Abstract: Objective To investigate the effect of early application of sertraline on post-stroke depression (PSD) and cognitive dysfunction after ischemic stroke. Methods Patients with first acute ischemic stroke who were hospitalized in neurology department of 6 hospitals in Suzhou from February 2016 to August 2017 were randomly divided into 3 groups: the control group was given conventional treatment, the low-dose treatment group was given sertraline hydrochloride 50 mg/d on the basis of conventional treatment, and the high-dose treatment group was given sertraline hydrochloride 100 mg/d on the basis of conventional treatment, with the treatment course for 3 months. At 1 month, 3 months, 6 months and 1 year after stroke, the patients were evaluated by Hamilton depression scale (HAMD), MMSE and mRS. The incidence of PSD, cognitive function and prognosis at the above point-in-time and ischemic stroke recurrence within one year were compared among the 3 groups. Results A total of 404 patients were included in the final analysis, including 136 in control group,

140 in the low-dose treatment group, and 128 in the high-dose treatment group. (1) There were

no statistical difference in the incidence of 1-year ischemic stroke among the 3 groups; (2) The incidence of PSD in the low-dose (22.9% vs . 44.1%, P <0.001) and high-dose treatment groups (18.8% vs . 44.1%, P <0.001) were lower than that in the control group at 3 months, and the incidence of PSD in the low-dose (5.7% vs . 44.1%, P <0.001) and high-dose treatment groups (4.7% vs . 44.1%, P <0.001) were lower than that in the control group at 6 months,all with statistical differences; (3) The HAMD scores of the low-dose and high-dose treatment groups were lower than those of the control group at 3, 6 months and 1 year, all with statistical differences; (4) The MMSE score of the high-dose treatment group was higher than that of the control group at 3 months, and the MMSE scores of the low-dose and the high-dose treatment groups were higher than that of the control group at 6 and 12 months, all with statistical differences. Conclusions Early application of sertraline hydrochloride after acute ischemic stroke can reduce the incidence of post-stroke depression, improve cognitive function of patients at 1 year after stroke, while had no influence on recurrent stroke and functional prognosis.

Key words: Sertraline hydrochloride; Early intervention; Ischemic stroke; Post-stroke depression; Cognition

摘要：

目的 探讨缺血性卒中后早期应用盐酸舍曲林对卒中后抑郁（post-stroke depression，PSD）和认知功能障碍的影响。 

方法 前瞻性连续入组2016年2月-2017年8月苏州市6家三级医院神经内科住院的首发急性缺血性卒中患者。将其随机分为3组，对照组给予常规治疗，低剂量治疗组在常规治疗基础上加用盐酸舍曲林50 mg/d，高剂量治疗组在常规治疗基础上加用盐酸舍曲林100 mg/d，疗程均为3个月。分别于卒中后1个月、3个月、6个月和1年对患者进行汉密尔顿抑郁量表（Hamilton depression scale，HAMD）、 MMSE、mRS评定，比较3组上述随访时间点的PSD发生率、认知功能和预后情况，以及1年缺血性卒中的复发率。 

结果 最终完成随访的患者为404例，其中对照组136例，低剂量治疗组140例，高剂量治疗组128例。①3组间1年缺血性卒中复发率差异无统计学意义，不同随访时间mRS差异均无统计学意义；②卒中后 3个月时低剂量治疗组（22.9% vs. 44.1%，P <0.001）和高剂量治疗组（18.8% vs. 44.1%，P <0.001）的 PSD发生率均低于对照组；卒中后6个月时低剂量治疗组（5.7% vs. 44.1%，P <0.001）和高剂量治疗组 （4.7% vs. 44.1%，P <0.001）的PSD发生率均显著低于对照组；③卒中后3个月、6个月和1年时低剂量治疗组和高剂量治疗组的HAMD评分均低于对照组，差异有统计学意义；④卒中后3个月时高剂量治疗 组的MMSE评分高于对照组，6个月与12个月时低剂量治疗组和高剂量治疗组的MMSE评分均高于对照组，差异有统计学意义。

结论 盐酸舍曲林早期干预急性缺血性卒中患者可降低3个月和6个月时PSD的发生率，改善患者发病1年的认知功能，但对缺血性卒中的复发率和功能预后无影响。

关键词: 盐酸舍曲林; 早期干预; 缺血性卒中; 卒中后抑郁; 认知