基于GDS-15评价老年卒中后抑郁状态的影响因素及其纵向分析

doi:10.3969/j.issn.1673-5765.2025.09.008

摘要/Abstract

摘要： 目的基于简版老年抑郁量表（geriatric depression scale 15，GDS-15）评估老年卒中后抑郁（post-stroke depression，PSD）的影响因素，并纵向分析其抑郁状态的变化情况。
方法回顾性分析2019年1月—2021年12月合肥市第三人民医院收治的老年首发急性缺血性卒中（acute ischemic stroke，AIS）患者的临床资料，记录患者出院时的GDS-15评分以评估PSD发生情况。将GDS-15评分＞10分的患者纳入PSD组，≤10分的患者纳入非PSD组。比较两组临床资料，使用多因素logistic回归分析评估老年AIS患者发生PSD的危险因素，并对出院后随访时间≥12个月患者的GDS-15评分进行纵向分析。
结果共纳入168例老年AIS患者，其中PSD组57例，非PSD组111例。PSD组大专及以上学历患者的占比低于非PSD组（P=0.042），入院时NIHSS评分＞4分（P=0.007）、入院时改良巴塞尔指数（modified Barthel index，mBI）评分＜60分（P=0.003）及入院时老年营养风险指数（geriatric nutritional risk index，GNRI）≤98（P=0.021）的占比高于非PSD组。多因素logistic回归分析显示，入院时NIHSS评分＞4分（OR 2.489，95%CI 0.017～0.995，P＜0.05）、入院时mBI评分＜60分（OR 3.357，95%CI 1.883～5.986，P＜0.05）及入院时GNRI≤98（OR 2.818，95%CI 1.537～5.165，P＜0.05）是老年AIS患者发生PSD的危险因素，而大专及以上学历是老年AIS患者发生PSD的保护因素（OR 0.519，95%CI 0.017～0.995，P＜0.05）。168例老年AIS患者中，有69例出院后随访时间≥12个月，出院后12个月GDS-15评分、mBI评分及GNRI高于出院时（P均＜0.01），而NIHSS评分低于出院时（P＜0.01）。
结论老年AIS患者出院后抑郁水平较高，入院时神经功能损伤严重、日常活动能力受限明显及营养状态不佳的患者，更易发生PSD；而大专及以上学历的老年AIS患者PSD发生风险较低。

文章导读： 发病早期神经功能损伤严重、日常活动能力受限、营养状态不佳及受教育程度不高的老年AIS患者更易发生PSD，且抑郁程度随病程的延长而升高，这一结论可为老年AIS患者的临床管理提供参考。

关键词: 缺血性卒中; 老年; 卒中后抑郁; 老年抑郁量表

Abstract: Objective To evaluate the influencing factors of post-stroke depression (PSD) in the elderly based on the geriatric depression scale 15 (GDS-15) and to longitudinally analyze the changes in depressive status.
Methods A retrospective analysis was performed on the clinical data of elderly patients with first-episode acute ischemic stroke (AIS) admitted to the Third People’s Hospital of Hefei from January 2019 to December 2021. All patients completed the GDS-15 questionnaire at discharge to evaluate the occurrence of PSD. Patients with a GDS-15 score>10 were included in the PSD group, while those with a score≤10 were included in the non-PSD group. Clinical data were compared between the two groups, and multivariate logistic regression analysis was used to assess the risk factors for PSD in elderly patients with AIS. Longitudinal analysis of GDS-15 scores was performed for patients with a follow-up period of ≥12 months after discharge.
Results A total of 168 elderly AIS patients were enrolled, including 57 patients in the PSD group and 111 patients in the non-PSD group. The proportion of patients with an education level of junior college or above in the PSD group was lower than that in the non-PSD group (P=0.042). The proportions of patients with an admission NIHSS score>4 points (P=0.007), an admission modified Barthel index (MBI) score<60 points (P=0.003), and an admission geriatric nutritional risk index (GNRI)≤98 (P=0.021) were higher in the PSD group than in the non-PSD group. Multivariate logistic regression analysis showed that an admission NIHSS score>4 points (OR 2.489, 95%CI 0.017～0.995, P<0.05), an admission MBI score<60 points (OR 3.357, 95%CI 1.883～5.986, P<0.05), and an admission GNRI≤98 (OR 2.818, 95%CI 1.537～5.165, P<0.05) were risk factors for PSD in elderly patients with AIS, while an education level of junior college or above was a protective factor (OR 0.519, 95%CI 0.017～0.995, P<0.05). Among the 168 elderly patients with AIS, 69 patients had a follow-up period of≥12 months after discharge. At 12 months after discharge, GDS-15 score, MBI score, and GNRI were higher than those at discharge (P all<0.01), while NIHSS score was lower than that at discharge (P<0.01).
Conclusions Depressive levels in elderly patients with AIS may increase after discharge. Those with severe neurological impairment, significant limitations in activities of daily living, and poor nutritional status at admission are more likely to develop PSD, whereas those with an education level of junior college or above have a low risk of PSD.

Key words: Ischemic stroke; Elderly; Post-stroke depression; Geriatric depression scale 15

中图分类号:

苗连海, 陈继群, 宋诗涛, 杨志勇, 赵辉. 基于GDS-15评价老年卒中后抑郁状态的影响因素及其纵向分析[J]. 中国卒中杂志, 2025, 20(9): 1131-1136.

MIAO Lianhai, CHEN Jiqun, SONG Shitao, YANG Zhiyong, ZHAO Hui. Influencing Factors and Longitudinal Analysis of Post-Stroke Depression in the Elderly Based on GDS-15[J]. Chinese Journal of Stroke, 2025, 20(9): 1131-1136.

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