卒中后抑郁发病的病理机制及治疗研究进展
Pathogenesis and Research Progress in Treatment of Post-Stroke Depression
DOI: 10.12677/ns.2026.1510342, PDF,   
作者: 王天驰*, 杨 慧#:佳木斯大学附属第一医院神经内科,黑龙江 佳木斯
关键词: 卒中后抑郁;病理机制;治疗机制;研究进展 ;Post-Stroke Depression; Pathogenesis; Therapeutic Mechanism; Research Progress
摘要: 卒中后抑郁(Post-Stroke Depression, PSD)是脑卒中后最为常见的神经精神并发症之一,可严重影响脑卒中患者的神经功能恢复与生活质量。其发病机制涉及多方面因素,目前尚未完全阐明。本文就卒中后抑郁的病理机制及治疗策略的最新研究进展作一综述。
Abstract: Post-Stroke Depression (PSD) is one of the most common neuropsychiatric complications following stroke, which seriously impairs neurological recovery and quality of life in stroke patients. Its pathogenesis is multifactorial and remains incompletely elucidated. This article reviews the latest research progress regarding the pathological mechanisms and therapeutic strategies of PSD.
文章引用:王天驰, 杨慧. 卒中后抑郁发病的病理机制及治疗研究进展[J]. 护理学, 2026, 15(10): 192-200. https://doi.org/10.12677/ns.2026.1510342

参考文献

[1] 王陇德, 彭斌, 张鸿祺, 等. 《中国脑卒中防治报告2020》概要[J]. 中国脑血管病杂志, 2022, 19(2): 136-144.
[2] 王少石, 周新雨, 朱春燕. 卒中后抑郁临床实践的中国专家共识[J]. 中国卒中杂志, 2016, 11(8): 685-693.
[3] 李世明, 冯为, 崔凤伟, 等. 中国脑卒中后抑郁患病率meta分析[J]. 实用医学杂志, 2021, 37(16): 2058-2064.
[4] 符家武, 吴昊, 廖志敏, 等. miRNA-146a基因多态性与缺血性卒中后抑郁的相关性[J]. 实用医学杂志, 2024, 40(19): 2708-2712.
[5] 李晶, 牟建明, 赵珩, 等. 急性脑卒中后抑郁状态血清单胺类递质的变化[J]. 中国老年学杂志, 2010, 30(24): 3641-3642.
[6] 戢运建, 况娥. 脑卒中后抑郁患者血清TSH含量与神经递质、神经营养状态及神经细胞凋亡的关系[J]. 海南医学院学报, 2017, 23(9): 1276-1278.
[7] 李梦瑶, 吴彦, 杜亚松. 焦虑障碍的谷氨酸学说研究进展[J]. 上海交通大学学报(医学版), 2014, 34(4): 459-463.
[8] 沈路遥, 朱东亚. 卒中后焦虑和抑郁的研究进展[J]. 南京医科大学学报(自然科学版), 2020, 40(2): 287-292.
[9] Spalletta, G., Bossù, P., Ciaramella, A., Bria, P., Caltagirone, C. and Robinson, R.G. (2006) The Etiology of Poststroke Depression: A Review of the Literature and a New Hypothesis Involving Inflammatory Cytokines. Molecular Psychiatry, 11, 984-991.
https://doi.org/10.1038/sj.mp.4001879
[10] 胡佳, 周伟, 周志明, 等. 炎症指标对缺血性脑卒中卒中后抑郁的预测价值[J]. 南方医科大学学报, 2019, 39(6): 665-671.
[11] Chi, C.H., Huang, Y.Y., Ye, S.Z., Shao, M., Jiang, M., Yang, M., et al. (2021) Interleukin-10 Level Is Associated with Post-Stroke Depression in Acute Ischaemic Stroke Patients. Journal of Affective Disorders, 293, 254-260.
https://doi.org/10.1016/j.jad.2021.06.037
[12] Cai, Z., He, W., Zhuang, F. and Chen, Y. (2019) The Role of High High-Sensitivity C-Reactive Protein Levels at Admission on Poor Prognosis after Acute Ischemic Stroke. International Journal of Neuroscience, 129, 423-429.
https://doi.org/10.1080/00207454.2018.1538139
[13] Yang, R.R., Lu, B.C., Li, T., Du, Y., Wang, X. and Jia, Y. (2015) The Relationship between High‐Sensitivity C‐Reactive Protein at Admission and Post Stroke Depression: A 6‐Month Follow‐Up Study. International Journal of Geriatric Psychiatry, 31, 231-239.
https://doi.org/10.1002/gps.4315
[14] Hsu, Y.C., Huang, Y.Y., Tsai, S.Y., Kuo, Y., Lin, J., Ho, H., et al. (2023) Efficacy of Probiotic Supplements on Brain-Derived Neurotrophic Factor, Inflammatory Biomarkers, Oxidative Stress and Cognitive Function in Patients with Alzheimer’s Dementia: A 12-Week Randomized, Double-Blind Active-Controlled Study. Nutrients, 16, Article No. 16.
https://doi.org/10.3390/nu16010016
[15] Banerjee, A., Thekkekkara, D., Manjula, S.N., Nair, S.P. and Lalitha, M.S. (2025) Correlation of Autophagy and Alzheimer’s Disease with Special Emphasis on the Role of Phosphodiesterase-4. 3Biotech, 15, Article No. 139.
https://doi.org/10.1007/s13205-025-04306-5
[16] Pascotini, M.E.T., Flores, D.A.E., Kegler, M.A., Konzen, M.V., Fornari, M.A.L., Arend, M.J., et al. (2018) Brain-Derived Neurotrophic Factor Levels Are Lower in Chronic Stroke Patients: A Relation with Manganese-Dependent Superoxide Dismutase ALA16VAL Single Nucleotide Polymorphism through Tumor Necrosis Factor-α and Caspases Pathways. Journal of Stroke and Cerebrovascular Diseases, 27, 3020-3029.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.06.032
[17] 李玉雄, 郭子运, 张雄新. 脑卒中后抑郁患者的炎性因子和脑源性神经营养因子水平变化及相关性分析[J]. 解放军医药杂志, 2018, 30(12): 101-104.
[18] Xu, H.B., Xu, Y.H., He, Y., Xue, F., Wei, J., Zhang, H., et al. (2018) Decreased Serum Brain-Derived Neurotrophic Factor May Indicate the Development of Poststroke Depression in Patients with Acute Ischemic Stroke: A Meta-Analysis. Journal of Stroke and Cerebrovascular Diseases, 27, 709-715.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.10.003
[19] 张一清. 脑卒中后抑郁症与下丘脑-垂体-肾上腺轴的关系及运动干预的研究进展[J]. 中国康复医学杂志, 2014, 29(5): 492-494.
[20] Micale, V. and Drago, F. (2018) Endocannabinoid System, Stress and HPA Axis. European Journal of Pharmacology, 834, 230-239.
https://doi.org/10.1016/j.ejphar.2018.07.039
[21] Mehdi, S., Wani, S.U.D., Krishna, K.L., Kinattingal, N. and Roohi, T.F. (2023) A Review on Linking Stress, Depression, and Insulin Resistance via Low-Grade Chronic Inflammation. Biochemistry and Biophysics Reports, 36, Article ID: 101571.
https://doi.org/10.1016/j.bbrep.2023.101571
[22] Wakabayashi, I. and Daimon, T. (2015) The “Cardiometabolic Index” as a New Marker Determined by Adiposity and Blood Lipids for Discrimination of Diabetes Mellitus. Clinica Chimica Acta, 438, 274-278.
https://doi.org/10.1016/j.cca.2014.08.042
[23] Li, F.E., Luo, Y., Zhang, F.L., Zhang, P., Liu, D., Ta, S., et al. (2021) Association between Cardiometabolic Index and Stroke: A Population-Based Cross-Sectional Study. Current Neurovascular Research, 18, 324-332.
https://doi.org/10.2174/1567202618666211013123557
[24] Xu, B., Wu, Q., La, R., Lu, L., Abdu, F.A., Yin, G., et al. (2024) Is Systemic Inflammation a Missing Link between Cardiometabolic Index with Mortality? Evidence from a Large Population-Based Study. Cardiovascular Diabetology, 23, Article No. 212.
https://doi.org/10.1186/s12933-024-02251-w
[25] Zhou, X., Tao, X., Zhang, L., Yang, Q., Li, Z., Dai, L., et al. (2024) Association between Cardiometabolic Index and Depression: National Health and Nutrition Examination Survey (NHANES) 2011-2014. Journal of Affective Disorders, 351, 939-947.
https://doi.org/10.1016/j.jad.2024.02.024
[26] Hajjar, D.P. and Gotto, A.M. (2013) Biological Relevance of Inflammation and Oxidative Stress in the Pathogenesis of Arterial Diseases. The American Journal of Pathology, 182, 1474-1481.
https://doi.org/10.1016/j.ajpath.2013.01.010
[27] Cheng, L., Wu, Q. and Wang, S. (2024) Cardiometabolic Index Is Associated with Increased Depression: A Population-Based Study. Journal of Affective Disorders, 348, 259-264.
https://doi.org/10.1016/j.jad.2023.12.073
[28] van de Vyver, M. (2023) Immunology of Chronic Low-Grade Inflammation: Relationship with Metabolic Function. Journal of Endocrinology, 257, e220271.
https://doi.org/10.1530/joe-22-0271
[29] Simats, A. and Liesz, A. (2022) Systemic Inflammation after Stroke: Implications for Post‐stroke Comorbidities. EMBO Molecular Medicine, 14, e16269.
https://doi.org/10.15252/emmm.202216269
[30] Brebner, K., Hayley, S., Zacharko, R., et al. (2000) Synergistic Effects of Interleukin-1β, Interleukin-6, and Tumor Necrosis Factor-α Central Monoamine, Corticosterone, and Behavioral Variations. Neuropsychopharmacology, 22, 566-580.
https://doi.org/10.1016/s0893-133x(99)00166-9
[31] Hassamal, S. (2023) Chronic Stress, Neuroinflammation, and Depression: An Overview of Pathophysiological Mechanisms and Emerging Anti-Inflammatories. Frontiers in Psychiatry, 14, Article ID: 1130989.
https://doi.org/10.3389/fpsyt.2023.1130989
[32] Feng, X., Ma, X., Li, J., et al. (2024) Inflammatory Pathogenesis of Post-Stroke Depression. Aging and Disease, 16, 209-238.
[33] Himmerich, H., Patsalos, O., Lichtblau, N., Ibrahim, M.A.A. and Dalton, B. (2019) Cytokine Research in Depression: Principles, Challenges, and Open Questions. Frontiers in Psychiatry, 10, Article No. 30.
https://doi.org/10.3389/fpsyt.2019.00030
[34] Nezi, M., Mastorakos, G. and Mouslech, Z. (2000) Corticotropin Releasing Hormone and the Immune/Inflammatory Response. In: Feingold, K.R., Adler, R.A., Ahmed, S.F., et al., Eds., Endotext, MDText.com, Inc.
[35] Abercrombie, H.C., Jahn, A.L., Davidson, R.J., Kern, S., Kirschbaum, C. and Halverson, J. (2011) Cortisol’s Effects on Hippocampal Activation in Depressed Patients Are Related to Alterations in Memory Formation. Journal of Psychiatric Research, 45, 15-23.
https://doi.org/10.1016/j.jpsychires.2010.10.005
[36] Perez-Caballero, L., Torres-Sanchez, S., Romero-López-Alberca, C., González-Saiz, F., Mico, J.A. and Berrocoso, E. (2019) Monoaminergic System and Depression. Cell and Tissue Research, 377, 107-113.
https://doi.org/10.1007/s00441-018-2978-8
[37] Wichers, M.C. and Maes, M. (2004) The Role of Indoleamine 2,3-Dioxygenase (IDO) in the Pathophysiology of Interferon-α-Induced Depression. Journal of Psychiatry and Neuroscience, 29, 11-17.
https://doi.org/10.1139/jpn.0402
[38] Wijeratne, T. and Sales, C. (2021) Understanding Why Post-Stroke Depression May Be the Norm Rather than the Exception: The Anatomical and Neuroinflammatory Correlates of Post-Stroke Depression. Journal of Clinical Medicine, 10, Article No. 1674.
https://doi.org/10.3390/jcm10081674
[39] Morris, P.L.P., Robinson, R.G., Raphael, B. and Bishop, D. (1991) The Relationship between the Perception of Social Support and Post-Stroke Depression in Hospitalized Patients. Psychiatry, 54, 306-316.
https://doi.org/10.1080/00332747.1991.11024559
[40] Mortensen, J.K., Larsson, H., Johnsen, S.P. and Andersen, G. (2013) Post Stroke Use of Selective Serotonin Reuptake Inhibitors and Clinical Outcome among Patients with Ischemic Stroke: A Nationwide Propensity Score-Matched Follow-Up Study. Stroke, 44, 420-426.
https://doi.org/10.1161/strokeaha.112.674242
[41] Freedman, M., et al. (2017) Challenging Neuropathic Pain Syndromes: Evaluation and Evidence-Based Treatment. Elsevier.
https://sc.panda985.com/scholar?hl=zh-CN&as_sdt=0%2C5&q=Challenging+Neuropathic+Pain+Syndromes%3A+Evaluation+and++++Evidence-Based+Treatment.+Elsevier+Health+Sciences+&btnG=
[42] Agius, M. and Bonnici, H. (2017) Antidepressants in Use in Clinical Practice. Psychiatria Danubina, 29, 667-671.
[43] Yan, N. and Hu, S. (2024) The Safety and Efficacy of Escitalopram and Sertraline in Post-Stroke Depression: A Randomized Controlled Trial. BMC Psychiatry, 24, Article No. 365.
https://doi.org/10.1186/s12888-024-05833-w
[44] Azizi, M., Khani, S., Kamali, M., et al. (2022) The Efficacy and Safety of Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitors in the Treatment of Menopausal Hot Flashes: A Systematic Review of Clinical Trials. Iranian Journal of Medical Sciences, 47, 173-193.
[45] Paolucci, S. (2017) Advances in Antidepressants for Treating Post-Stroke Depression. Expert Opinion on Pharmacotherapy, 18, 1011-1017.
https://doi.org/10.1080/14656566.2017.1334765
[46] Sun, Y., Liang, Y., Jiao, Y., Lin, J., Qu, H., Xu, J., et al. (2017) Comparative Efficacy and Acceptability of Antidepressant Treatment in Poststroke Depression: A Multiple-Treatments Meta-Analysis. BMJ Open, 7, e016499.
https://doi.org/10.1136/bmjopen-2017-016499
[47] Moraczewski, J., Awosika, A.O. and Aedma, K.K. (2026) Tricyclic Antidepressants. StatPearls Publishing.
[48] Cai, W., Ma, W., Wang, G. and Shen, W. (2018) Efficacy and Safety of Electroacupuncture for Post Stroke Depression: Study Protocol for a Randomized Controlled Trial. Trials, 19, Article No. 152.
https://doi.org/10.1186/s13063-018-2548-0
[49] Semkovska, M., Landau, S., Dunne, R., Kolshus, E., Kavanagh, A., Jelovac, A., et al. (2016) Bitemporal versus High-Dose Unilateral Twice-Weekly Electroconvulsive Therapy for Depression (EFFECT-Dep): A Pragmatic, Randomized, Non-Inferiority Trial. American Journal of Psychiatry, 173, 408-417.
https://doi.org/10.1176/appi.ajp.2015.15030372
[50] van Diermen, L., van den Ameele, S., Kamperman, A.M., Sabbe, B.C.G., Vermeulen, T., Schrijvers, D., et al. (2018) Prediction of Electroconvulsive Therapy Response and Remission in Major Depression: Meta-Analysis. The British Journal of Psychiatry, 212, 71-80.
https://doi.org/10.1192/bjp.2017.28
[51] Valiengo, L.C.L., Goulart, A.C., de Oliveira, J.F., Benseñor, I.M., Lotufo, P.A. and Brunoni, A.R. (2017) Transcranial Direct Current Stimulation for the Treatment of Post-Stroke Depression: Results from a Randomised, Sham-Controlled, Double-Blinded Trial. Journal of Neurology, Neurosurgery & Psychiatry, 88, 170-175.
https://doi.org/10.1136/jnnp-2016-314075
[52] Hordacre, B., Comacchio, K., Williams, L. and Hillier, S. (2021) Repetitive Transcranial Magnetic Stimulation for Post-Stroke Depression: A Randomised Trial with Neurophysiological Insight. Journal of Neurology, 268, 1474-1484.
https://doi.org/10.1007/s00415-020-10315-6
[53] Yeung, W., Chung, K., Zhang, Z., Zhang, S., Chan, W., Ng, R.M., et al. (2019) Electroacupuncture for Tapering off Long-Term Benzodiazepine Use: A Randomized Controlled Trial. Journal of Psychiatric Research, 109, 59-67.
https://doi.org/10.1016/j.jpsychires.2018.11.015
[54] Liu, R., Xu, N., Yi, W. and Ji, C. (2020) Electroacupuncture Attenuates Inflammation after Ischemic Stroke by Inhibiting NF-κB‐Mediated Activation of Microglia. Evidence-Based Complementary and Alternative Medicine: eCAM, 2020, Article ID: 8163052.
https://doi.org/10.1155/2020/8163052
[55] Sun, H., Zhao, H., Ma, C., Bao, F., Zhang, J., Wang, D., et al. (2013) Effects of Electroacupuncture on Depression and the Production of Glial Cell Line-Derived Neurotrophic Factor Compared with Fluoxetine: A Randomized Controlled Pilot Study. The Journal of Alternative and Complementary Medicine, 19, 733-739.
https://doi.org/10.1089/acm.2011.0637
[56] 李文鑫, 何聪, 刘征. 针刺治疗脑卒中后抑郁机制研究进展[J]. 环球中医药, 2024, 17(8): 1679-1684.
[57] 杨晓华. 胡浩教授针药并用治疗卒中后抑郁经验[J]. 光明中医, 2024, 39(4): 683-685.
[58] 卢威, 方无杰. 方无杰教授基于辨体从肝论治卒中后抑郁经验[J]. 中医康复, 2024, 1(9): 27-31.
[59] 王佩, 李警卓, 袁捷, 等. 加味补阳还五汤联合宁心解郁电针法治疗卒中后抑郁患者的临床观察[J]. 广州中医药大学学报, 2025, 42(7): 1596-1602.
[60] 李晗, 高磊, 杨峰, 等. 张宪忠治疗中风后抑郁临床经验[J]. 实用中医药杂志, 2023, 39(8): 1691-1692.
[61] 李志良, 段必双, 刘海静. 卒中后抑郁的中西医治疗研究进展[J]. 心理月刊, 2025, 20(22): 225-228.
[62] 王玉琳, 王宗兴, 刘同岩, 等. 卒中后抑郁的现代研究及针刺治疗进展[J]. 河北中医, 2023, 45(1): 147-153.