颈动脉夹层患者长期心理健康与生活质量研究

文献信息

中文摘要

引言： 大多数颈动脉夹层（CeAD）患者长期功能预后良好。关于这些患者的长期心理后遗症知之甚少。
患者与方法： 在CeAD患者中，我们评估了长期生活质量（QoL）、焦虑水平升高、创伤后应激障碍（PTSD）、抑郁和疲劳的发生频率，并探讨基线特征能否识别出发生上述情况的高风险患者。我们对基线后3个月预后极佳且既往无精神疾病的CeAD患者进行了长期随访（基线后≥12个月）。要求患者填写公认的问卷。
结果： 对89例CeAD患者在基线后中位53个月时进行了长期随访。65例为颈动脉夹层，37例为椎动脉夹层（13例两者均有）。在长期随访时，14.6%达到焦虑正式诊断阈值，11.2%符合PTSD标准。29.2%的评分高于显著围创伤性解离阈值。19.1%报告在基线与长期随访之间任一时间点出现抑郁，48.3%的评分高于异常疲劳阈值。焦虑水平升高者和符合PTSD标准者报告生活质量降低。CeAD急性期的围创伤性解离与长期随访时焦虑水平升高相关。夹层动脉闭塞、基线耳鸣和既往吸烟与长期随访时的PTSD相关。
讨论： 围创伤性解离经历以及夹层动脉闭塞的预后重要性需要进一步研究。有必要开展进一步的前瞻性和干预性研究来治疗CeAD患者的心理后遗症。
结论： CeAD患者似乎有较高的长期发生焦虑、抑郁或PTSD的风险，并伴有生活质量下降。这些发现为探索性，应进一步确认。

英文摘要

INTRODUCTION: Most patients with Cervical Artery Dissection (CeAD) experience good long-term functional outcome. Little is known about long-term psychological sequelae in these patients.
PATIENTS AND METHODS: In CeAD-patients, we assessed long-term quality of life (QoL), frequency of increased anxiety levels, post-traumatic stress disorder (PTSD), depression and fatigue and explored if baseline characteristics can identify patients at high risk of developing the aforementioned. We performed long-term follow-up (> = 12 months after baseline) in CeAD-patients with excellent 3-month outcome and no prior psychiatric disorder. Patients were asked to answer established questionnaires.
RESULTS: Long-term follow-up was performed on 89 CeAD-patients at a median of 53 months after baseline. Sixty-five patients had carotid artery dissection and 37 patients had vertebral artery dissection (13 patients had both). At long-term follow-up the threshold for formal diagnosis of anxiety was met by 14.6, and 11.2% met the criteria for PTSD. 29.2% had a score above threshold for significant peri-traumatic dissociation. 19.1% reported depression at any point between baseline and long-term follow-up and 48.3% scored above thresholds for abnormal fatigue. Those who experienced increased levels of anxiety and those who met criteria for PTSD reported reduced QoL. Peritraumatic dissociation at the acute phase of CeAD was associated with increased anxiety levels at long-term follow-up. Occlusion of the dissected artery, tinnitus at baseline and prior smoking were associated with PTSD at long-term follow-up.
DISCUSSION: Prognostic importance of the experience of peritraumatic dissociation as well as occlusion of the dissected artery requires further research. Further prospective and interventional studies in treatment of psychological sequela in CeAD-patients are warranted.
CONCLUSION: CeAD-patients seem to have a high long-term risk of developing anxiety, depression or PTSD, which was accompanied by decreased QoL. These findings are exploratory and should be further confirmed.