(cè)別、病變部位、神經(jīng)功能以及日常生活活動(dòng)能力具有明顯的差異(P0.05)。 2多因素Logistic回歸分析結(jié)果顯示,性別、性格、社會(huì)支持、病變側(cè)別、病變部位、神經(jīng)功能以及日常生活活動(dòng)能力是影響PSD發(fā)生的主要危險(xiǎn)因素。 結(jié)論： 女性、性格內(nèi)向、社會(huì)支持少、病變?cè)谧髠?cè)和額葉、神經(jīng)功能缺損和日常生活活動(dòng)能力差是促進(jìn)PSD發(fā)生發(fā)展的高危因素。 第二部分解郁安神顆粒對(duì)腦卒中后抑郁患者的影響及機(jī)制研究 目的： 探討解郁安神顆粒對(duì)PSD的影響及可能機(jī)制。 方法： 將80例PSD患者隨機(jī)分為治療組(40例)和對(duì)照組(40例)。兩組患者均予常規(guī)腦卒中治療和氟西汀,治療組在對(duì)照組的基礎(chǔ)上予以解郁安神顆粒,連續(xù)8周。比較兩組的療效、抑郁程度、神經(jīng)功能缺損程度、日常生活活動(dòng)能力以及血清5-HT、NE、TNF-α、IL-1β和BDNF水平。 療效標(biāo)準(zhǔn) 于治療前和治療第8周末評(píng)定療效。減分率=(治療前評(píng)分-治療后評(píng)分)/治療前評(píng)分×100%。HAMD減分率75%為痊愈,50%為顯效,25%為有效,25%為無(wú)效�？傆行�=(痊愈例數(shù)+顯效例數(shù)+有效例數(shù))/各組樣本數(shù)×100%。 結(jié)果： 1治療組總有效率為97.5%；對(duì)照組總有效率為87.5%。兩組的總有效率差異具有統(tǒng)計(jì)學(xué)意義(?=10.660,P0.05)。 2經(jīng)治療后,兩組的HAMD、SSS量表評(píng)分明顯降低,且治療組明顯低于對(duì)照組(P0.05)；ADL量表評(píng)分明顯升高,且治療組明顯高于對(duì)照組(P0.05)。 3經(jīng)治療后,兩組的5-HT和NE水平明顯升高(P0.05),且治療組略高于對(duì)照組(P0.05)。 4經(jīng)治療后,兩組的TNF-a和IL-1p水平均明顯降低(P0.05),且治療組明顯低于對(duì)照組(P0.05) 5經(jīng)治療后,兩組的BDNF水平明顯升高(P0.05),且治療組略高于對(duì)照組(P0.05)。 結(jié)論： 解郁安神顆粒能夠有效地治療PSD,緩解抑郁癥狀,促進(jìn)神經(jīng)功能恢復(fù),提高日常生活活動(dòng)能力,可能與上調(diào)血清5-HT、NE、BDNF水平,下調(diào)血清TNF-α和IL-1β水平相關(guān)。
[Abstract]:Part I High risk factors of Post-stroke Depression Objective: To analyze the high risk factors of post-stroke depression. Methods: Two hundred and eight patients with stroke were divided into PSD group (n = 110) and non-PSD group (n = 128). By univariate analysis, multivariate Logistic regression analysis, sex, age, personality, education, fixed occupation, income, place of residence, social support, complications. The effects of stroke type, lesion side, lesion location, neurological function and activity of daily living on PSD. Results: 1 the results of univariate analysis showed that there were significant differences in sex, personality, fixed occupation, social support, complications, lesion side, lesion site, nerve function and activity of daily living between the two groups (P 0.05). 2Multivariate Logistic regression analysis showed that sex, personality, social support, pathological side, lesion location, nerve function and daily living ability were the main risk factors affecting the occurrence of PSD. Conclusion: Female, introverted, less social support, lesion in left and frontal lobe, neurological deficit and poor daily living ability are the high risk factors to promote the development of PSD. The second part: effect and mechanism of Jieyu Anshen granule on patients with post-stroke depression Objective: To explore the effect of Jieyu Anshen granule on PSD and its possible mechanism. Methods: 80 patients with PSD were randomly divided into treatment group (n = 40) and control group (n = 40). Two groups of patients were given routine stroke treatment and fluoxetine treatment group on the basis of the control group on the basis of Jieyu Anshen granule for 8 weeks. The therapeutic effect, degree of depression, degree of neurological impairment, activity of daily living (ADL) and serum levels of IL-1 尾 and BDNF were compared between the two groups. Curative effect standard The efficacy was evaluated before treatment and at the end of the 8th week. The score reduction rate before and after treatment was 75%, the recovery rate was 50%, the significant effect was 25%, and the effective rate was 25%. Total effective rate (effective number of cases of recovery, effective number of cases / sample number of each group 脳 100). Results: 1 the total effective rate was 97.5 in the treatment group and 87.5 in the control group. The difference of total effective rate between the two groups was statistically significant (P 0.05). 2After treatment, the scores of HAMD-SSS in the two groups were significantly decreased, and the scores of ADL in the treatment group were significantly lower than those in the control group (P 0.05), and the scores in the treatment group were significantly higher than those in the control group (P 0.05). 3After treatment, the levels of 5-HT and NE in the two groups were significantly higher than those in the control group. 4After treatment, the levels of TNF-a and IL-1p in both groups were significantly lower than those in the control group (P 0.05), and those in the treatment group were significantly lower than those in the control group (P 0.05). 5After treatment, the level of BDNF in the two groups was significantly higher than that in the control group, and the level of BDNF in the treatment group was slightly higher than that in the control group. Conclusion: Jieyu Anshen granule can effectively treat PSD, relieve depression, promote the recovery of nerve function and improve the activity of daily life, which may be related to the up-regulation of serum 5-HTNE-BDNF level and down-regulation of serum TNF- 偽 and IL-1 尾 levels.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R749.1

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