目的 探讨急性脑梗死后不同部位的脑白质病变(WML)对抑郁发生的影响.方法 纳入大连市第三人民医院神经内科2012年3月至2013年4月住院的急性脑梗死患者97例,根据有无脑白质病变分为2组,比较2组间汉密尔顿焦虑量表(HAMA)评分及汉密尔顿抑郁量表(HAMD)评分有无差异.对有WML组行改良Scheltens评分,并将改良Scheltens评分与HAMD评分进行直线相关分析,了解额叶、颞叶、顶叶、枕叶、基底节、侧脑室旁及小脑、脑干等不同部位的白质损害程度与抑郁严重程度的相关性.结果 有WML组HAMD评分(10±6)分,HAMA评分(11±4)分,无WML组HAMD评分(6±4)分,HAMA评分(9±3)分,2组之间HAMD及HAMA评分比较差异均有统计学意义(均P＜0.05);有WML组59例患者HAMD评分(10±6)分与改良Scheltens评分总分(4.39±0.49)分及额叶(2.76±0.43)分、枕叶白质(1.61±0.49)分、额部脑室旁白质(2.85±0.36)分,病变呈明显正相关(r=0.395,P=0.002;r=0.438,P =0.001;r =0.247,P=0.005;r =0.385,P=0.003).结论 急性脑梗死后不同部位的WML与抑郁障碍相关,主要以额部白质病变为主,额部白质病变越严重,抑郁程度越重.

Objective To evaluate the relationship between white matter lesions(WML) of different parts of brain after acute cerebral infarction and depressive disorder.Methods The clinical data of 97 patients with acute cerebral infarction were analyzed.All patients were divided into 2 groups according to with or without WML.The differences of Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) between 2 groups were analyzed.The WML group was scored using the semiquatitative rating scale of Scheltens Rating Scale(Scheltens).The correlation between the scheltens of lateral ventricle,frontal lobe,parietal lobe,temporal lobe,occipital lobe,basal ganglia,cerebella,brainstem and HAMD were observed.Results In WML group,the scale of HAMD was 10 ±6 and HAMA was 11 ±4.In without WML group,the scale of HAMD was 6 ±4 and HAMA was 9 ±3.There were significant differences of HAMA and HAMD between WML group and without WML group.HAMD was positively correlated with total scores of to

目的 探讨界定抑郁症临床治愈的17项HAMD(HAMD17)评分的临界值,并检验其有效性.方法 对251例经治疗症状得到明显改善的抑郁症患者评定HAMD17、大体评定量表、生活质量综合评定问卷,并应用受试者工作特征曲线法分析临界值.结果 抑郁症患者经过急性期治疗,HAMD17≤7分时,92.3％(203/220)的被试者存在至少一种阈下症状,48.6％ (107/220)的患者心理社会功能未恢复正常.HAMD17评分0～3分组患者心理功能、社会功能、躯体功能评分[分别为(60.1±15.4)、(62.0±l1.2)、(60.5±14.3)分],高于4～ 14分组患者[分别为(52.0±12.3)、(54.0±11.0)、(52.7±10.2)分],差异具有统计学意义(t=3.307、4.119、3.626,均P＜0.01).0～3分组心理社会功能恢复正常的比例(74.2％,92/124)高于4～ 14分组患者(12.6％,16/127;x2=97.103,P＜0.01).结论 抑郁症患者经过急性期治疗,HAMD17评分0～3分的患者心理社会功能更好,当HAMD17评分＞3分时,患者可能存在较多的阈下症状,临床上应予以重视.

Objective To explore the optimal cutoff point defining remission on 17-item Hamilton Depression Scale (HAMD17) for major depressive disorder (MDD),and examine the validity of this cutoff point.Method We interviewed 251 MDD responders with the HAMD17,Global Assessment of Functioning,Generic Quality of Life Inventory.Results After acute phase treatment for MDD,even the HAMD17 scored 7 or less,92.3％ (203/220) of remitters had at least one subthreshold depressive symptoms,48.6％ (107/220) of them also experienced functioning impairment,when psychosocial functioning taken into account,a cutoff of ≤ 3 might be the operational criterion of MDD remission.Compared to MDD patients scoring 4-14 on HAMD17,patients scoring 0-3 had significantly better psychological functioning,social functioning and physical functioning (separately 60.1 ± 15.4 vs.52.0 ± 12.3,62.0 ± 11.2 vs.54.0 ± 11.0,60.5±14.3vs.52.7±10.2; t=3.307,4.119,3.626,all P＜0.01).Compared to4-14 score group,the rate of o

比较精神分析心理治疗联合舍曲林与单用舍曲林治疗产后抑郁的疗效。方法:选择符合《国际疾病分类》(international classification of diseases,ICD-10)抑郁发作诊断标准的产后抑郁症患者56例,按随机数字表法分成观察组和对照组,各28例。观察组给予精神分析心理治疗联合舍曲林治疗,对照组给予舍曲林治疗。用汉密尔顿抑郁量表(HAMD)在治疗前及治疗1、2、4、6周评定疗效。结果:治疗前两组的HAMD评分比较,差异无统计学意义(P0.05)。治疗后两组HAMD评分均低于治疗前(P0.01)。治疗后观察组HAMD评分低于对照组(P0.01)。结论:精神分析联合舍曲林治疗产后抑郁效果更好。

Objective:To compare clinical efficacy between utilization psychoanalysis combined with sertraline and only the use of sertraline in the treatment of postnatal depression.Method:Fifty-six patients with postnatal depression accorded international classification of diseases were selected,and they were divided into the two groups by the random table,and there were 28 cases in each groups respectively.Patients in the observation group were treated with psychoanalysis combined with sertraline,and patients in the control group were treated with sertraline only.The clinical effects were measured by Hamilton depressive scale(HAMD) before treatment and 1,2,4,6 weeks after treatment.Result:HAMD scores of the two groups were compared,and there was no statistically significant difference(P>0.05).HAMD scores of the two groups after the treatment were lower than that before the treatment(P<0.01). HAMD scores after treatment in the observation group were lower than that in the control group(P<0.01).C

目的：探究阿托伐他汀对脑梗死后抑郁的影响。方法：回顾性分析400例脑梗死患者的资料并分组，随访3个月，分析治疗前、后汉密尔顿抑郁量表（HAMD ）评分。结果：强化、标准降脂组治疗前、后 HAMD评分无显著差异（P＞0．05）。治疗3个月后，女性组HAMD评分高于男性（P＜0．05），但组间阿托伐他汀剂量、血脂水平无统计学差异（P＞0．05）。结论：阿托伐他汀不影响脑梗死后抑郁症状，女性脑梗死后抑郁情况与阿托伐他汀剂量及血脂水平无关。

Objective :To study the atorvastafin in depressive symptoms among cerebral infarction patients .Methods :Collect the data of 400 targeted patients and group them .Hamilton Depression Rating Scale(HAMD)was tested before and after treatment and analysized after 3-months treatment .Results:No significant difference in HAMD score between intensive and standard lipid lowering group (P> 0 .05) .The HAMD scores in female group was higher than that in male group after treatment (P 0.05) .Conclusion:The use of atorvastatin will not influence depressive symptoms in cerebral infarction patients .The female patients’depressive symptoms is not related to the level of lipid and the dosage of atorvastatin .

目的探讨低频及高频重复经颅磁刺激(rTMS)对脑卒中后抑郁(PSD)的治疗作用。方法将111例PSD患者随机分为低频组37例(接受1Hz低频rTMS治疗)、高频组37例(接受10Hz高频rTMS治疗)和对照组37例(接受假刺激治疗),每周5次,共治疗4周。于治疗前、治疗第2周末及治疗第4周末分别采用汉密尔顿抑郁量表(HAMD)对3组患者评分。结果 rTMS治疗前,3组HAMD评分差异无统计学意义;治疗后第2、4周末,低频组、高频组HAMD评分明显低于对照组,特别是高频组;治疗后第2周末,高频组HAMD评分下降幅度较低频组明显。结论低频与高频rTMS治疗PSD安全有效,高频rTMS治疗起效更快。

Objective To investigate the curative effect of low-or high-frequency repetitive transcranial magnetic stimula-tion (rTMS) on patients with depression after stroke (PSD).Methods One hundred and eleven patients with PSD were ran-domly divided into low-frequency group (n=37 ,treated with 1 Hz low frequency rTMS) ,high-frequency group (n=37 ,trea-ted with 10 Hz high-frequency rTMS) and control group (n=37 ,treated by sham stimulation). Three groups were treated by five times per week and a total of 4 weeks treatment. The Hamilton Rating Scale for Depression (HAMD) was used to evaluate the condition of three groups before treatment ,2nd and 4th week after treatment.Results The HAMD scores among three groups had no significant difference before rTMS treatment ;the HAMD score of low-and high-frequency groups were lower than that of control group ,especially in the high-frequency group 2nd and 4th week after treatment ;the descend range of HAMD score in the high-frequency group was